How we wish to be cited:
Norberg B..Painful sensory neuropathy [editorial]. Rondel 2003; 16. URL: http://www.rondellen.net

Painful sensory neuropathy

The 4th International Conference, was held in Basel, Switzerland, June 29 – July 3, 2003 (J Inher Metabol Dis 2003;26: Suppl 1). In summary, the homocysteine movement has gone from revivalism to meditation. The role of homocysteine in the biological process of aging is reconsidered – spectator (risk marker), player (risk determinant), or manager (risk factor). In any case, homocysteine remains an efficient marker for early stages of cobalamin/folate deficiency. One clinical consequence of the marker role of homocysteine is suggested in the editorial below.

The paper on painful sensory neuropathy by Mendell and Shenk (1) provides food for thought. There is at least one painful sensory neuropathy, which is easily healed - the one caused by cobalamin/folate deficiency (2). The pain of deficiency neuropathy is often most pronounced during the first two years of treatment, a phenomenon often misinterpreted as therapy failure (3). Since recent studies suggest that about every second citizen develops cobalamin/folate deficiency during his last 10 years of life (4,5,6), I would like to suggest that every elderly patient with mild depression/neuropathy should start with psychotherapy and test treatment with cobalamin and folic acid for 6-12 months, while the nature of the condition is elucidated.

Bo Norberg

References

  1. Mendell JR, Sahenk Z. Painful sensory neuropathy. N Engl J Med 2003; 348:1243-55
  2. Norberg B. Oral high-dose cobalamin for B12-dependent polyneuropathy [case 11]. Rondel 2002; 11. URL: http://www.rondellen.net/case11_eng.htm
  3. Suhr O. Familial amyloidosis with polyneuropathy [culture]. Rondel 2001; 7. URL: http://www.rondellen.net/culture07_eng.htm
  4. Hultdin J. High homocysteine levels in elderly [editorial]! Rondel 2003; 14. URL: http://www.rondellen.net/publisher14_eng.htm
  5. Nilsson M. Cobalamin communication – receivers and senders [editorial]. Rondel 2003; 15. URL: http://www.rondellen.net/publisher15_eng.htm
  6. Björkegren K. Studies on vitamin B12 and folate deficiency markers in the elderly. A populations-based study (dissertation). Uppsala University, Uppsala, Sweden 2003.

Published July 29, 2003