당뇨병성 말초 신경병증의 개괄과 한의학적 연구의 필요성

김진미(Jin-Mi Kim),윤성식(Sung-Sik Youn),안소현(So-Hyun An),최정식(Jeong-Sik Choi),조충식(Chung-Sik Cho),손창규(Chang-Gue Son),김철중(Chul-Jung Kim) 대한한의학회 2009 대한한의학회지 Vol.30 No.5

Assessment of Peripheral Neuropathy in Patients With Rheumatoid Arthritis Who Complain of Neurologic Symptoms

Mi Kyung Sim,Dae-Yul Kim,Jisun Yoon,Dae Hwan Park,Yong-Gil Kim 대한재활의학회 2014 Annals of Rehabilitation Medicine Vol.38 No.2

Objective To assess the prevalence of peripheral neuropathy in patients with rheumatoid arthritis (RA) having neuropathic symptoms, and to investigate the relationship between electrophysiological findings of peripheral neuropathy and clinical findings of RA.Methods Patients with a clinical diagnosis of RA and who had tingling or burning sensation in any extremity were electrophysiologically examined for evidence of peripheral neuropathy. Study parameters, including age, gender, laboratory parameters, duration of RA, and medication, were recorded. The symptoms and signs of neuropathy were quantified with the neuropathy symptom score, and the functional statuses of these patients were assessed.Results Out of a total of 30 RA patients, 10 (33%) had peripheral neuropathy: 2 had bilateral carpal tunnel syndrome (CTS), 5 had unilateral CTS, 1 had sensory polyneuropathy, and 2 had motor-sensory polyneuropathy. The mean ages of the patients with and without peripheral neuropathy were 69.4 and 56.5 years, respectively (p<0.05). A significant relationship was found between peripheral neuropathy and anti-cyclic citrullinated peptide (anti-CCP) antibody. However, no relationship was found between peripheral neuropathy and the type of medication, RA duration, the patients’ functional status, neuropathic symptoms, erythrocyte sedimentation rate, and C-reactive protein values.Conclusion Neuropathic symptoms are common in RA patients, and it is difficult to distinguish peripheral neuropathy symptoms from those of arthritis. Patients with RA, particularly elderly patients and anti-CCP antibody positive patients who complain of neuropathic symptoms should undergo electrophysiological examination.

족부족관절 주위의 신경병성 통증 질환

김학준(Hak Jun Kim),박영환(Young Hwan Park),김수현(Soo Hyun Kim) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.4

족부 및 족관절에 흔히 관찰되는 말초신경병은 당뇨병과 관련이 있는 경우가 가장 흔하지만 류마티스 관절염, 대사성 질환, 유전 질환, 독성 물질 등 다양한 원인이 존재한다. 말초신경병의 주된 증상은 통증이지만 감각 이상, 균형 감각 이상, 근력 저하 등의 신경학적 증상 이외에도 족부의 변형이나 신경병성 관절증이 나타나기도 한다. 말초신경병의 원인을 알아내기 위해서는 환자의 병력 청취가 가장 중요하며 일반적인 신경학적 검사에 추가적으로 침통각 검사, 진동 지각, 10 g 단섬유 압각 검사 및 발목 반사 검사를 시행하여야 한다. 특히 족부에서는 관절의 변화와 족부의 변형 정도를 관찰하기 위한 방사선 사진이 필수적이다. 말초신경병의 존재 유무, 침범 정도, 중증도 등을 평가하기 위한 신경 전도 검사가 필요하다. 당뇨병성 신경병의 경우는 혈관의 폐색에 대한 검사가 필요하다. 말초신경병의 치료는 원인이 되는 질환의 내과적 치료가 선행되어야 하겠지만 원인을 알 수 없는 경우가 있으므로 주로 통증에 대한 약물 치료가 우선적으로 고려되어야 한다. 약물치료는 항우울제, 항경련제, 마약성 진통제, 도포제 등이 있으며 증상을 초래하는 기전에 따라서 약제를 사용하여야 한다. 족부의 변형이나 신경병성 관절증이 동반된 경우에는 변형 교정, 전접촉 석고 고정, 관절 유합술 등의 수술적인 치료가 필요할 수 있으며 선택적으로 침범된 신경의 감압술을 시행하기도 한다. Most common peripheral neuropathy around foot and ankle is diabetic neuropathy, but there are another cause of peripheral neuropathy, such as rheumatoid arthritis, metabolic disease, genetic disease, toxic material, and so on. The main symptom of peripheral neuropathy is pain. The disturbance of sensory and balancing, weakness of muscle, deformity of foot and neuropathic arthropathy are also the symptoms of the peripheral neuropathy. History taking is most important to identify the cause of peripheral neuropathy. Neurological exam have to include the pin prick test, vibration test, 10 g-monofilamant test and ankle reflex test. Simple radiography is essential to observe the deformities or neuropathic arthropathy at foot and ankle. The presence of peripheral neuropathy, involvement and severity can be identified from nerve conduction study. The study of occlusive arteritis is essential for diabetic neuropathy. The medical treatment of associated disease is important but the pain of peripheral neuropathy should be controlled simultaneously. Medicine include the antidepressants, anticonvulsants, opioids and topical agents. The surgical treatment of peripheral neuropathy include lengthening of Achilles tendon, correction of deformity, the total contact cast and arthrodesis. Surgical decompression of specific nerve might helpful in pain control of peripheral neuropathy.

