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Neurological Complications of Bariatric Surgery

  • Neurology of Systemic Diseases (J Biller, Section Editor)
  • Published:
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Abstract

Obesity has attained pandemic proportions, and bariatric surgery is increasingly being employed resulting in turn to more neurological complications which must be recognized and managed. Neurological complications may result from mechanical or inflammatory mechanisms but primarily result from micro-nutritional deficiencies. Vitamin B12, thiamine, and copper constitute the most frequent deficiencies. Neurological complications may occur at reasonably predictable times after bariatric surgery and are associated with the type of surgery used. During the early post-operative period, compressive or stretch peripheral nerve injury, rhabdomyolysis, Wernicke’s encephalopathy, and inflammatory polyradiculoneuropathy may occur. Late complications ensue after months to years and include combined system degeneration (vitamin B12 deficiency) and hypocupric myelopathy. Bariatric surgery patients require careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-operatively and then annually after surgery and multivitamin supplementation for life. Sustained vigilance for common and rare neurological complications is essential.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ogden CL et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.

    Article  CAS  PubMed  Google Scholar 

  2. Krispel CM et al. Undiagnosed papilledema in a morbidly obese patient population: a prospective study. J Neuroophthalmol. 2011;31(4):310–5.

    Article  PubMed  Google Scholar 

  3. Levin AA, Hess D, Hohler AD. Treatment of idiopathic intracranial hypertension with gastric bypass surgery. Int J Neurosci. 2015;125(1):78–80.

    Article  PubMed  Google Scholar 

  4. Marton E et al. Pseudotumor cerebri in pediatric age: role of obesity in the management of neurological impairments. Nutr Neurosci. 2008;11(1):25–31.

    Article  PubMed  Google Scholar 

  5. Spitznagel MB et al. Neurocognitive effects of obesity and bariatric surgery. Eur Eat Disord Rev. 2015.

  6. Bolen SD et al. Clinical outcomes after bariatric surgery: a five-year matched cohort analysis in seven US states. Obes Surg. 2012;22(5):749–63.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Chang SH et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3):275–87.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Livingston EH. Is bariatric surgery worth it?: comment on “Impact of bariatric surgery on health care costs of obese persons”. JAMA Surg. 2013;148(6):562.

    Article  PubMed  Google Scholar 

  9. Livingston EH. The incidence of bariatric surgery has plateaued in the U.S. Am J Surg. 2010;200(3):378–85.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Livingston EH. Bariatric surgery in the new millennium. Arch Surg. 2007;142(10):919–22.

    Article  PubMed  Google Scholar 

  11. Puzziferri N et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Torpy JM, Lynm C, Livingston EH. JAMA patient page. Bariatric surgery. JAMA. 2012;308(11):1173.

    Article  CAS  PubMed  Google Scholar 

  13. Aasheim ET et al. Peripheral neuropathy and severe malnutrition following duodenal switch. Obes Surg. 2008;18(12):1640–3.

    Article  PubMed  Google Scholar 

  14. Rudnicki SA. Prevention and treatment of peripheral neuropathy after bariatric surgery. Curr Treat Options Neurol. 2010;12(1):29–36.

    Article  PubMed  Google Scholar 

  15. Thaisetthawatkul P et al. Good nutritional control may prevent polyneuropathy after bariatric surgery. Muscle Nerve. 2010;42(5):709–14.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ziegler O et al. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35(6 Pt 2):544–57.

    Article  CAS  PubMed  Google Scholar 

  17. Frantz DJ. Neurologic complications of bariatric surgery: involvement of central, peripheral, and enteric nervous systems. Curr Gastroenterol Rep. 2012;14(4):367–72.

    Article  PubMed  Google Scholar 

  18. Koffman BM et al. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33(2):166–76.

    Article  PubMed  Google Scholar 

  19. Thaisetthawatkul P et al. A controlled study of peripheral neuropathy after bariatric surgery. Neurology. 2004;63(8):1462–70.

    Article  CAS  PubMed  Google Scholar 

  20. Gudzune KA et al. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Becker DA et al. Dry Beriberi and Wernicke’s encephalopathy following gastric lap band surgery. J Clin Neurosci. 2012;19(7):1050–2.

    Article  PubMed  Google Scholar 

  22. Kuhn AL et al. Vitamin B1 in the treatment of Wernicke’s encephalopathy due to hyperemesis after gastroplasty. J Clin Neurosci. 2012;19(9):1303–5.

