Pyridoxine deficiency and excess have been implicated as a cause for peripheral neuropathy. As a result, unrelated neuropathies are often treated with pyridoxine based on questionable evidence. However, neurological practitioners frequently discourage patients from taking pyridoxine in excess of 50 mg/d given concerns around the development of a toxic sensory neuronopathy. There is no systematic review to support either of the 2 practices. To address this gap in knowledge, we reviewed the available literature on neuropathy attributed to pyridoxine deficiency and excess. Based on the current limited data, it can be concluded that very low doses of daily pyridoxine are required to prevent peripheral neuropathy. There is inadequate evidence to support routine pyridoxine supplementation in patients with disorders of peripheral nervous system. Supplementation with pyridoxine at doses greater than 50 mg/d for extended duration may be harmful and should be discouraged.

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In the absence of a clinical trial because of the rarity of this entity, the treatment of SIH complicated by decreased level of consciousness remained controversial in the past. However, current collective experience supports early treatment of patients with SIH and decreased level of consciousness with one or more epidural blood patches. Fibrin glue and surgical duroplasty are the next steps in the management of patients in whom epidural blood patches fail. Drainage of the subdural collections may be detrimental.

Background: Myotonic dystrophy (DM1) is an autosomal dominant, progressive, and multisystem condition that impacts affected individuals physically, socially, and emotionally. Understanding individuals' perceptions of their disease is critical to ensuring appropriate information, education, and counseling. Methods: We conducted a content analysis of findings from a larger study that used a novel, qualitative research approach called photovoice to explore nine patients' experiences of living with DM1. Participants took pictures that illustrated barriers or facilitators to living with DM1; their photographs then formed the basis of semistructured interviews. Transcripts were analyzed and, among themes, we identified one titled "DM1 truths and misinformation" that described participants' disease knowledge. Analysis revealed four categories within this broader theme: "the physical and emotional cost of DM1," "managing my DM1," "genetics and me" and "patients as advocates and educators." Results: Findings showed that DM1 participants had good core knowledge with respect to their disease and its implications. However, each participant held as fact fragments of misinformation that shaped decisionmaking and pointed to a clear need for strategies to mitigate variable interpretation of health information. Conclusions: We conclude that there is a need for increased education and awareness about symptoms, genetic information and treatment strategies for patients, their family members, and health care providers.RÉSUMÉ: Vérités et mésinformation : une exploration qualitative de la dystrophie myotonique. Contexte: La dystrophie myotonique (DM1) est une maladie plurisystémique progressive, à hérédité dominante, qui a un impact physique, social et émotionnel chez les individus qui en sont atteints. Il est très important de comprendre les perceptions qu'ont de la maladie les individus qui en sont atteints afin de leur fournir de l'information ainsi qu'un enseignement et des conseils appropriés. Méthode: Nous avons procédé à une analyse de contenu des observations d'une grande étude au moyen d'une approche de recherche qualitative novatrice, la méthodologie « Photovoice », pour explorer les expériences de 9 patients qui vivent avec la DM1. Les participants ont pris des photos qui illustraient les barrières ou les commodités qui leur facilitaient la vie avec la DM1; ces photographies ont ensuite servi de base à des entrevues semi-structurées. La retranscription de ces entrevues a été analysée et, parmi les thèmes abordés, nous en avons identifié un, « vérités et mésinformation sur la DM1 », qui décrivait les connaissances qu'ont les participants de la maladie. L'analyse a révélé quatre catégories à l'intérieur de ce thème plus vaste : « le coût physique et émotionnel de la DM1 », « gérer ma DM1 », « la génétique et moi » et « les patients comme défenseurs et éducateurs ». Résultats: Nous avons constaté que les participants atteints de DM1 avaient de bonnes connaissances de base concernant leur maladie et ses implications. ...