당뇨병환자에서 다발성 말초신경염 증상과 흡연의 관계

박영주,원진숙,강희철,정의식 大韓家庭醫學會 1994 Korean Journal of Family Medicine Vol.15 No.4-5

Wernicke’s Encephalopathy and Peripheral Polyneuropathy Developed during Long Term Metronidazole Therapy in a Patient with a Brain Abscess- A Case Report -

Nyo Kyung Park,권범선,박진우,이호준,류기형,Sang Wuk Jeong,Sang Mi Noh 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.1

Metronidazole can induce serious neurologic problems including peripheral neuropathy, seizures, and encephalopathy. We examined a patient with acute Wernicke’s encephalopathy and peripheral polyneuropathy that had developed after prolonged metronidazole therapy without a history of chronic alcoholism or poor nutritional intake. The 68-year-old man had been hospitalized for a brain abscess and was treated for 10 weeks with metronidazole (2 grams per day). This patient, who showed symptoms of numbness and tingling in the legs, was referred for electromyography (EMG) and was diagnosed with peripheral polyneuropathy. A few days later, he developed sudden ataxia, dizziness, and diplopia. The neurologic examination revealed nystagmus and ophthalmoplegia, and the FLAIR brain MRI showed symmetrical high signal intensity lesions in the cerebellar dentate nucleus, midbrain, tegmentum around the periaqueductal gray matter, and tectum. After administering intravenous thiamine and stopping the metronidazole therapy, he recovered from the ophthalmoplegia and ataxia. Brain MR showed complete recovery within 3 weeks; however the EMG remained abnormal for a further 6 months, although the symptoms were almost completely resolved by this time.

다발성 말초신경병증에서의 면역글로불린 치료

윤동환,김희상,안경희 경희대학교 1998 慶熙醫學 Vol.14 No.3-4

Transcutaneous neurostimulatory treatment for peripheral polyneuropathy induced by hypereosinophilic syndrome - A case report -

Kwon Kihyug,Park Ji Eun,Park Woosoo,Lee Teakseon 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.3

Background: Hypereosinophilic syndrome is a rare disease that increases the number of circulating eosinophils in the body. It has many complications, including peripheral polyneuropathy. Peripheral polyneuropathy often does not respond well to conventional therapies. Transcutaneous neurostimulatory treatment, also known as scrambler therapy, is an alternative modality for the treatment of chronic retractable pain. Case: A 47-year-old woman presented with complaints of bilateral calf pain. She had been under treatment for peripheral polyneuropathy induced by hypereosinophilic syndrome for 7 years. Pharmacologic treatment did not affect the patient’s symptoms. Conclusions: Transcutaneous neurostimulatory treatment was administered to the patient. It was effective on her symptoms, and the effect of pain alleviation continued for 3 months.

사람면역결핍바이러스 감염과 연관된 말초신경병증

이민환,임영민,변소영,김지민,김광국 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Background: Peripheral neuropathy is the most frequent neurological complication in human immunodeficiency virus (HIV)infection, related with diverse etiologies including inflammation, opportunistic infection and side effects of medications. The purpose of the present study was to evaluate characteristics of HIV associated neuropathy according to the stage of HIV infection. Methods: In reviewing the medical records of HIV patients who underwent electrodiagnostic studies between 1997and 2011, total 11 patients (all males; median age, 47 years; range, 28-71 years) with comorbid neuropathy were enrolled. Stage of HIV infection was categorized according to the Centers for Disease Control and Prevention (CDC) criteria. Classification of peripheral neuropathy was based on clinical and electrophysiological features. Results: Distal symmetric polyneuropathy was observed in 8 patients (72.7%), inflammatory demyelinating polyneuropathy in 2 patients (18.1%), and polyradiculopathy in 1 patient (9.1%). Median CD4+ T cell count was 123/mm 3(range, 8-540/mm 3) and 7 patients (60%) had the most advanced HIV disease stage (CDC-C3). There was no neuropathy caused by CMV infection. Conclusions: Distal symmetric polyneuropathy was the most common type of neuropathy in HIV infection, but various forms of neuropathy such as inflammatory demyelinating polyneuropathy and polyradiculopathy were also present. HIV associated neuropathy is more frequently associated with advancing immunosuppression, although it can occur in all stages of HIV infection.

