Materiały źródłowe

• #1 Peripheral Neuropathy: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1215/p732.html

  Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if indicated, by results of electrodiagnostic studies for axonal and demyelinating disease. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases. […] The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. The most common identifiable causes of peripheral neuropathy include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy affects 25% to 50% of patients with diabetes, depending on factors such as the patient’s age, number of years with diabetes, and level of diabetes control. Peripheral neuropathy is idiopathic in 25% to 46% of cases, and this is more common with increasing patient age.

• #2

  https://link.springer.com/article/10.1007/s10654-015-0094-6

  Polyneuropathy is a disabling condition of the peripheral nerves, characterized by symmetrical distal numbness and paresthesia, often accompanied with pain and weakness. Although the disease is often encountered in neurological clinics and is well known by physicians, incidence and prevalence rates are not well known. […] The overall prevalence of polyneuropathy in the general population seems around 1 % and rises to up to 7 % in the elderly. Polyneuropathy seemed more common in Western countries than in developing countries and there are indications that females are more often affected than males. […] Most of these studies have been performed over 15 years ago. More recent evidence suggests that the prevalence of polyneuropathy in the general population has increased over the years. Future research is necessary to confirm this increase in prevalence and to identify new and potentially modifiable risk factors.

• #3 Peripheral Polyneuropathy Part 1: Evaluation and Differential Diagnosis | PM&R KnowledgeNow

  https://now.aapmr.org/approach-to-peripheral-polyneuropathy-evaluation-and-differential-diagnosis/

  Worldwide, the prevalence of peripheral polyneuropathy varies widely and depends largely on the socioeconomic status and age distribution of the study population, but in the general population ranges from 1-3%, and increases to 7% in those over age 50.1 It is expected that this number will continue to grow due to an aging population and increasing disparities in healthcare. Diabetes, specifically, is shown to account for 40% of polyneuropathy cases. Further, those with polyneuropathy are almost four times more likely to have a lower limb amputation than those without polyneuropathy. 20 The lack of existing interventions to delay progression or relieve symptoms of neuropathy is one reason for worsened quality of life in these patients. Common risk factors are mentioned above. […] For ~25% of patients with a peripheral neuropathy in a referral population, etiology remains elusive despite a careful search.8 After additional workup, a proportion can be attributed to hereditary forms, immunologic causes (acquired demyelinating, e.g., CIDP and variants), paraproteinemia, or undiagnosed medical conditions.2,8,9

• #4

  https://journals.lww.com/annalsofian/fulltext/2017/20030/epidemiology_of_peripheral_neuropathy__an_indian.1.aspx

  Peripheral neuropathy (PN) is a common disorder and presents as diagnostic and therapeutic challenge to physicians and neurologists. In epidemiological studies from India from various regions the overall prevalence of PN varied from 5 to 2400 per 10,000 population in various community studies. […] Various epidemiological studies from India showed wide prevalence varying from 5 to 2400 per 10,000 population in different community studies. […] There are many papers on PN from India which are often case reports and small series, but no holistic compilation of data on epidemiology of PN was available. […] Hence, we plan to review the epidemiology of PN in the context of Indian scenario to highlight important peripheral neuropathies and also find deficiencies where further research is needed for planned epidemiological studies and possible direction to the occurrence of underlying etiology and risk factors for diagnostic and therapeutic targets.

• #5 Peripheral Neuropathy: Differential Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0401/p887.html

  One study estimated that the prevalence of peripheral neuropathy in the family medicine setting is 8 percent in persons 55 years and older. The prevalence in the general population may be as high as 2.4 percent. A community-based study estimated the prevalence of peripheral neuropathy in patients with type 2 diabetes mellitus to be 26.4 percent. […] Peripheral neuropathy can be caused by a variety of systemic diseases, toxic exposures, medications, infections, and hereditary disorders. The most common treatable causes are diabetes, hypothyroidism, and nutritional deficiencies.

