article
Inflammatory Bowel Disease Linked to High Prevalence of Neurological Disorders
April 25, 2007 - Inflammatory bowel disease (IBD) has been linked to
an increased risk for subsequent neurological disorders, new research
suggests.
Initial 2-year results from an ongoing study that will be presented
May 1 at the American Academy of Neurology's 59th Annual Meeting, in
Boston, Massachusetts, showed individuals with IBD were 4 times more
likely to develop neuromuscular conditions (including carpal tunnel
syndrome and small fiber neuropathy) and 6 times more likely to have
sensorimotor polyneuropathy (PN) compared with individuals with other
types of gastric conditions.
"Based on these initial results, we believe IBD itself is directly
related to the neuropathy and that neuropathy in these patients is
much more common than we previously thought," the study's principal
investigator, Francisco De Assis Gondim, MD, PhD, from the Federal
University in Ceara, Brazil, told Medscape.
Women at Greater Risk for Neuromuscular Complications
Although the link between IBD and neurologic disease has been
reported before, most of the studies have been small, retrospective
case series. In 2005 (Gondim FA et al. Brain. 2005;128:867-879), Dr.
Gondim and colleagues also reported the association in a case series
of 33 patients with IBD and PN as well as a literature analysis, At
the time, this was the largest study and provided the most convincing
evidence of the link between IBD and peripheral neuropathy to date.
The initial aim of the current cohort study, said Dr. Gondim, was to
determine the prevalence of IBD-associated neurologic disease. To do
this, investigators compared 103 individuals with IBD - 37 with
Crohn's disease (CD) and 66 with ulcerative colitis (UC) - with 51
control subjects who had other gastric disorders, including
dyspepsia, gastritis, and irritable bowel syndrome (IBS).
All subjects received a standard neurological evaluation, including
vibration assessment, electromyography, screening for common causes
of neuropathy, including possible vitamin B12 deficiency, diabetes,
glucose intolerance, and hypothyroidism. They also underwent a
neurological workup that included neuroimaging.
Headache was the most commonly reported neurological complaint and
had a similar prevalence in all 3 study groups - 48.6% in CD
patients, 56.9% in the UC group, and 56.9% among controls.
However, the investigators report neuromuscular diseases, including
parasthesias and SFN, were much more likely to occur in UC and CD
patients compared with the control group.
Carpal tunnel syndrome was 4 times more prevalent in the UC group,
and SP was more than 6 times more common in IBD patients, affecting
21% of subjects in the UC and CD groups.
In addition, said Dr. Gondim, the study also showed that
neuromuscular complications in general and carpal tunnel syndrome in
particular were much more common in women.
A Good Start
"Compared with the control group, the IBD group had a much higher
prevalence of neuropathy. In spite of the fact that some of the IBD
patients had [neuropathy] risk factors, there were a substantial
number who did not, which leads us to conclude there is a direct
relationship between IBD and neuropathy," said Dr. Gondim.
Whether this is due to an immune-mediated phenomenon, an undetected
vitamin deficiency, or some other mechanism is not clear, he said.
However, the link between IBD and neuropathy is something clinicians
need to be aware of, since neuromuscular disease is a common IBD
complication that is frequently misdiagnosed as a rheumatological
disorder.
The investigators intend to follow study participants for at least
another 3 years, with the aim of gaining a better understanding of
the natural history of neurological complications in IBD patients.
In the future, Dr. Gondim also hopes to launch a larger, long-term,
multicenter cohort study in IBD patients who are neurologically
competent at study outset to confirm the link between IBD and
neuropathy and better characterize patients who are at risk for
neurological complications.
"There's a lot of work still to do, but this is a good start," he said.
Caroline Cassels
http://www.medscape.com/viewarticle/555727?src=mp
American Academy of Neurology 59th Annual Meeting: Abstract S16.005.
April 28 - May 5, 2007
April 25, 2007 - Inflammatory bowel disease (IBD) has been linked to
an increased risk for subsequent neurological disorders, new research
suggests.
Initial 2-year results from an ongoing study that will be presented
May 1 at the American Academy of Neurology's 59th Annual Meeting, in
Boston, Massachusetts, showed individuals with IBD were 4 times more
likely to develop neuromuscular conditions (including carpal tunnel
syndrome and small fiber neuropathy) and 6 times more likely to have
sensorimotor polyneuropathy (PN) compared with individuals with other
types of gastric conditions.
"Based on these initial results, we believe IBD itself is directly
related to the neuropathy and that neuropathy in these patients is
much more common than we previously thought," the study's principal
investigator, Francisco De Assis Gondim, MD, PhD, from the Federal
University in Ceara, Brazil, told Medscape.
Women at Greater Risk for Neuromuscular Complications
Although the link between IBD and neurologic disease has been
reported before, most of the studies have been small, retrospective
case series. In 2005 (Gondim FA et al. Brain. 2005;128:867-879), Dr.
Gondim and colleagues also reported the association in a case series
of 33 patients with IBD and PN as well as a literature analysis, At
the time, this was the largest study and provided the most convincing
evidence of the link between IBD and peripheral neuropathy to date.
The initial aim of the current cohort study, said Dr. Gondim, was to
determine the prevalence of IBD-associated neurologic disease. To do
this, investigators compared 103 individuals with IBD - 37 with
Crohn's disease (CD) and 66 with ulcerative colitis (UC) - with 51
control subjects who had other gastric disorders, including
dyspepsia, gastritis, and irritable bowel syndrome (IBS).
All subjects received a standard neurological evaluation, including
vibration assessment, electromyography, screening for common causes
of neuropathy, including possible vitamin B12 deficiency, diabetes,
glucose intolerance, and hypothyroidism. They also underwent a
neurological workup that included neuroimaging.
Headache was the most commonly reported neurological complaint and
had a similar prevalence in all 3 study groups - 48.6% in CD
patients, 56.9% in the UC group, and 56.9% among controls.
However, the investigators report neuromuscular diseases, including
parasthesias and SFN, were much more likely to occur in UC and CD
patients compared with the control group.
Carpal tunnel syndrome was 4 times more prevalent in the UC group,
and SP was more than 6 times more common in IBD patients, affecting
21% of subjects in the UC and CD groups.
In addition, said Dr. Gondim, the study also showed that
neuromuscular complications in general and carpal tunnel syndrome in
particular were much more common in women.
A Good Start
"Compared with the control group, the IBD group had a much higher
prevalence of neuropathy. In spite of the fact that some of the IBD
patients had [neuropathy] risk factors, there were a substantial
number who did not, which leads us to conclude there is a direct
relationship between IBD and neuropathy," said Dr. Gondim.
Whether this is due to an immune-mediated phenomenon, an undetected
vitamin deficiency, or some other mechanism is not clear, he said.
However, the link between IBD and neuropathy is something clinicians
need to be aware of, since neuromuscular disease is a common IBD
complication that is frequently misdiagnosed as a rheumatological
disorder.
The investigators intend to follow study participants for at least
another 3 years, with the aim of gaining a better understanding of
the natural history of neurological complications in IBD patients.
In the future, Dr. Gondim also hopes to launch a larger, long-term,
multicenter cohort study in IBD patients who are neurologically
competent at study outset to confirm the link between IBD and
neuropathy and better characterize patients who are at risk for
neurological complications.
"There's a lot of work still to do, but this is a good start," he said.
Caroline Cassels
http://www.medscape.com/viewarticle/555727?src=mp
American Academy of Neurology 59th Annual Meeting: Abstract S16.005.
April 28 - May 5, 2007