Peripheral nerve disease secondary to systemic conditions in children

Abstract

This review is an overview of systemic conditions that can be associated with peripheral nervous system dysfunction. Children may present with neuropathic symptoms for which, unless considered, a causative systemic condition may not be recognized. Similarly, some systemic conditions may be complicated by comorbid peripheral neuropathies, surveillance for which is indicated. The systemic conditions addressed in this review are critical illness polyneuropathy, chronic renal failure, endocrine disorders such as insulin-dependent diabetes mellitus and multiple endocrine neoplasia type 2b, vitamin deficiency states, malignancies and reticuloses, sickle cell disease, neurofibromatosis, connective tissue disorders, bowel dysmotility and enteropathy, and sarcoidosis. In some disorders presymptomatic screening should be undertaken, while in others there is no benefit from early detection of neuropathy. In children with idiopathic peripheral neuropathies, systemic disorders such as celiac disease should be actively excluded. While management is predominantly focused on symptomatic care through pain control and rehabilitation, some neuropathies improve with effective control of the underlying etiology and in a small proportion a more targeted approach is possible. In conclusion, peripheral neuropathies can be associated with a diverse range of medical conditions and unless actively considered may not be recognized and inadequately managed.

Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child–parent reported disability

“…Sensory loss is common in adults with NeuP (.50%), particularly with polyneuropathy, 7,122 and with conditions that are rare in children (eg, postherpetic neuralgia 7 ) or produce subclinical sensory signs (eg, diabetes 11,130 ). Here, painful distal polyneuropathy was relatively uncommon (15% vs 55% in adult cohorts 7,78 ), but included chemotherapy-induced neuropathy in childhood cancer survivors, 68,100 and genetic conditions with specific management implications (eg, erythromelalgia 4 and Fabry disease 36 ).…”

Phenotyping Chronic Musculoskeletal Pain in Male and Female Adolescents: Psychosocial Profiles, Somatosensory Profiles and Pain Modulatory Profiles

“…Sensory loss is common in children with rare conditions (eg, postherpetic neuralgia 78 ) or with conditions that produce subclinical sensory signs (eg, diabetes 87 , 88 ), but was relatively uncommon in our cohort of patients with chronic MSK pain (5.3%) similarly to a cohort of patients with peripheral neuropathic pain (21.2%). 16 This sensory profile is characterized by a loss of small and large fiber function and has been described to be similar to a compression nerve block.…”

Wernicke encephalopathy in combination with acute polyneuropathy under the guise of a demyelinating disease in a teenager with an eating disorder

“…нической картины в большинстве случаев мог отсрочить или исключить установление диагноза ЭВ, поэтому авторы рекомендуют рассмотреть вопрос о наличии ЭВ у ребенка с 2 или даже 1 компонентом триады [26]. Дефицит тиамина у детей подросткового возраста может сопровождаться полиневритическим синдромом (в сочетании с ЭВ или без нее) в виде симметричных сенсорно-моторных нарушений (мышечная боль и слабость), дизартрии, пареза или паралича нижних конечностей, прогрессирующего нарушения походки, атаксии, снижения глубоких сухожильных рефлексов, как правило, в нижних конечностях [11,23,29]. В литературе больше данных о том, что острый дефицит тиамина проявляется поражением центральной нервной системы в виде ЭВ, тогда как периферические нервы обычно страдают при длительном дефиците тиамина, который принято называть болезнью бери-бери [28].…”