    Article  CAS  PubMed  Google Scholar 

  23. Loh Y et al. Acute Wernicke’s encephalopathy following bariatric surgery: clinical course and MRI correlation. Obes Surg. 2004;14(1):129–32.

    Article  PubMed  Google Scholar 

  24. Makarewicz W et al. Wernicke’s syndrome after sleeve gastrectomy. Obes Surg. 2007;17(5):704–6.

    Article  PubMed  Google Scholar 

  25. Manatakis DK, Georgopoulos N. A fatal case of Wernicke’s encephalopathy after sleeve gastrectomy for morbid obesity. Case Rep Surg. 2014;2014:281210.

    PubMed Central  PubMed  Google Scholar 

  26. Milone M et al. Wernicke encephalopathy in subjects undergoing restrictive weight loss surgery: a systematic review of literature data. Eur Eat Disord Rev. 2014;22(4):223–9.

    Article  PubMed  Google Scholar 

  27. Sola E et al. Rapid onset of Wernicke’s encephalopathy following gastric restrictive surgery. Obes Surg. 2003;13(4):661–2.

    Article  PubMed  Google Scholar 

  28. Landais A. Neurological complications of bariatric surgery. Obes Surg. 2014;24(10):1800–7. Dr. Landais reports two cases of neurological complications following bariatric surgery in Europe and then does a comprehensive review with careful attention to the timing of complications.

    Article  PubMed  Google Scholar 

  29. Berger JR, Singhal D. The neurologic complications of bariatric surgery. Handb Clin Neurol. 2014;120:587–94. Dr. Berger and Singhal provide a contemporary overview of neurological complications of bariatric surgery.

    Article  PubMed  Google Scholar 

  30. Chang CG, Adams-Huet B, Provost DA. Acute post-gastric reduction surgery (APGARS) neuropathy. Obes Surg. 2004;14(2):182–9.

    Article  PubMed  Google Scholar 

  31. Manzanares W, Hardy G. Thiamine supplementation in the critically ill. Curr Opin Clin Nutr Metab Care. 2011;14(6):610–7.

    Article  CAS  PubMed  Google Scholar 

  32. Becker DA, Balcer LJ, Galetta SL. The neurological complications of nutritional deficiency following bariatric surgery. J Obes. 2012;2012:608534.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Fragoso YD et al. Neurological complications following bariatric surgery. Arq Neuropsiquiatr. 2012;70(9):700–3.

    Article  PubMed  Google Scholar 

  34. Sawicka-Pierko A et al. Nutritional optic neuropathy following bariatric surgery. Wideochir Inne Tech Maloinwazyjne. 2014;9(4):662–6.

    PubMed Central  PubMed  Google Scholar 

  35. Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol. 2014;28(4):741–9.

    Article  CAS  PubMed  Google Scholar 

  36. Chen M et al. Hematological disorders following gastric bypass surgery: emerging concepts of the interplay between nutritional deficiency and inflammation. Biomed Res Int. 2013;2013:205467.

    PubMed Central  PubMed  Google Scholar 

  37. Balsa JA et al. Copper and zinc serum levels after derivative bariatric surgery: differences between Roux-en-Y Gastric bypass and biliopancreatic diversion. Obes Surg. 2011;21(6):744–50.

    Article  PubMed  Google Scholar 

  38. Gletsu-Miller N et al. Incidence and prevalence of copper deficiency following Roux-en-Y gastric bypass surgery. Int J Obes (Lond). 2012;36(3):328–35.

    Article  CAS  Google Scholar 

  39. Halfdanarson TR et al. Hematological manifestations of copper deficiency: a retrospective review. Eur J Haematol. 2008;80(6):523–31.

    Article  CAS  PubMed  Google Scholar 

  40. Jaiser SR, Winston GP. Copper deficiency myelopathy. J Neurol. 2010;257(6):869–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Plantone D et al. Copper deficiency myelopathy: a report of two cases. J Spinal Cord Med. 2014.

  42. Tan JC, Burns DL, Jones HR. Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy. JPEN J Parenter Enteral Nutr. 2006;30(5):446–50.

    Article  PubMed  Google Scholar 

  43. Yarandi SS et al. Optic neuropathy, myelopathy, anemia, and neutropenia caused by acquired copper deficiency after gastric bypass surgery. J Clin Gastroenterol. 2014;48(10):862–5.

