UNASSIGNED: Diabetic peripheral neuropathy (DPN) results in an enormous burden and reduces the quality of life for patients. Considering there is no specific drug for the management of DPN, traditional Chinese medicine (TCM) has increasingly drawn attention of clinicians and researchers around the world due to its characteristics of multiple targets, active components, and exemplary safety.
UNASSIGNED: To summarize the current status of TCM in the treatment of DPN and provide directions for novel drug development, the clinical effects and potential mechanisms of TCM used in treating DPN were comprehensively reviewed.
UNASSIGNED: Existing evidence on TCM interventions for DPN was screened from databases such as PubMed, the Cochrane Neuromuscular Disease Group Specialized Register (CENTRAL), and the Chinese National Knowledge Infrastructure Database (CNKI). The focus was on summarizing and analyzing representative preclinical and clinical TCM studies published before 2023.
UNASSIGNED: This review identified the ameliorative effects of about 22 single herbal extracts, more than 30 herbal compound prescriptions, and four Chinese patent medicines on DPN in preclinical and clinical research. The latest advances in the mechanism highlight that TCM exerts its beneficial effects on DPN by inhibiting inflammation, oxidative stress and apoptosis, endoplasmic reticulum stress and improving mitochondrial function.
UNASSIGNED: TCM has shown the power latent capacity in treating DPN. It is proposed that more large-scale and multi-center randomized controlled clinical trials and fundamental experiments should be conducted to further verify these findings.

BACKGROUND: Evaluation publications typically summarize the results of studies to demonstrate the effectiveness of an intervention, but little is shared concerning any changes implemented during the study. We present a process evaluation protocol of a home-based gait, balance, and resistance exercise intervention to ameliorate persistent taxane-induced neuropathy study according to 7 key elements of process evaluation.
METHODS: The process evaluation is conducted parallel to the longitudinal, randomized control clinical trial examining the effects of the home-based gait, balance, and resistance exercise program for women with persistent peripheral neuropathy following treatment with taxanes for breast cancer (IRB approval: Pro00040035). The flowcharts clarify how the intervention should be implemented in comparable settings, fidelity procedures help to ensure the participants are comfortable and identify their individual needs, and the process evaluation allows for the individual attention tailoring and focus of the research to avoid protocol deviation.
CONCLUSIONS: The publication of the evaluation protocol plan adds transparency to the findings of clinical trials and favors process replication in future studies. The process evaluation enables the team to systematically register information and procedures applied during recruitment and factors that impact the implementation of the intervention, thereby allowing proactive approaches to prevent deviations from the protocol. When tracking an intervention continuously, positive or negative intervention effects are revealed early on in the study, giving valuable insight into inconsistent results. Furthermore, a process evaluation adds a participant-centered element to the research protocols, which allows a patient-centered approach to be applied to data collection.
BACKGROUND: ClinicalTrials.gov NCT04621721, November 9, 2020, registered prospectively.
METHODS: April 27, 2020, v2.

OBJECTIVE: Treatment with taxanes can result in chemotherapy-induced peripheral neuropathy (CIPN). We investigated the efficacy and safety of mirogabalin for the treatment of CIPN in patients who had been administered perioperative chemotherapy including taxane-based agents for breast cancer.
METHODS: We retrospectively analyzed the case of 43 patients with early breast cancer who received a taxane as perioperative chemotherapy and were administered mirogabalin at the diagnosis of CIPN.
RESULTS: Thirty-six patients (83.7%) had grade 1 CIPN and the other seven patients (16.3%) had grade 2 CIPN. The median mirogabalin dose was 10 mg (5-30 mg). CIPN improved from grade 1 to 0 in 12 patients (27.9%) and from grade 2 to 1 in one patient (2.3%); 13 (30.2%) patients thus had an objective therapeutic response. There were no cases in which chemotherapy was reduced or discontinued due to CIPN. Adverse events were evaluated by Common Terminology Criteria for Adverse Events and included five cases of dizziness (11.7%), three of somnolence (7.0%), and two of nausea (4.7%), all of which were grade ≤2. There were no cases of serious (grade ≥3) adverse effects.
CONCLUSIONS: Mirogabalin may be effective and safe for treating CIPN of patients who receive a taxane in a perioperative breast cancer setting.

The peripheral nervous system can encounter alterations due to exposure to some of the most commonly used anticancer drugs (platinum drugs, taxanes, vinca alkaloids, proteasome inhibitors, thalidomide), the so-called chemotherapy-induced peripheral neurotoxicity (CIPN). CIPN can be long-lasting or even permanent, and it is detrimental for the quality of life of cancer survivors, being associated with persistent disturbances such as sensory loss and neuropathic pain at limb extremities due to a mostly sensory axonal polyneuropathy/neuronopathy. In the state of the art, there is no efficacious preventive/curative treatment for this condition. Among the reasons for this unmet clinical and scientific need, there is an uncomplete knowledge of the pathogenetic mechanisms. Ion channels and transporters are pivotal elements in both the central and peripheral nervous system, and there is a growing body of literature suggesting that they might play a role in CIPN development. In this review, we first describe the biophysical properties of these targets and then report existing data for the involvement of ion channels and transporters in CIPN, thus paving the way for new approaches/druggable targets to cure and/or prevent CIPN.

