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Autonomic neuropathy in mixed cryoglobulinemia

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Abstract

A retrospective, cross-sectional study was performed on a series of HCV-related mixed cryoglobulinemia (HCV-MC) patients to assess autonomic neuropathy (AN) and its relation to peripheral neuropathy (PN). Thirty consecutive patients affected by HCV-MC underwent clinical, neurological and electrodiagnostic examinations. Autonomic nervous system (ANS) involvement was assessed by functional cardiovascular tests and sympathetic skin response (SSR) evaluation. Sural nerve biopsy was performed in 10 patients with PN. All patients received steroids, 15 also received recombinant interferon-α2b (RIfn-α2b). PN occurred in 27 patients (90.0%) and AN in 4 (13.3 %) all with signs of PN. SSR was the autonomic test more frequently altered. Biopsy disclosed axonal degeneration more evident in the 4 patients with AN. Three out of 4 patients with AN received steroids and rIFN-α2b and 1 steroids alone. In our study on HCV-MC, it was concluded that AN can occur also without dysautonomic symptoms, SSR appears to be one of the optional tests to use together with dysautonomic tests to identify AN and finally PN and AN do not seem to be positively influenced by addition of rIFN-α2b to steroid treatment.

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References

  1. Ammendola A, Di Iorio G, Migliaresi S, Cantore R, Sanges G, Valentini G, Bravaccio F, Tirri G, Bonavita V (1990) Studio neurofisiologico in 17 casi di crioglobulinemia. Riv Ital EEG Neurofisiol Clin 13:247–258

    Google Scholar 

  2. Baron R, Ewing DJ (1999) Heart rate variability. In: Deuschl G and Eisen A (eds) Recommendations for the Practice of Clinical Neurophysiology: Guidelines of the International Federation of Clinical Neurophysiology. (EEG Suppl. 52), Elsevier Science B.V., pp 283–286

  3. Bellavere F (1990) La diagnosi strumentale della neuropatia autonomica diabetica. Rec Progr Diabetol 1(4):51–65

    Google Scholar 

  4. Bonetti B, Scardoni M, Monaco S, Rizzuto N, Scarpa A (1999) Hepatitis C virus infection of peripheral nerves in type II cryoglobulinemia. Virchows Arch 434:533–535

    Article  PubMed  CAS  Google Scholar 

  5. Braune S, Elam M, Baron R, Low PA (1999) Assessment of blood pressure regulation. In: Deuschl G and Eisen A (eds) Recommendations for the Practice of Clinical Neurophysiology: Guidelines of the International Federation of Clinical Neurophysiology. (EEG Suppl. 52), Elsevier Science B.V., pp 287–291

  6. Brouet JC, Clauvel JP, Danon F, Klein M, Seligmann M (1974) Biological and clinical significance of cryoglobulins. Am J Med 57:775–788

    Article  PubMed  CAS  Google Scholar 

  7. Chad D, Pariser K, Bradley WG, Adelman LS, Pinn VW (1982) The pathogenesis of cryoglobulinemic neuropathy. Neurology 32:725–729

    PubMed  CAS  Google Scholar 

  8. Crespi V, Cavaletti G, Pioltelli P, Zincone A, Tredici G, Marmiroli P, Petruccioli MG (1995) Cryoglobulinaemic neurophaty: lack of progression in patients with good haematological control. Acta Neurol Scand 92:372–375

    Article  PubMed  CAS  Google Scholar 

  9. Elie B, Guiheneuc P (1990) Sympathetic skin response: normal results in different experimental conditions. Electroencephalogr Clin Neurophysiol 76:258–267

    Article  PubMed  CAS  Google Scholar 

  10. Feiner HD (1983) Relationship of tissue deposits of cryoglobulin to clinical features of mixed cryoglobulinemia. Hum Pathol 14:710–715

    PubMed  CAS  Google Scholar 

  11. Ferri C, La Civita L, Cirafisi C, Siciliano G, Longobardo G, Bombardieri S, Rossi B (1992) Peripheral neuropathy in mixed cryoglobulinemia: clinical and electrophysiologic investigations. J Rheumatol 19:889–895

    PubMed  CAS  Google Scholar 

  12. Gorevic PD, Kassab HJ, Levo Y, Kohn R, Meltzer M, Prose P, Franklin EC (1980) Mixed cryoglobulinemia: clinical aspects and long term follow-up of 40 patients. Am J Med 69:287–308

    Article  PubMed  CAS  Google Scholar 

  13. Irioka T, Yamada M, Yamawaki M, Saito Y, Mizusawa H (2001) Acute autonomic and sensory neuropathy after interferon α2b therapy for chronic hepatitis C. J Neurol Neurosurg Psychiatry 70:408–410

    Article  PubMed  CAS  Google Scholar 

  14. La Civita L, Zignego AL, Lombardini F, Monti M, Longobardo G, Pasero G, Ferri C (1996) Exacerbation of peripheral neuropathy during alpha-interferon therapy in a patient with mixed cryoglobulinemia ad hepatitis B virus infection. J Rheumatol 23:1641–1643

    PubMed  CAS  Google Scholar 

  15. Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O’Brien PC, Slezak JM (1997) Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 20:1561–1568

    Article  PubMed  CAS  Google Scholar 

  16. McLeod JG (1999) Evaluation of the autonomic nervous system. In: Aminoff MJ (ed) Electrodiagnosis in clinical neurology. Churchill Livingstone, New York Edinburgh London Philadelphia San Francisco, pp 381–393

    Google Scholar 

  17. Meltzer M, Franklin EC (1966) Cryoglobulinemia: a study of 29 patients. Am J Med 40:828–836

    Article  PubMed  CAS  Google Scholar 

  18. Piaggesi A, Castro Lopez E, Bini L, Benzi L, Giampietro O, Schipani E, Navalesi R (1992) Measurable deficit of autonomic and sensory nerve function in asymptomatic diabetic patients. J Diabetes Complications 6:157–162

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Dept. of Neurological Sciences, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy

    A. Ammendola MD, S. Sampaolo, E. Ammendola, G. Ciccone & G. Di Iorio

  2. Division of Rheumatology, Second University of Medicine, Naples, Italy

    S. Migliaresi & L. Ambrosone

Authors
  1. A. Ammendola MD
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  2. S. Sampaolo
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  3. S. Migliaresi
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  4. L. Ambrosone
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  5. E. Ammendola
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  6. G. Ciccone
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  7. G. Di Iorio
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Corresponding author

Correspondence to A. Ammendola MD.

Additional information

Received in revised form: 4 April 2006

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Ammendola, A., Sampaolo, S., Migliaresi, S. et al. Autonomic neuropathy in mixed cryoglobulinemia. J Neurol 254, 215–219 (2007). https://doi.org/10.1007/s00415-006-0333-6

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  • DOI: https://doi.org/10.1007/s00415-006-0333-6

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