• #6 Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6755905/

  Diabetic peripheral neuropathy eventually affects nearly 50% of adults with diabetes during their lifetime, and is associated with substantial morbidity including pain, foot ulcers, and lower limb amputation. […] The prevalence of peripheral neuropathy is estimated to be between 6% and 51% among adults with diabetes depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes. […] Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease. […] Diabetic peripheral neuropathy is the most common form of neuropathy worldwide. […] More recent cross-sectional studies from the US and Europe have reported a prevalence of diabetic peripheral neuropathy ranging from 6% to 51% depending on the population studied.

• #7 Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy.

  https://vivo.weill.cornell.edu/display/pubid29709457

  Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. […] DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. […] Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.

• #8 Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31456118/

  Diabetic peripheral neuropathy eventually affects nearly 50% of adults with diabetes during their lifetime and is associated with substantial morbidity including pain, foot ulcers, and lower limb amputation. […] The prevalence of peripheral neuropathy is estimated to be between 6 and 51% among adults with diabetes depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes. […] Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease.

• #9 Diabetic Neuropathy: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1170337-overview

  A large American study estimated that 47% of patients with diabetes have some peripheral neuropathy. Neuropathy is estimated to be present in 7.5% of patients at the time of diabetes diagnosis. More than half of cases are distal symmetric polyneuropathy. Focal syndromes such as carpal tunnel syndrome (14-30%), radiculopathies/plexopathies, and cranial neuropathies account for the rest. Solid prevalence data for the latter 2 less-common syndromes is lacking. […] The wide variability in symmetric diabetic polyneuropathy prevalence data is due to lack of consistent criteria for diagnosis, variable methods of selecting patients for study, and differing assessment techniques. In addition, because many patients with diabetic polyneuropathy are initially asymptomatic, detection is extremely dependent on careful neurologic examination by the primary care clinician. The use of additional diagnostic techniques, such as autonomic or quantitative sensory testing, might result in a higher recorded prevalence.

• #10 Diabetic Neuropathy: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1170337-overview

  In a cohort of 4400 Belgian patients, Pirart et al found that 7.5% of patients already had neuropathy when diagnosed with diabetes. After 25 years, the number with neuropathy rose to 45%. In the United Kingdom, the prevalence of diabetic neuropathy among the hospital clinic population was noted to be around 29%. A study by Pan et al found that in Beijing, peripheral neuropathy had prevalence rates of 21.92% and 35.34% in patients with type 1 and type 2 diabetes, respectively. […] A Korean study, by Moon et al, looked at changes over a 10-year period in the prevalence of diabetic neuropathy among people with diabetes aged 30 years or older. The investigators found that the annual prevalence rose from 24.9% in 2006 to 26.6% in 2007. The value then gradually fell, declining to 20.8% in 2015. The prevalence was 3-4% greater in women than men throughout the study period.

• #11 Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6755905/

  The burden of diabetic peripheral neuropathy is higher in older age and among adults with long-standing type 1 or type 2 diabetes. […] Most estimates suggest that approximately 50% of adults with diabetes will be affected by diabetic peripheral neuropathy over the course of their lifetime. […] The prevalence of diabetes peripheral neuropathy is somewhat higher among persons with type 2 diabetes. […] The estimated global prevalence of diabetic foot ulcers is 6%, with major risk factors including older age, lower body mass index, longer duration of diabetes, hypertension, diabetic retinopathy, and smoking. […] Approximately 25% of people with diabetes will develop a foot ulcer during their lifetime, which can progress to infection and limb amputation in severe cases. […] Thus, early diagnosis and treatment are essential.

• #12 Epidemiology and Treatment of Peripheral Neuropathy in Systemic Sclerosis | The Journal of Rheumatology

  https://www.jrheum.org/content/48/12/1839

  Objective The epidemiology and treatment of peripheral neuropathy in systemic sclerosis (SSc) is poorly understood. The objectives of this study were to evaluate the incidence, prevalence, risk factors, and treatments of peripheral neuropathy in SSc. […] This systematic review identified 113 studies that reported 949 of 2143 subjects with at least 1 type of peripheral neuropathy. The mean age was 48.5 years. The mean time between SSc onset and detection of peripheral neuropathy was 8.85 years. The pooled prevalence of neuropathy was 27.37% (95% CI 22.3532.70). Risk factors for peripheral neuropathy in SSc included advanced diffuse disease, anticentromere antibodies, calcinosis cutis, ischemia of the vasa nervorum, iron deficiency anemia, metoclopramide, pembrolizumab, silicosis, and uremia.