OBJECTIVE: Chemotherapy-induced peripheral neuropathy (CIPN) continues to be a major source of chronic morbidity in patients with cancer. Current treatment options and efficacy are limited; thus, there is a need to investigate more effective therapeutic options. Spinal neuromodulation including dorsal column spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S) are being explored for these patients. The purpose of this narrative review was to critically summarize and evaluate the advancements that have been made in utilizing SCS and DRG-S for CIPN.
METHODS: A thorough literature search was conducted using PubMed for any research on patients with CIPN who underwent DRG-S or SCS. Studies involving patients with general cancer-related pain were not included. Only articles that were published in English, had original, extractable data, and were available on or before August 1, 2023, were included.
RESULTS: This study evaluated twelve studies with a total of 13 patients that reported using SCS for CIPN and four studies with a total of 12 patients that reported using DRG-S for CIPN. Many of the studies demonstrated that DRG-S or SCS can assist in reducing opioid consumption, lowering pain scores, and improving sensory deficits.
CONCLUSIONS: DRG-S and SCS have the potential to improve symptoms and lower medication usage in patients suffering from CIPN. Spinal neuromodulation could be considered as an alternative therapy for patients with persistent symptoms.

Peripheral neuropathy and amputation are common complications of diabetes mellitus (DM) that significantly impact the quality of life of the affected individuals. This study aims to investigate the prevalence of peripheral neuropathy, the level of amputation, and the quality of life in patients with DM. This cross-sectional study was conducted after approval of the synopsis involving 225 diagnosed patients with DM on pre-defined eligibility criteria, selected from public sector OPDs, specialized diabetes centres, and centres manufacturing orthotics and prosthetics. Data were collected through interviews, observations, and the administration of the Michigan Neuropathy Screening Instrument and the Asian Diabetes Quality of Life Questionnaire. The level of amputation was recorded for each participant. Data was entered into SPSS, and results were synthesized. Pearson correlation is applied to find an association between gender and the quality of life of the participants, while P ≤ 0.05 will be considered significant. The prevalence of peripheral neuropathy in a sample of 225, based on a self-administered questionnaire, was (44.4%), and in terms of foot examination was (51.1%). As people progressed in age, the prevalence increased to 20.0% in patients above 60 years and 8.9% in ≤ 35 years of age. The majority of participants (56.0%) have had DM for less than five years. Females were 57.8% of the study population, while 97.8% of participants had type II DM. Below-knee amputation of the right limb was observed in 22(9.8%) of the participants. The QoL was poor in the majority of the participants (96.9%) patients with DM (P = 0.638 and T = -0.471). This cross-sectional study highlights a high prevalence of peripheral neuropathy and amputation and poor QoL in patients with diabetic mellitus.

Corneal confocal microscopy (CCM) is an ophthalmic imaging technique that enables the identification of corneal nerve fibre degeneration and regeneration. To undertake a systematic review and meta-analysis of studies utilizing CCM to assess for corneal nerve regeneration after pharmacological and surgical interventions in patients with peripheral neuropathy. Databases (EMBASE [Ovid], PubMed, CENTRAL and Web of Science) were searched to summarize the evidence from randomized and non-randomized studies using CCM to detect corneal nerve regeneration after pharmacological and surgical interventions. Data synthesis was undertaken using RevMan web. Eighteen studies including 958 patients were included. CCM identified an early (1-8 months) and longer term (1-5 years) increase in corneal nerve measures in patients with peripheral neuropathy after pharmacological and surgical interventions. This meta-analysis confirms the utility of CCM to identify nerve regeneration following pharmacological and surgical interventions. It could be utilized to show a benefit in clinical trials of disease modifying therapies for peripheral neuropathy.

OBJECTIVE: Chemotherapy-induced peripheral neuropathy (CIPN) and falls can be persistent side effects of cancer treatment. Standing postural sway and gait tests with body-worn, inertial sensors provide objective digital balance and gait measures that represent several different domains controlling mobility. Specific domains of balance and gait that related to neuropathy and falls are unknown. The aim of this study was to determine which domains of balance and gait differed between cancer survivors who report (1) CIPN symptoms versus no symptoms, (2) a history of falls in the past 6 months versus no falls, and (3) prospective falls over 12 months versus no falls.
METHODS: Postural sway during 30 seconds of quiet standing and gait characteristics from a 7-m timed up and go test were recorded with six synchronized inertial sensors (Opals by APDM Wearable Technologies, a Clario Company) in 425 older, female cancer survivors (age: 62 ± 6 years). A principal component analysis (PCA) approach was used to identify independent domains of mobility from 15 balance and gait measures.
RESULTS: PCA analysis revealed five independent domains (PC1 = sway amplitude, PC2 = gait pace, PC3 = sway frequency, PC4 = gait spatial-temporal, and PC5 = turning) that accounted for 81% of the variance of performance. Cancer survivors who reported CIPN symptoms had significantly higher sway frequency (PC3) than asymptomatic survivors. Past fallers had significantly larger sway area (PC1) and slower gait pace (PC2) than nonfallers. Prospective fallers showed a significantly smaller stride length (PC4) than nonfallers.
CONCLUSIONS: Digital balance and gait measures using wearable sensors during brief standing and walking tests provide objective metrics of CIPN-related mobility impairment and fall risk that could be useful for oncology clinical trials.