급성기 후 척수손상환자에서 발생된 말초신경병증의 임상적 분석

신용식,김상현,김명옥 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.5

Objective: To determine the incidence of peripheral neuropathy occurring in post-acute spinal cord injury patients.Method: We retrospectively reviewed the distribution of involved nerves in 94 spinal cord injury patients (men: 77, mean age: 45.2 years) who underwent electrodiagnostic studies at an early stage of rehabilitative therapy between March 1999 and June 2007 and looked for the existence of peripheral neuropathy according to the injured area (cervical/ thoracolumbar cord). Results: The incidence of peripheral neuropathy observed on electrodiagnostic studies was 38.3% (36/94). Twenty-one (46.7%) of 45 patients with injured cervical cords exhibited peripheral neuropathy, and 15 (30.6%) of 49 thoracolumbar cord injury patients exhibited peripheral neuropathy; hence, tetraplegia had a higher incidence. The most commonly involved nerve was the peroneal nerve (24 cases), followed by the median nerve (9 cases) and the ulnar nerve (9 cases). Conclusion: The incidence of peripheral neuropathy observed in electrodiagnostic studies was high in spinal cord injury patients at the initiation of intensive rehabilitative therapy. The incidence of peripheral neuropathy in cervical cord injury patients was higher than that seen in thoracolumbar injury patients. Active education and training concerning appropriate bed positioning are necessary for spinal cord injury patients at an early stage after injury to prevent peripheral neuropathy.

항암화학요법을 받는 암환자의 말초신경병증 증상 정도

황원희(Hwang, Won Hee),박금자(Park, Geum Ja) 고신대학교 전인간호과학연구소 2015 전인간호과학학술지 Vol.7 No.-

Purpose: to assess peripheral neuropathy which affects negative impact on the quality of lives of cancer patients. Method: From October 1, to November 5, 2012. 138 patients admitted at 1 hospital in Busan and 1 in Ulsan with questionnaires. Results: The highest incidence in sensory symptom of peripheral neuropathy was tingling in hand’(73.2%), and then, tingling in feet, in motor symptom, muscle weakness(62.3%). The highest severity in sensory symptom was ‘Tingling feeling in the foot , and in motor symptom, muscle or joint pain . The highest distress in sensory symptom was ‘Tingling feeling in the foot , and. in exercise symptom, muscle or joint pain . The highest frequency in sensory symptom was ‘tingling feeling in the foot , and in motor, muscle or joint pain . The highest Daily life-interference in manual dexterity was ‘lifting things, and in general activities, exercise. The time of occurrence, severity of peripheral neuropathy and interference of daily activities had differnces according to characteristics of subjects. Conclusion: hand and feet was most fragile areas in peripheral neuropathy. And the daily activities of subjects were interferenced by peripheral neuropathy. Therefore, it is needed to development and apply the intervention method for managing the peripheral neuropathy.