• #13 Epidemiology and treatment of peripheral neuropathy in systemic sclerosis | The Journal of Rheumatology

  https://www.jrheum.org/content/early/2021/06/24/jrheum.201299

  Objective The epidemiology and treatment of peripheral neuropathy in systemic sclerosis (SSc) is poorly understood. The objectives of this study were to evaluate the incidence, prevalence, risk factors, and treatments of peripheral neuropathy in SSc. […] 113 studies reported 949 subjects with at least one type of peripheral neuropathy out of 2143 SSc patients studied. The mean age was 48.5 years. The mean time between SSc onset and detection of peripheral neuropathy was 8.85 years. The pooled prevalence of neuropathy was 27.4% (95%CI 22.4% – 32.7%). Risk factors for peripheral neuropathy in SSc included advanced diffuse disease, anticentromere antibodies, calcinosis cutis, ischemia of the vasa nervosum, iron deficiency anemia, metoclopramide, pembrolizumab, silicosis and uremia. […] All-cause peripheral neuropathy is not uncommon in SSc. Compression neuropathies can be treated with decompression surgery. Observational data reporting immunosuppressive and anticonvulsants to treat peripheral neuropathy in SSc is limited and conflicting. This data provides the signal of effect to justify RCT to evaluate the efficacy of these interventions.

• #14 Peripheral Neuropathies Associate with Systemic Disease | PM&R KnowledgeNow

  https://now.aapmr.org/peripheral-neuropathies-associate-with-systemic-disease/

  Peripheral neuropathies associated with systemic disease refers to any disorder of the peripheral nervous system that is a sequela of a systemic disease process. […] Diabetes mellitus is the most common etiology of peripheral neuropathy. At the time of diagnosis of diabetes mellitus, about 10-20% of patients are concomitantly diagnosed with peripheral neuropathy. […] Peripheral neuropathy is a common complication of chronic liver disease. Studies have cited a prevalence ranging between 19 and 80%. […] Hypothyroidism has highly variable incidence of peripheral neuropathy but reported to be around 50%. […] The prevalence varies depending on the cause of toxic-induced peripheral neuropathy. In developed countries, the most common cause of toxic neuropathy is adverse reactions to medications such as chemotherapy with prevalence rates reported to be around 68% within first month of chemotherapy.

• #15 Peripheral Neuropathies Associate with Systemic Disease | PM&R KnowledgeNow

  https://now.aapmr.org/peripheral-neuropathies-associate-with-systemic-disease/

  The prevalence varies depending on the cause of the peripheral neuropathy. Some studies have shown an increased incidence of acute neuropathy during winter months compared to summer months. […] 70% of patients in intensive care unit for 2 weeks can present with some form of critical illness neuropathy. […] About 15-30% of patients with amyloidosis experience peripheral neuropathy. […] About five percent of patients with sarcoidosis have both peripheral and central nervous system involvement. […] The incidence of celiac disease peripheral neuropathy is low.

• #16 Peripheral neuropathy epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Peripheral_neuropathy_epidemiology_and_demographics

  The prevalence of the peripheral neuropathy is approximately 2400 per 100,000 to 7000 per 100,000 individuals depending on the region. […] The case-fatality rate of the peripheral neuropathy is very low. […] Patients of all age groups may develop peripheral neuropathy. […] The incidence of peripheral neuropathy increases with age. […] Peripheral neuropathy affects men more then women. […] The males develop neuropathy earlier than the females.

• #17 Diabetic Neuropathy: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1170337-overview

  No definite racial predilection has been demonstrated for diabetic neuropathy. However, members of minority groups (eg, Hispanics, African Americans) have more secondary complications from diabetic neuropathy, such as lower-extremity amputations, than whites. They also have more hospitalizations for neuropathic complications. […] DM affects men and women with equal frequency. However, male patients with type 2 diabetes may develop diabetic polyneuropathy earlier than female patients, and neuropathic pain causes more morbidity in females than in males. […] Diabetic neuropathy can occur at any age but is more common with increasing age and severity and duration of diabetes.