Various diseases of the peripheral nervous system are associated with metabolic disorders of B vitamins. A lack of neurotropic vitamins, which began in the early stages of the development of a bacterial disease, led to its more rapid development. The article analyzes data on B vitamin deficiency in the pathogenesis of the most dangerous diseases of the peripheral nervous system. Information is provided about the dangers of the clinical use of the drug Combilipen for the treatment of such patients.
Различные заболевания периферической нервной системы ассоциированы с нарушениями обмена витаминов группы B. Недостаток в организме нейротропных витаминов способствует раннему появлению клинических проявлений заболевания, его более быстрому прогрессированию. В статье анализируются данные о роли дефицита витаминов группы B в патогенезе наиболее распространенных заболеваний периферической нервной системы. Приведены сведения о результатах изучения клинического применения препарата Комбилипен для лечения таких больных.

BACKGROUND: A common complication of transcondylar fractures (TCF) in children is neuropathy requiring not only therapeutic but also surgical treatment. Despite numerous reports, clear criteria for selecting patients for surgical treatment have not been defined.
OBJECTIVE: To clarify the role of clinical and electrophysiological diagnostics in choosing treatment tactics for neuropathies in children with TCF.
METHODS: There were 20 patients with neuropathies after TCF between 2020 and 2022. Of these, 10 ones were selected for surgical treatment according to electrophysiological diagnostic data. Inclusion criteria: age 6-12 years, closed TCF within previous 3-12 months, symptoms of neuropathy confirmed by electroneuromyography (ENMG), no nerve disruption according to ultrasound data. Exclusion criteria: elbow joint contracture and post-traumatic ulnar nerve dislocation. All patients underwent needle myography with functional assessment of motor and sensory fibers, spontaneous activity in muscles, recruitment pattern and motor unit potentials. Intraoperative electrophysiological diagnostics included stimulation of motor fascicles with registration of M-responses from the target muscles. The follow-up period was 3-6 months.
RESULTS: The study included 20 patients aged 6-12 years without peripheral nerve disruption. A group of 10 patients who required surgical treatment was identified. The control group consisted of 10 patients who did not require surgical treatment. To choose treatment tactics, we considered ENMG data. Surgical procedure was determined according to intraoperative neuromonitoring (IONM) data.
CONCLUSIONS: When choosing treatment strategy, surgeons should consider objective ENMG and IONM criteria, as well as fascicular anatomy.
Частым осложнением чрезмыщелковых переломов (ЧМП) у детей является нейропатия, требующая не только консервативного, но и хирургического лечения. Несмотря на многочисленные публикации, четкие критерии отбора пациентов на хирургическое лечение не определены, что сформировало цель данной работы.
UNASSIGNED: Уточнить и продемонстрировать роль клинико-электрофизиологической диагностики в выборе тактики лечения нейропатий у детей с ЧМП.
UNASSIGNED: С 2020 по 2022 г. в ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии Департамента здравоохранения города Москвы» на базе отдела нейрохирургии и нейротравмы наблюдались 20 пациентов с нейропатиями после ЧМП, из них 10 были отобраны на хирургическое лечение на основании результатов электрофизиологической диагностики. Критерии включения: возраст 6—12 лет, закрытый ЧМП давностью от 3—12 мес, клиника нейропатии, подтвержденная данными электронейромиографии (ЭНМГ), отсутствие анатомического перерыва нерва по данным ультразвукового исследования (УЗИ). Критерии исключения: наличие контрактуры локтевого сустава и посттравматического вывиха локтевого нерва. Всем пациентам проводилась стимуляционная и игольчатая миография с оценкой функционального состояния моторных и сенсорных волокон исследуемых нервов, наличия или отсутствия спонтанной активности в мышцах, присутствия паттерна рекрутирования и потенциалов двигательных единиц. Интраоперационная электрофизиологическая диагностика включала стимуляцию моторных фасцикул нервов с регистрацией M-ответов с целевых мышц. Катамнез оценивался через 3—6 мес по клинико-электрофизиологическим данным.
UNASSIGNED: В исследование вошли 20 пациентов с достоверно исключенным нарушением целостности стволов и ветвей периферических нервов в возрасте 6—12 лет. Была выделена группа из 10 пациентов, которым потребовалось хирургическое лечение. Контрольную группу составили 10 больных, которым хирургическое лечение не потребовалось. Критериями выбора тактики лечения являлись результаты ЭНМГ, а выбор вида хирургии определялся результатами интраоперационного нейромониторинга (ИОНМ).
UNASSIGNED: При выборе тактики лечения хирург должен опираться на объективные критерии ЭНМГ, а также учитывать данные ИОНМ и внутриствольной фасцикулярной анатомии.