인슐린 비의존성 당뇨병 환자에서 말초신경병증과 신기능 및 영양상태와의 관계

남직화,이현정,한정훈,정상원,신병호,서예경,김정국,하승우,김보완 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.1

목적 : 당뇨병성 신경병증은 당뇨병의 이환기간 및 혈당조절정도와 상관성을 보이며 병인적 기전으로 대사성 요인 및 미세혈류장애성 허혈을 들 수 있으나 대사 이상에 따른 영양상태의 변화나 미세혈류장애를 반영하는 신기능의 장애 정도와의 관계에 대한 연구는 많지 않은 실정이다. 이에 저자들은 당뇨병 환자에서 이환기간에 따라 말초신경병증의 합병이 신기능의 변화 및 영양상태와 관련이 있는지를 검토하였다. 대상 및 방법 : 인슐린 비의존성 당뇨병 환자 400명을 당뇨병의 이환기간에 따라 Ⅰ군(1년 이하), Ⅱ군(1-5년), Ⅲ 군(5년 초과)으로 나누고 말초신경병증의 임상 증상 및 신경전도검사에 의거하여 각 군별로 다발성 말초신경병증 합병군과 비합병군사이의 요중 알부민 배설률을 포함한 신기능및 영양상태 반영지표들을 후향적으로 비교하고 신경병증의 합병과 임상 인자들과의 상관성을 다중 로짓 회귀분석법 및 X^2-test로 분석하였다. 결과: 1) 전체 대상환자에서 이환기간이 길수록, 당화혈색소(HbAlc) 및 요중 알부민 배설률이 높을수록, 혈청 알부민 농도가 낮을수록 다발성 말초신경병증의 발생위험율이 높았다(p<0.05). 또한 이환기간이 길수록 망막병증 및 신병증도 빈번하게 합병되었다. 특히 이환기간이 5년을 초과한 Ⅲ 군에서는 말초신경병증이 있는 군에서 대조군에 비해 이들 미세혈관성 합병증의 발생빈도가 통계학적으로 유의하게 높았다(p<0.05). 2) 다발성 말초신경병증의 유병률은 Ⅰ 군에서 52.5%, Ⅱ 군에서 67.7%, Ⅲ 군에서 83.3%였다. 3) Ⅰ 군중 말초신경병증이 합병된 환자군에서 연령, 공복혈당, 식후 2시간 혈당이 대조군에 비해 높았으며, 혈청 알부민 농도는 낮았다. 위험인자의 비교에서는 연령이 많을수록, 혈청 알부민 농도가 낮을수록 말초신경병증이 발생할 위험율이 높았다(p<0.05). 4) Ⅱ 군중 말초신경병증 합병군에서 비합병군에 비해 당화혈색소(HbAlc), 공복혈당, 요중 알부민 배설률이 높았으며, 헤모글로빈, 헤마토크리트, 혈청 알부민 농도, 체용적지수는 낮았다. 위험인자의 비교에서는 당화혈색소치가 높을수록, 체용적지수 및 혈청 알부민 농도가 낮을수록 말초신경병증이 발생할 위험율이 높았다(p<0.05). 5) Ⅲ 군중 말초신경병증 환자군에서 대조군에 비해 당화혈색소(HbAlc), 공복혈당, 식후 2시간 혈당이 높았으며, 헤모글로빈, 헤마토크리트, 혈청 총단백 및 알부민 농도가 낮았다. 위험인자의 비교에서는 당화혈색소치가 높을수록, 혈청 알부민 농도가 낮을수록 말초신경병증의 발생위험율이 높았다(p<0.05). 결론 : 인슐린 비의존성 당뇨병 환자에서 다발성 말초신경병증의 합병은 혈당조절의 정도 및 이환기간과 밀접한 관계가 있으며, 이환기간에 관계없이 혈청 알부민 농도의 저하와도 관련이 있을 가능성을 시사한다. Bakground : Peripheral polyneuropathy (PPN), the most common complication of diabetes, has been known to relate to the duration of diabetes and degree of glycemic control. However, studies for the relationships between PPN and nutritional status and/or changes of renal function in non-insulin dependent diabetics were uncommon. In patients with NIDDM, the differences in prevalence of PPN and the relationships between PPN and nutritional status and/or changes of renal function according to duration of diabetic state were analyzed. Mehods : Four hundred non-insulin dependent diabetics were allocated into 3 groups according to diabetes duration; group Ⅰ consisted of 59 subjects with ≤ 12 months of NIDDM; group Ⅱ 96 with 12 months