Early Diagnosis Of Peripheral Neuropathy

Fluoroquinolones and Peripheral Neuropathy

Peripheral neuropathy, this is an often devastatingconditionwhich people develop pain and numbnesstheir hands and feet. Basicallythey're told on the evening news that they should be taking this or that mediion sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know thatAmerica,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic amatically increases yourrisk for having peripheral neuropathy and

fact being devastated by it. This is adisease that effects 115 Americans. Let's take a look. So again this is 115 Americans—thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month,the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory

infections and even urinary tract infections.Things like Levaquin and Cipro are commonly usedwalks. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study publishedSeptember2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodandthis group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of

antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolonesthe United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these ugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most

well respected peer journals is nowtelling us that the use of these mediions—these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep thatmind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.

HIV Neuropathy Screening Exam with Grading Reflexes

These are the instructions for evaluating perceptionof vibration. Use a 128 hertz tuning fork. SOUND Hit the tuning fork hardenough so that the sides touch. And make sure that the subjectknows the type of sensation. Do you feel this asa vibration or a buzzing? gt;gt; Vibration. gt;gt; As a vibration, very good.

Now repeat the procedurein the feet. Again, strike the tuningfork hard enough so that the sides touch andimmediately put the tuning fork on the distalinterphalangeal joint. Count the number of seconds. Ask the subject to tell youwhen the vibration stops. gt;gt; Now. gt;gt; It stopped now?

Good. And repeat the procedureto the opposite side. Again, the tuning fork goeson the distal interphalangeal joint. Make sure you strikethe tuning fork hard enough so that the sides touch. For evaluating deeptendon reflexes, with the subject seated,examiner should use the hand

to gently dorsiflex the footat about 90 degrees. Press upwards slightlyon the sole of the foot. Use a reflex hammer, preferablya longhandled reflex hammer. A tomahawk hammeris also acceptable. And strike the Achillestendon just behind the heel. Contraction of the gastrocnemiusmuscle will be both seen and felt. Repeat the procedurewith the opposite leg.

Have to do now is showthe discrepancy between the knee reflex and the ankle reflex. Many patients with HIVdisease have both central and peripheral nervoussystem disease. So one may see a mix ofhyperreflexia at the knee and reduced reflexes,or hyporeflexia or areflexia at the ankles. So now we'll attemptto demonstrate this.

So here first for the patellareflex, the knee reflex, this would be graded as a 3plus, there is hyperrefelxia and spread of the reflexto other muscles. In the same patient,ankle reflexes are reduced significantly outof proportion to knee reflexes. So these are the differentgradings for ankle reflexes. Absent means that with a strongpercussion of the Achilles tendon, there is no contractionof the gastrocnemius.

Category: Peripheral Neuropathy

Leave a Reply