• #18 Epidemiology and regional variance of traumatic peripheral nerve injuries in Sweden: A 15-year observational study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0310988

  Traumatic peripheral nerve injuries pose significant challenges to healthcare systems and individuals, affecting sensory function, causing neuropathic pain, and impairing quality of life. […] Despite their impact, comprehensive studies on the epidemiology and regional variance of these injuries are scarce. Understanding the incidence, trends, and anatomical distribution of such injuries is essential for targeted interventions and resource allocation. […] Higher incidences of peripheral nerve injuries were observed among men compared to women across all age groups. […] Regional variations in incidence rates were evident, with some regions consistently exhibiting higher rates compared to others. […] Notably, a decreasing trend in injuries was observed over the study period. […] This study underscores the importance of targeted interventions and preventive strategies, considering sex, age, and regional disparities.

• #19 Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts | Scientific Reports

  https://www.nature.com/articles/s41598-021-98565-w

  Based on data from NHANES and ARIC, we found that the age, sex, and race-adjusted prevalence of PN defined by monofilament sensitivity for adults aged 70 years or older was 26.8% in US adults and 34.4% in the ARIC Study compared to 10.4% in US adults aged 4069 years. Risk factors associated with PN in both NHANES and ARIC included long-standing diabetes, older age, male sex, black race, higher body mass index, and greater height. Notably, although diabetes was significantly associated with PN for all groups, PN was also present in a large proportion of adults without diabetes in both the US population and ARIC. This finding suggests that PN defined by monofilament sensitivity may affect a greater proportion of adults without diabetes than previously appreciated. […] The higher prevalence of PN among older ARIC participants as compared to NHANES may be due to several factors. First, the ARIC and NHANES populations are different. Participants in ARIC had more comorbidities than in NHANES, potentially due to differences in study recruitment and selection. Second, a higher proportion of older ARIC versus NHANES participants had diabetes, the most commonly described risk factor for PN.

• #20 Epidemiology and regional variance of traumatic peripheral nerve injuries in Sweden: A 15-year observational study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0310988

  The primary aim of this study is to examine the epidemiology and regional variance of traumatic peripheral nerves injuries in Sweden. […] Our observed incidence of peripheral nerve injuries, 15.6 per 100,000 in men and 10.1 per 100,000 in women, aligns closely with findings from other studies. […] Our study shows a decreasing trend in the incidence of traumatic peripheral nerve injuries over the study period, with notable regional variations. […] Regional variations in the incidence of peripheral nerve injuries were evident, with certain regions consistently exhibiting higher rates compared to others. […] The identification of region specific challenges and etiology of peripheral nerve injuries could prove valuable in guiding public health interventions, and regional policy initiatives. […] The strengths of our study include its nationwide scope, long-term analysis, and utilization of high-quality register-based data from the NPR. […] Further research incorporating individual patient-level data could enhance our understanding and inform preventive strategies.

• #21 Metabolic Neuropathy: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1171051-overview

  On the other hand, in a large cohort of patients with more advanced type 2 diabetes and confirmed coronary artery disease participating in the BARI 2D trial, 50% had confirmed diabetic neuropathy at baseline, and 4-year cumulative incidence was 66-72% in those with no neuropathy at baseline. […] Using the Global Burden of Disease (GBD) Study 2021, the GBD 2021 Nervous System Disorders Collaborators reported diabetic neuropathy as the third leading cause of disability-adjusted life years (DALYs), after stroke and migraine, for adults aged 20-59 years; the figure was 260.5 per 100,000 people. […] For persons aged 60-79 years, diabetic neuropathy again ranked third for DALYs, after stroke and dementia, at 1397.3 per 100,000 people. […] The second most common metabolic neuropathy is that associated with uremia, with studies showing ranges of peripheral neuropathy prevalence of 10-80%.