to 5 years of NIDDM; group Ⅲ 245 with > 5 years of NIDDM. In each group, indices of glycemic control and nutritional status were compared between those with and without PPN, defined by measuring nerve conduction velocity (unpaired t-test). Correlation of PPN with clinical variables including age, diabetes duration, BMI, waist/hip ratio, indices of glycemic control and nutritional status, and renal function were stuied by multiple logistic regression analysis. Results : 1) In total NIDDM subjects, as the duration, HbAlc, albumin excretion rate were increased and serum albumin was decreased, the development of PPN was increased(p<0.05). As the duration was increased, diabetic retinopathy and nephropathy were also complicated. Particularly, in group Ⅲ, the prevalences of diabetic microvascular complications were statistically significantly increased in diabetics with PPN than those without(p<0.05). 2) The prevalence of PPN was 52.5% in group Ⅰ, 67.7% in Ⅱ and 83.3% in Ⅲ. 3) In group Ⅰ, the age, fasting blood glucose, 2 hour postprandial blood glucose were increased and serum albumin was decreased in diabetics with PPN than those without. As the age was increased and serum albumin was decreased, the development of PPN was increased (p<0.05). 4) In group Ⅱ, HbAlc, fasting blood glucose, erythrocyte sediment rate, albumin excretion rate were increased and body mass index(BMI), hemoglobin, hematocrit, serum albumin were decreased in diabetics with PPN than those without. As HbAlc was increased and serum albumin, BMI were decreased, the development of PPN was increased(p<0.05). 5) In group Ⅲ, HbAlc, fasting blood glucose, 2-h postprandial blood glucose, erythrocyte sediment rate, albumin excretion rate were increased and hemoglobin, hematocrit, serum total protein, serum albumin were decreased in diabetics with PPN than those without PPN. As HbAlc was increased and serum albumin was decreased, the development of PPN was increased (p<0.05). Conclusion : In non-insulin dependent diabetics, peripheral polyneuropathy (PPN) is closely related to the duration of diabetes and degree of glycemic control. Regardless of the duration, peripheral polyneuropathy may be related to nutritional status, i.e., decreased serum albumin.

