Neurological

Neurological outcomes and survival in lumbosacral radiculoplexus neuropathy

Lumbar sacral radiculoplexus neuropathy (LRPN), a painful, paralytic, immune-mediated neuropathy, is associated with an increased risk of mortality, according to study results published in Neurology, which is likely due to a higher incidence of diabetes mellitus and other comorbidities in these patients.

The incidence of LRPN is significantly higher in patients with diabetes mellitus, and LRPN can be divided into diabetic and non-diabetic LRPN. The aim of the current population-based study was to examine the outcomes and survival of patients with LRPN.

Using data from the Rochester Epidemiology Project facilities, the study researchers identified all potential cases of LRPN from early 2000 to late 2015 in Olmsted County, Minnesota.

The sample consisted of 59 patients (mean age 70 years; 56% men) with 62 LRPN episodes, including 39 patients with diabetes mellitus. At the time of diagnosis, pain and / or weakness were reported in over 90% of the episodes, and the disease was bilateral in over a third of the episodes (37.1%).

The Median Neuropathy Impairment Score (NIS) improved from 20 points at baseline to 17 points (P = 0.0002) during the follow-up, and most patients (55.6%) had an improvement of at least 4 points. Similarly, the median modified Rankin scale value improved from 3 at the start of the study to 2 at the end of the follow-up examination.

While the survival rates in patients with LRPN were significantly lower compared to age- and sex-matched controls (median survival 12.2 vs. ≥ 17 years; P = 0.0182), there were no deaths that were directly related to the LRPN . The probability of survival in patients with LRPN was 86% after 5 years and 55% after 10 years. Patients with LRPN had a 76% increased mortality risk compared to age- and sex-matched controls (P = 0.0164).

Multivariate Cox proportional risk models for mortality risk factors showed that diabetes mellitus, age and stroke were mortality risk factors in 3 different models, while chronic kidney disease, coronary artery disease and peripheral vascular disease were associated with an increased mortality risk in 2 models. However, an LRPN episode was not an independent mortality risk factor in the multivariate analysis.

“LRPN is a self-limiting inflammatory neuropathy that improves over time, but often leaves people with problematic dysfunction and a persistent need for walking aids. Although LRPN increases the risk of mortality, this increased mortality is likely due to a higher prevalence of [diabetes mellitus] and other comorbidities and not the LRPN itself, ”the study’s researchers concluded.

reference

Pinto MV, Ng PS, Howe BM, et al. Lumbar sacral radiculoplexus neuropathy: neurological outcomes and survival in a population-based study. Neurology. Published online March 2, 2021. doi: 10.1212 / WNL.0000000000011799

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