Thursday, 26 December 2013

Peripheral nerve involvement in MS


Objective. Chronic inflammatory demyelinating polyneuropathy (CIDP) has been reported in patients with multiple sclerosis (MS). However, there have been limited reports of peripheral neuropathy as a complication of neuromyelitis optica (NMO). In this paper, we showed the characteristics and differences between peripheral neuropathy as a complication of MS and NMO. Method. We analyzed a series of 58 MS and 28 NMO patients and evaluated nerve conduction studies (NCS) in 21 MS and 5 NMO patients. Results. Six of the 58 MS and 3 of the 28 NMO patients revealed abnormal NCS findings. Three (5.2%) of the 58 MS patients fulfilled the criteria for CIDP. One (3.6%) of the 28 NMO patients showed peripheral neuropathy at the same time of NMO relapse, although CIDP was not seen in NMO. The other 5 (3 MS and 2 NMO) patients were complicated with neuropathy caused by concomitant diabetes mellitus and Sjögren's syndrome. Conclusion. Frequency of abnormal NCS findings might exhibit no significant difference between MS and NMO, although the cause and pathophysiology of peripheral neuropathy were different in MS and in NMO. There might be a group of NMO who were affected simultaneously in the central and peripheral nervous tissues.

For many we are lead to believe that MS is a CNS disease, here it shows that there can be peripheral nerve abnormalities. Is this a consequence of CNS problems or a primary issue. Some of the antigens in the CNS are present in the Peripheral nervous system also e.g. myelin basic protein and myelin associated glycoprotein. In EAE in rabbit there can be quite a lot of peripheral nerve involvement. Whilst a minor component in MS, peripheral nerve issues needs to be built into the big picture.

7 comments:

  1. I had a huge relapse. I had bodywide twitching for 12 months (not spasms). The twitches would wake me up in the night for many months. Also I had an autonomic nervous system problem with my hands. My left palm of hand would go purple in the shower, tingle for a while in the shower and for a little after. My right palm had no discolouration but would still tingle in the shower. Is peripheral nerve damage in MS related to severity of relapse? I read somewhere that advanced MS patients may have peripheral nerve involvement.

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    1. I'm this same MSer. I've just had a warm shower and both palms of hands went purple in the shower and tingled. I thought it was improving but now the right palm has this discolouration. I have had it a year now. I know some neurologists will say it's nothing to do with my MS but I don't know what to make of it. I will ask my neurologist next appointment.

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  2. Is this the same as my foot going purply colour, the foot that has the footdrop?

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  3. I am the same MSer. It may be acroycianosis making your foot purple. When I took steroids for my relapse both my feet swelled up and reduced. The left foot stayed a deep purple colour. Two neuro's said this may have been a steroid reaction. It is improving well. This may be acroycianosis (spelling may be not correct) and this is to do with blood flowing to the foot I think. My foot returns to normal colour when foot is elevated. Acroycianosis from what I understand can be common in MS though is it more connected to do with MSers not being so active and sitting for long periods. Acroycianosis is in most cases is a cosmetic problem rather than a more serious problem but it can be more serious on occasion. It is a relative of Raynauds Syndrome but not the same.

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  4. About ten months ago I had a sunburnt back feeling (have RRMS). I always wondered if this was PNS involvement as when I would lean over it would sting when the skin is stretched. I know the sunburnt back symptom is not uncommon in MS. So may be it can be CNS and also PNS symptomatic.

    This week I have been doing yoga poses and they involve alot of stretching my back and arms. Now my back is stinging again, the sunburnt back is back. To me this sounds like PNS involvement. Hopefully it will heal and go away. No more yoga poses like that.

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  5. I had Peripheral Neuropathy (caused my stress) since 1989 slight tingling to feel and hands. 6 years ago I had a bunion operation several months later my symptoms increased and I was then diagnosed with M.S. I only had the one foot done. I was given no warning told my M.S. had nothing to do with my peripheral neuropathy. This is a warning to anyone in the same circumstances.

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  6. >Some of the antigens in the CNS are present in the Peripheral nervous system also e.g. myelin basic protein and myelin associated glycoprotein

    MS has nothing to do with an antigen to anything related to myelin. You know this better than anyone.

    If MS was due to a specific antigen or antigens, they would have been found by now, is that not true? For sure it is an immune mediated disease but not in the way, say, NMO, or RA, is.

    This study doesn't show that MS affects any peripheral nerves. A lot of people have some degree of peripheral neuropathy, including some people with MS. That's all that this study showed.

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