소아에서 말초신경병증의 임상적 고찰

이환석(Hwan Seok Lee),박우생(Woo Saeng Park),고철우(Cheol Woo Ko),손윤경(Yoon Kyung Sohn),권순학(Soon Hak Kwon) 대한소아신경학회 2003 대한소아신경학회지 Vol.11 No.1

목적 : 소아에서 말초신경병증의 임상적 양상을 분석해봄으로서 미흡한 국내 자료에 보탬이 되고 각 질환들의 조기진단 및 조기치료에 도움을 주고자 본 연구를 실시하게 되었다. 방법 : 2000년 1월부터 2002년 12월까지 만 3년간 경북대학교병원 소아신경클리닉에서 말초신경병증의 임상적 증상이 있거나 인슐린 의존형 당뇨병 환자로 내분비 클리닉에서 추적 관찰하는 아이들 가운데 신경생리검사에서 비정상 소견을 보여 말초신경질환을 가지고 있을 가능성이 많은 62명의 아이들을 대상으로 후향적 조사를 실시하였다. 이 가운데 임상소견 및 검사소견을 근거로 말초신경병증이 있는 것으로 생각되는 39명을 환자 군으로 분류하여 자료를 정리 및 분석하였고 신경생리검사에는 이상이 있었으나 임상적 이상이 없었던 대부분의 당뇨병 환자(subclinical diabetic neuropathy)는 제외시켰다. 결론 : 임상적으로 유의한 말초신경병증이 있는 39명(남 24명, 여자 15명; 평균연령 7.6±4.3세)을 병인에 따라 분류해 보면 염증성/면역성이 원인이 된 경우가 18례(Guillain Barre 증후군 5례, 만성 염증성 탈수초성 다발성 신경병증 1례, Bell 마비 12례)로 46%를 차지하여 가장 많았고, 유전성이 원인이 된 경우가 6례(유전성 운동감각 신경병증 3례, hereditary neuropathy with liability to pressure palsy 1례, 이염성 백질이영양증 2례)로 15%, vincristine을 포함한 항암제 치료와 관련된 경우가 3례(8%), 외상 2례(5%), 당뇨성 1례(3%), 원인 불명을 포함하여 기타 7례(23%)였다. 침범된 신경의 기능해부학적 혹은 임상적 분류를 했을 때 운동성 신경병증이 32례로 80%로 가장 많았고 이어서 혼합형 즉 운동 감각 신경병증이 6례로 15%, 감각성 신경병증 2례로 5%이었고 자율신경병증은 없었다. 손상된 신경의 수에 따른 분류를 보면 다발성 신경병증이 23례로 59%를 차지하여 가장 많았고, 이어서 단신경병증이 15례로 38%, 다단신경병증이 1례로 3%가 되었다. 병리조직학적으로 살펴보면 탈수초성 신경병증이 22례로 56%를 차지하여 가장 많았고 이어서 축삭성 신경병증이 12례로 31%, 혼합형이 5례로 13%가 되었다. 전기 생리학적 검사 결과를 비교해보면 정상치에 비해 탈수초성인 경우는 운동신경 전달속도가 감소되었고 활동 전위폭이 다소 감소된 소견을 보였으며, 축삭성인 경우는 운동 및 감각신경 활동 전위폭이 감소되고 운동신경 전달속도가 다소 감소된 소견을 보였고 각 군들간에 있어서는 운동신경 전달속도가 통계적으로 유의하게 차이가 있었다(P<0.05). 결론 : 염증성/면역성 말초신경병증이 소아에 있어서 가장 흔하였으며 유전성 신경병증 가운데에는 유전성 운동 감각 신경병증이 가장 많았다. 또한 염증성/면역성 말초신경병증이 주를 이루지만 치료가 가능한 경우가 약 46%를 차지했고 약물이나 사고 등과 같이 잠재적으로 발병이나 악화를 예방이 가능했던 경우가 36%이었다. Purpose : To analyze the clinical features of peripheral neuropathy in Korean children. Methods : A total of 62 children with acute flaccid paralysis, longstanding weakness of extremities, or abnormal electrophysiological studies, suggestive of peripheral neuropathy, were evaluated retrospectively from the hospital records. The subjects were recruited at the pediatric neurology and endocrine clinic, Kyungpook National University Hospital from 2000 to 2002 and they all went through neurological examination and electrophysiological studies with or without nerve biopsy. Results : Thirty nine children(Male 24 : Female 15; Mean age 7.6±4.3 years) were found to have clinical peripheral neuropathy. Inflammatory neuropathy(5 children with Guillain Barre syndrome, 1 children with chronic inflammatory demyelinating polyneuropathy, 12 children with Bell's palsy; 46%) was the most common, followed by hereditary neuropathy(4 children, 10%), Chemotherapy induced neuropathy(3 children, 8%), metachromatic leukodystrophy(2 children, 5%), trauma(2 children, 5%), diabetic neuropathy(1 children, 3%) and so on. Thirty two children had motor neuropathy(82%), six children had combined motor and sensory neuropathy(15%), two had pure sensory(5%), but nobody had autonomic neuropathy. With respect to the type of involvement, polyneuropathies constitute 59%(23 children), mononeuropathy simplex accounted for 38%(15 children), mononeuropathy multiplex was found in 3%(1 child). Based on electrophysiological studied and biopsy results, demyelinating neuropathy was seen in 22 children(56%), axonal neuropathy in 12 children(31%), combined neuropathy in 5 children(13%). Eighteen children(46%) were completely or almost completely recovered from the illness. Conclusion : Inflammatory neuropathy was the most common among the acquired neuropathies and hereditary motor sensory neuropathy was the most common among the genetic neuropathies. Treatable neuropathies took up 46%. Potentially preventable neuropathies accounted for 36%. Early diagnosis and early intervention may have significant impacts on the prognosis of peripheral neuropathy in children.