• #22 Diabetic neuropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_neuropathy

  Globally diabetic neuropathy affects approximately 132 million people as of 2010 (1.9% of the population). […] Diabetes is the leading known cause of neuropathy in developed countries, and neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes. A systematic review has found that diabetic peripheral neuropathy affects 30% of diabetes patients. […] Diabetic neuropathy is implicated in 50-75% of nontraumatic amputations. […] The main risk factor for diabetic neuropathy is hyperglycemia. In the DCCT (Diabetes Control and Complications Trial, 1995) study, the annual incidence of neuropathy was 2% per year but dropped to 0.56% with intensive treatment of Type 1 diabetics. The progression of neuropathy is dependent on the degree of glycemic control in both Type 1 and Type 2 diabetes. Duration of diabetes, age, cigarette smoking, hypertension, height, and hyperlipidemia are also risk factors for diabetic neuropathy.

• #23 Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts | Scientific Reports

  https://www.nature.com/articles/s41598-021-98565-w

  Because PN is classically attributed to hyperglycemia, the high prevalence of PN in non-diabetic adults in our study is novel and warrants attention. The high prevalence of non-diabetic PN among adults70 years of age suggests that there may be an unexplained loss of peripheral sensation among older adults (i.e. idiopathic PN) that is underrecognized. Notably, there are no formal guidelines for foot examinations or monofilament testing among adults without diabetes. […] Novel aspects of our study include the characterization of the epidemiology and risk factors associated with PN among middle-aged and older adults, separately, and stratified by diabetes status. Our study adds to the existing literature by describing the prevalence of and risk factors associated with PN, defined by monofilament insensitivity, among older adults (70 years of age) both with and without diabetes.

• #24 Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6755905/

  Implementation of regular foot exams among adults with diabetes has been shown to reduce the rate of foot ulcers in a variety of populations, and is essential to preventing progression of the disease to infection or lower limb amputation. […] The American Diabetes Association currently recommends that screening for diabetic peripheral neuropathy be performed in all adults at the time of diabetes diagnosis, and annually thereafter.

• #25 Screening for diabetic peripheral neuropathy in resource-limited settings | Diabetology & Metabolic Syndrome | Full Text

  https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01032-x

  Epidemiological data for diabetic peripheral neuropathy is heterogeneous. The prevalence of diabetic peripheral neuropathy is known to increase with age and is estimated to be 660% among adult patients. Painful diabetic neuropathy (PDN) is particularly common in adults and has an estimated prevalence of 1068% among diverse patient cohorts. Therefore, screening for diabetic peripheral neuropathy is an important preventive care practice that may lead to a substantial reduction in disease burden. […] Current screening practices are region specific, but the position statement by the American Diabetes Association (ADA) and the ADA evidence-based standards of care in diabetes guideline provide comprehensive guidance. The ADA recommends that medical history and comprehensive foot examination be used to screen for diabetic peripheral neuropathy at time of diagnosis for patients with T2DM and five years after diagnosis for patients with T1DM. Furthermore, patients should be reassessed at least annually regardless of DM type using 10-g Semmes-Weinstein monofilament evaluation (SWME) and at least one other clinical assessment such as vibration perception, pinprick, temperature perception, or ankle reflexes.

• #26 Screening for diabetic peripheral neuropathy in resource-limited settings | Diabetology & Metabolic Syndrome | Full Text

  https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01032-x

  Lack of a standardized methodology for the screening of DM or its microvascular complications in resource-limited settings is an unmet medical need. Additionally, there is no single tool that can be used to objectively evaluate sensory, motor, and autonomic deficits associated with diabetic peripheral neuropathy. Evidence suggests that combining multiple assessments increases sensitivity, specificity, and accuracy of detecting diabetic peripheral neuropathy. Therefore, multiphasic screening where one or more tools for assessing the signs and symptoms of diabetic peripheral neuropathy are used concurrently or sequentially may detect a greater proportion of deficits, thereby aiding clinical decision-making. […] Based on current guidelines, there are several criteria for stratifying patients according to their clinical risk for DFS and amputation. The International Diabetes Federation (IDF) stratifies patients into four groups: Low risk – normal plantar sensation; Moderate risk – presence of LOPS; High risk – presence of LOPS + PAD; Very high risk – history of ulceration, amputation, or neuropathic fracture. […] Patients at increased risk for DFS and lower-extremity amputation are recommended to undergo SWME, despite concerns about diagnostic accuracy of SWME during screening for diabetes-related foot disease and questions about the number of sites on the foot that must be assessed.

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