Recent Background: Diabetic neuropathy is one of the major complications in long standing hyperglycemic patients. Though exact mechanism of neuronal damage is unclear, accumulation of excess sorbitol through polyol pa...Recent Background: Diabetic neuropathy is one of the major complications in long standing hyperglycemic patients. Though exact mechanism of neuronal damage is unclear, accumulation of excess sorbitol through polyol pathway is believed to contribute significantly. Epalrestat and methylcobalamin are extensively used in this area to counter neuronal damage. This study was aimed to evaluate the combined effect of these drugs. Materials and Methods: A total of 220 patients with diabetic neuropathy were included in this study. The patients were divided into two groups;group A was administered combination of epalrestat 50 mg and methylcobalamin 500 mcg while group B was administered epalrestat 50 mg alone (both thrice daily). The treatment period was 12 weeks with monitoring on week 4, 8 and 12 of the study. At baseline and at follow up visits following parameters were evaluated: loss of sensation, burning sensation, numbness, muscle cramps, spontaneous pain, weakness, dizziness, loss of the thermal sensitivity, tendon reflexes, muscle strength and pain intensity using visual analog scale (VAS). Results: All the parameters were improved in both the groups compared to baseline. In group A significant improvement was seen on week 4 itself and continued for the rest of the study in all the measured parameters. Group B showed significant improvement from 8th week onwards. The inter-group difference is statistically significant in favour of the combination therapy. Conclusion: Combination of epalrestat and methylcobalamin is a better option for the treatment of diabetic neuropathy than epalrestat alone. Combination therapy was associated with faster onset and better symptomatic relief.展开更多
The effects of large dose methylcobalamin injection on diabetic peripheral neuropathy in patients were observed to observe the subjective symptom of diabetic perpheral neuropathy （DPN） patients and detect the motor ...The effects of large dose methylcobalamin injection on diabetic peripheral neuropathy in patients were observed to observe the subjective symptom of diabetic perpheral neuropathy （DPN） patients and detect the motor nerve conduction velocity （MCV） and sense nerve conduction velocity （SCV）. Fifteen patients were received large dose methylcobalamin injection for two weeks as treatment group, another eleven patients were received muscular injection VitB1 100mg/ d, VitB12 500ug/ d for two weeks as control group. After 2 weeks treatment the subjective symptoms and signs were significantly improved with a total effective rate of 82.9% in the treatment group however the effective rate only has 52.0% in the control group. The result has obvious difference in statistics nerve MCV in median common peroneal nerve, SCV in median and superficial peroneal nerve were improved significantly in the treatment group and no such changes were observed in the control group. So, large dose methylcobalamin is an effective and safe agent for treatment of diabetic peripheral neuropathy.展开更多
Background: Peripheral neuropathy is a commonly encountered troublesome condition which is often disabling & worsens when left untreated. Traditional neuropathic pain medications primarily provide symptomatic reli...Background: Peripheral neuropathy is a commonly encountered troublesome condition which is often disabling & worsens when left untreated. Traditional neuropathic pain medications primarily provide symptomatic relief;however, the pathogenesis of nerve damage remains unresolved. Extensive literature survey reveals that patients with peripheral neuropathy experience significant benefits with the use of B-vitamins like methylcobalamin (B12), folic acid (B9), biotin (B7), benfotiamine (B1) and pyridoxine (B6). The other well documented antineuropathic agents include alpha lipoic acid, glutathione, omega fatty acids, myoinositol, certain trace elements, etc. Materials and Methods: A multicentre, prospective, open-label, non-comparative clinical study was carried out in 497 patients with peripheral neuropathy. A fixed dose combination of methylcobalamin, alpha lipoic acid (ALA), folic acid, biotin, benfotiamine & vitamin B6 capsule was orally administered once daily for 12 weeks. Results: Treatment led to significant reduction from baseline score in various neuropathy symptoms from the 4th week itself. After 12 weeks of treatment, the mean pain score declined by 78.0%, numbness by 92.1% and muscle weakness by 96.9%. Also, there was 96.0% & 99.2% reduction in tingling & burning sensation respectively. No serious adverse events were reported.Conclusion: The current study confirms that fixed dose combination of methylcobalamin, ALA, folic acid, biotin, benfotiamine & vitamin B6 is effective & well tolerated in the management of peripheral neuropathy.展开更多
Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guide...Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guidelines. Objective: To determine the clinical and neurophysiological effects of 1500 μgm/day of oral methylcobalamin among subjects with diabetic polyneuropathy. Methodology: We conducted a prospective, open-label study on adult diabetic subjects with polyneuropathy who were given 1500 μgm/day of oral methylcobalamin over 24-weeks. The primary outcome measure was the Toronto Clinical Scoring System (CSS) and secondary measures were Subjective Impression of Change, Clinicians Impression of Change and neurophysiological parameters. Results: Out of forty eight subjects, thirty seven completed treatment and twenty one agreed to have repeat neurophysiologic study post-treatment. At the end of treatment, there was a significant decline in the Toronto CSS score (p < 0.0001) indicating improvement. This was observed across all stages of severity and in any duration of diabetes whether more or less than 10 years. The symptoms that improved compared to baseline and that did not emerge over the course of 24 weeks were tingling (p < 0.03), upper limb symptoms (p < 0.003), ataxia (p < 0.004), and signs of impaired position (P < 0.009) sense, vibration sense (p < 0.0001), pinprick sensation (p < 0.004) and knee reflex (p < 0.004). No significant improvement was seen in the secondary outcomes (both p=0.06) except for ulnar nerve amplitude and distal latency. Conclusion: This 24-week open label study demonstrated that symptoms of diabetic polyneuropathy significantly improved among subjects given methylcobalamin 1500 μgm/day and new symptoms did not emerge over the 24 week observation period. Larger controlled trials are needed to corroborate these findings.展开更多
目的:通过网状Meta分析评价中医外治疗法缓解化疗诱导外周神经病变(CIPN)症状的疗效。方法:检索PubMed、the Cochrane Library、EMbase、Web of Science、中国知网、万方数据库、维普数据库等中英文数据库中有关中医外治疗法缓解CIPN症...目的:通过网状Meta分析评价中医外治疗法缓解化疗诱导外周神经病变(CIPN)症状的疗效。方法:检索PubMed、the Cochrane Library、EMbase、Web of Science、中国知网、万方数据库、维普数据库等中英文数据库中有关中医外治疗法缓解CIPN症状的随机对照试验,检索时限为各数据库建库到2023年8月15日。由2名研究者独立筛选文献、提取数据及文献质量评价。应用Stata 17.0软件进行网状Meta分析。结果:共纳入32项随机对照试验,共计2492例CIPN病人,涉及穴位贴敷、中药熏洗+甲钴胺联合治疗、穴位针灸+甲钴胺联合治疗等多种中西医结合疗法。网状Meta分析结果显示:总有效率疗效较好的为中药熏洗+甲钴胺治疗和穴位针灸大类+甲钴胺治疗;生活质量指数较优的为中药熏洗、穴位针灸大类+甲钴胺治疗。结论:现有证据显示,6种中西医结合治疗有效率高于常规护理和两种单纯西医治疗,且中药熏洗+甲钴胺治疗、穴位针灸大类+甲钴胺治疗两类中西医结合治疗疗效较好。展开更多
文摘Recent Background: Diabetic neuropathy is one of the major complications in long standing hyperglycemic patients. Though exact mechanism of neuronal damage is unclear, accumulation of excess sorbitol through polyol pathway is believed to contribute significantly. Epalrestat and methylcobalamin are extensively used in this area to counter neuronal damage. This study was aimed to evaluate the combined effect of these drugs. Materials and Methods: A total of 220 patients with diabetic neuropathy were included in this study. The patients were divided into two groups;group A was administered combination of epalrestat 50 mg and methylcobalamin 500 mcg while group B was administered epalrestat 50 mg alone (both thrice daily). The treatment period was 12 weeks with monitoring on week 4, 8 and 12 of the study. At baseline and at follow up visits following parameters were evaluated: loss of sensation, burning sensation, numbness, muscle cramps, spontaneous pain, weakness, dizziness, loss of the thermal sensitivity, tendon reflexes, muscle strength and pain intensity using visual analog scale (VAS). Results: All the parameters were improved in both the groups compared to baseline. In group A significant improvement was seen on week 4 itself and continued for the rest of the study in all the measured parameters. Group B showed significant improvement from 8th week onwards. The inter-group difference is statistically significant in favour of the combination therapy. Conclusion: Combination of epalrestat and methylcobalamin is a better option for the treatment of diabetic neuropathy than epalrestat alone. Combination therapy was associated with faster onset and better symptomatic relief.