신경손상이 있던 환자에서의 Cisplatin 에 의한 말초신경병

윤광무(Kwang Moo Yoon),윤선애(Sun Ae Yoon),진종률(Jong Youl Jin),문한림(Han Lim Moon),홍영선(Young Seon Hong),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.5

One of the major toxic effects of cisplatin is sensory peripheral neuropathy which is dose-related, but the risk factor is unknown. We experienced cisplatin-induced peripheral neuropathy confined to rhe extermities of previous abnormal neurologic manifestations in 3 patients who had a history of neuropathy. The first case with tonsillar cancer had a recent history of paraplegia by L1 cord compression and recovered completely with radiotherapy. After he received cisplatin 280mg/m², he developed grade I peripheral neuropathy on both lower extremities. Additional cisplatin treatment induced grade III peripheral neuropathy. The second case had a history of right hemiparesis by cerebral infarction 10 years ago. Stage IV laryngeal cancer was diagnosed, and he received cisplatin 80 mg/m². He developed grade I peripheral neuropathy on the right extremities 1,'day after chemotherapy. The third case had a history of paraparesis by tuberculous meningitis 10 years ago. Stage III laryngeal cancer was diagnosed. He developed grade II peripheral neuropathy on both lower extremities 1 day after cisplatin 100 mg/m² treatment, and after a second cycle of chemotherapy grade III peripheral neuropathy developed. The first and second cases recovered completely after discontinuation of cisplation treatment. We can conclude that previous neurologic damage could be a hight-risk factor in the development of cisplatin-induced peripheral neuropathy.

신경손상이 있던 환자에서의 Cisplatin에 의한 말초신경병

김훈교,진종률,문한림,홍영선,이경식,김동집 가톨릭 중앙의료원 가톨릭 암센터 1991 가톨릭 암센터 論集 Vol.5 No.1

당뇨병성 말초신경병증에 병발한 항암화학요법 유발 신경병증의 침구치료 1례

박지윤,김예슬,홍정화,이영주,석은주,안립 대한한방내과학회 2023 大韓韓方內科學會誌 Vol.44 No.2

Objectives: This study reports the effectiveness of acupuncture and moxibustion for Diabetic Peripheral Neuropathy concurrent with Chemotherapy-Induced Peripheral Neuropathy. Case presentation: A 58-year-old male was admitted for hand numbness and foot pain after his sixth chemotherapy. He was treated with acupuncture and moxibustion for 18 days. Symptoms were evaluated with a numeric rating scale (NRS). After 18 days of treatment, his foot pain improved from NRS 4 to NRS 2. His hand numbness disappeared. Conclusion: This study suggests that acupuncture and moxibustion can be used for managing diabetic peripheral neuropathy concurrent with chemotherapy-induced peripheral neuropathy.

대섬유성 말초신경병 환자들의 자세 불균형의 진단

이근호 대한노인병학회 2003 대한노인병학회지 Vol.7 No.3