    CAS  PubMed  Google Scholar 

  44. Boldery R et al. Nutritional deficiency of selenium secondary to weight loss (bariatric) surgery associated with life-threatening cardiomyopathy. Heart Lung Circ. 2007;16(2):123–6.

    Article  PubMed  Google Scholar 

  45. Chang CG et al. Weakness after gastric bypass. Obes Surg. 2002;12(4):592–7.

    Article  PubMed  Google Scholar 

  46. Ishaque N et al. Guillain-Barre syndrome (demyelinating) six weeks after bariatric surgery: a case report and literature review. Obes Res Clin Pract. 2015.

  47. Landais AF. Rare neurologic complication of bariatric surgery: acute motor axonal neuropathy (AMAN), a severe motor axonal form of the Guillain Barre syndrome. Surg Obes Relat Dis. 2014;10(6):e85–7.

    Article  PubMed  Google Scholar 

  48. Machado FC et al. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery. Arq Neuropsiquiatr. 2006;64(3A):609–12.

    Article  PubMed  Google Scholar 

  49. Hu WT et al. Ornithine transcarbamylase deficiency presenting as encephalopathy during adulthood following bariatric surgery. Arch Neurol. 2007;64(1):126–8.

    Article  PubMed  Google Scholar 

  50. Dahlquist NR et al. D-Lactic acidosis and encephalopathy after jejunoileostomy: response to overfeeding and to fasting in humans. Mayo Clin Proc. 1984;59(3):141–5.

    Article  CAS  PubMed  Google Scholar 

  51. Forsyth RJ, Moulden A, Hull D. D-Lactate associated encephalopathy in short bowel syndrome: management with long-term non-absorbable oral antimicrobials. Clin Nutr. 1991;10(6):352–5.

    Article  CAS  PubMed  Google Scholar 

  52. Hingorani AD, Chan NN. D-lactate encephalopathy. Lancet. 2001;358(9295):1814.

    Article  CAS  PubMed  Google Scholar 

  53. Htyte N et al. An extreme and life-threatening case of recurrent D-lactate encephalopathy. Nephrol Dial Transplant. 2011;26(4):1432–5.

    Article  PubMed  Google Scholar 

  54. Kadakia SC. D-lactic acidosis in a patient with jejunoileal bypass. J Clin Gastroenterol. 1995;20(2):154–6.

    Article  CAS  PubMed  Google Scholar 

  55. Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215. D-lactate acidosis with encephalopathy is probably widely unknown to neurologists but is a serious consideration in patient’s whose gastrointestinal tract has been altered surgically for disease or for bariatric purposes.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Thurn JR et al. D-lactate encephalopathy. Am J Med. 1985;79(6):717–21.

    Article  CAS  PubMed  Google Scholar 

  57. Traube M, Bock JL, Boyer JL. D-Lactic acidosis after jejunoileal bypass: identification of organic anions by nuclear magnetic resonance spectroscopy. Ann Intern Med. 1983;98(2):171–3.

    Article  CAS  PubMed  Google Scholar 

  58. Uribarri J, Oh MS, Carroll HJ. D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore). 1998;77(2):73–82.

    Article  CAS  Google Scholar 

  59. Javorsky BR et al. Discovery of Cushing’s syndrome after bariatric surgery: multicenter series of 16 patients. Obes Surg, 2015. Javorsky and colleagues draw our attention to the possibility of patients with pre-existing Cushing’s disease entering the bariatric surgery cohort. These patients are significantly less likely to have amelioration of obesity related co-morbidities.

  60. Devlieger R, Jans G, Matthys C. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(23):2266.

    Article  CAS  PubMed  Google Scholar 

  61. Folope V, Coeffier M, Dechelotte P. Nutritional deficiencies associated with bariatric surgery. Gastroenterol Clin Biol. 2007;31(4):369–77.

    Article  PubMed  Google Scholar 

  62. Jans G et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Adv Nutr. 2015;6(4):420–9.

    Article  PubMed  Google Scholar 

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  1. Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Jerry Clay Goodman

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  1. Jerry Clay Goodman
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This article is part of the Topical Collection on Neurology of Systemic Disease

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Goodman, J.C. Neurological Complications of Bariatric Surgery. Curr Neurol Neurosci Rep 15, 79 (2015). https://doi.org/10.1007/s11910-015-0597-2

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