Subgrouping of Peripheral Neuropathic Pain Patients According to Sensory Symptom Profile Using the Korean Version of the PainDETECT Questionnaire

Kyomin Choi,Ohyun Kwon,Bum Chun Suh,Eunhee Sohn,In Soo Joo,오지영 대한의학회 2022 Journal of Korean medical science Vol.37 No.3

Background: A culturally validated Korean version of the PainDETECT Questionnaire (PD-Q) was used to identify neuropathic pain components (NeP) in patients suffering from chronic pain. The purpose of this study was to determine if the Korean PD-Q can be used to subgroup patients with peripheral NeP according to sensory symptom profiles. Methods: This study included 400 Korean patients with peripheral neuropathic pain diagnosed as probable or definite NeP. The total scores and subscores for each item in PD-Q were transformed into a Z-score for standardization. Hierarchical cluster analysis was performed to identify clusters of subjects by PD-Q scores. Results: The mean total PD-Q score of the study participants was 14.57 ± 6.46. A hierarchical cluster analysis identified 5 clusters with distinct pain characteristic profiles. Cluster 1 had relatively severe burning and tingling sensations. The mean total PD-Q score for cluster 2 was the lowest of the 5 clusters. Cluster 3 tended to be vulnerable to pain in response to cold/heat stimulation. Cluster 4 showed relatively severe pain induced by physical stimuli, such as light touch or slight pressure. Cluster 5 had high scores for all NeP symptoms. Conclusion: This study demonstrates the ability of patients to cluster by symptoms using the Korean PD-Q. Subgrouping of peripheral neuropathic pain by sensory symptom profile may be useful in making effective drug treatment decisions.

Successful Recovery of Peripheral Polyneuropathy from Non-Freezing Cold Injury: A Case Report

이정재,김세희,이종인,남경은 대한근전도전기진단의학회 2021 대한근전도 전기진단의학회지 Vol.23 No.1

Non-freezing cold injury (NFCI) results from prolonged exposure to wet conditions at temperatures near or just above the freezing point. The clinically reported signs of NFCI are mostly sensory symptoms. In this case report, we present a young healthy woman who was presumed to have developed cold-induced peripheral polyneuropathy following whole-body exposure to cold temperatures for at least 48 hours. Our patient showed severe peripheral polyneuropathy in the lower extremities during the initial nerve conduction study and electromyography. The findings were consistent with her clinical symptoms of tingling sensation and gait disturbance. Serial electrodiagnostic studies demonstrated gradual improvement and eventually normalization. Her clinical symptoms also significantly improved over several weeks of comprehensive rehabilitation. NFCI is a rare condition, and its pathophysiology and clinical course remain unclear. Nonetheless, it shows a reversible pattern early after the injury, and early diagnosis and treatment are required.

Characteristics of Diverse Verbal Pain Descriptors in South Korean Patients With Peripheral Neuropathic Pain: ‘Jeorim’ (Tingling) and ‘Sirim’ (Cold) as Key Neuropathic Pain Descriptors

Kyomin Choi,Ohyun Kwon,Bum Chun Suh,Jeeyoung Oh,Sungkun Cho,Eunhee Sohn,In Soo Joo 대한신경과학회 2023 Journal of Clinical Neurology Vol.19 No.3

Background and Purpose The description of pain is the most-important indicator leading to the adequate treatment of patients with neuropathic pain (NeP). The purpose of this study was to identify and characterize the unique features of Korean verbal descriptions in patients with peripheral NeP. Methods This study included 400 patients (167 males and 233 females) and their 1,387 paindescription responses. Patients with peripheral NeP freely described their symptoms in Korean. Collected verbal descriptions were grouped according to terminologies with similar meanings. Participants completed validated patient-reported outcome scales including the neuropathic pain symptom inventory (NPSI) and painDETECT questionnaire (PD-Q). The frequencies of each verbal pain descriptor were compared between the NPSI and PD-Q scores. Results ‘Jeorim’ (tingling) was the most common among 17 types of organized verbal pain descriptors, and the ‘Sirim’ (cold) symptom had a significantly higher rate of use in the 2 highseverity groups when participants were classified by their total scores on the NPSI and PD-Q. Conclusions Korean verbal NeP descriptors were significantly diverse. The Jeorim (tingling) and Sirim (cold) descriptors can be utilized in evaluations of Korean patients with NeP.

상하지 다발성 말초신경을 침범한 과호산구증후군 (Hypereosinophilic Syndrome)의 치료경험

조대현 ( Dae Hyun Jo ),유경아 ( Kyung A Ryu ),김명희 ( Myoung Hee Kim ),이용희 ( Yong Hee Lee ) 대한통증학회 2003 The Korean Journal of Pain Vol.16 No.2