文摘The effects of large dose methylcobalamin injection on diabetic peripheral neuropathy in patients were observed to observe the subjective symptom of diabetic perpheral neuropathy （DPN） patients and detect the motor nerve conduction velocity （MCV） and sense nerve conduction velocity （SCV）. Fifteen patients were received large dose methylcobalamin injection for two weeks as treatment group, another eleven patients were received muscular injection VitB1 100mg/ d, VitB12 500ug/ d for two weeks as control group. After 2 weeks treatment the subjective symptoms and signs were significantly improved with a total effective rate of 82.9% in the treatment group however the effective rate only has 52.0% in the control group. The result has obvious difference in statistics nerve MCV in median common peroneal nerve, SCV in median and superficial peroneal nerve were improved significantly in the treatment group and no such changes were observed in the control group. So, large dose methylcobalamin is an effective and safe agent for treatment of diabetic peripheral neuropathy.
文摘Background: Peripheral neuropathy is a commonly encountered troublesome condition which is often disabling & worsens when left untreated. Traditional neuropathic pain medications primarily provide symptomatic relief;however, the pathogenesis of nerve damage remains unresolved. Extensive literature survey reveals that patients with peripheral neuropathy experience significant benefits with the use of B-vitamins like methylcobalamin (B12), folic acid (B9), biotin (B7), benfotiamine (B1) and pyridoxine (B6). The other well documented antineuropathic agents include alpha lipoic acid, glutathione, omega fatty acids, myoinositol, certain trace elements, etc. Materials and Methods: A multicentre, prospective, open-label, non-comparative clinical study was carried out in 497 patients with peripheral neuropathy. A fixed dose combination of methylcobalamin, alpha lipoic acid (ALA), folic acid, biotin, benfotiamine & vitamin B6 capsule was orally administered once daily for 12 weeks. Results: Treatment led to significant reduction from baseline score in various neuropathy symptoms from the 4th week itself. After 12 weeks of treatment, the mean pain score declined by 78.0%, numbness by 92.1% and muscle weakness by 96.9%. Also, there was 96.0% & 99.2% reduction in tingling & burning sensation respectively. No serious adverse events were reported.Conclusion: The current study confirms that fixed dose combination of methylcobalamin, ALA, folic acid, biotin, benfotiamine & vitamin B6 is effective & well tolerated in the management of peripheral neuropathy.
文摘Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guidelines. Objective: To determine the clinical and neurophysiological effects of 1500 μgm/day of oral methylcobalamin among subjects with diabetic polyneuropathy. Methodology: We conducted a prospective, open-label study on adult diabetic subjects with polyneuropathy who were given 1500 μgm/day of oral methylcobalamin over 24-weeks. The primary outcome measure was the Toronto Clinical Scoring System (CSS) and secondary measures were Subjective Impression of Change, Clinicians Impression of Change and neurophysiological parameters. Results: Out of forty eight subjects, thirty seven completed treatment and twenty one agreed to have repeat neurophysiologic study post-treatment. At the end of treatment, there was a significant decline in the Toronto CSS score (p < 0.0001) indicating improvement. This was observed across all stages of severity and in any duration of diabetes whether more or less than 10 years. The symptoms that improved compared to baseline and that did not emerge over the course of 24 weeks were tingling (p < 0.03), upper limb symptoms (p < 0.003), ataxia (p < 0.004), and signs of impaired position (P < 0.009) sense, vibration sense (p < 0.0001), pinprick sensation (p < 0.004) and knee reflex (p < 0.004). No significant improvement was seen in the secondary outcomes (both p=0.06) except for ulnar nerve amplitude and distal latency. Conclusion: This 24-week open label study demonstrated that symptoms of diabetic polyneuropathy significantly improved among subjects given methylcobalamin 1500 μgm/day and new symptoms did not emerge over the 24 week observation period. Larger controlled trials are needed to corroborate these findings.
