We enjoyed reading the Burns et al.1 article about the evaluation of polyneuropathies but missed the discussion of critical illness polyneuropathy.
It is the primary axonal degeneration of motor and sensory fibers that can lead to degeneration of muscle fibers. This occurs in critically ill patients, including those with systemic inflammatory response syndrome, sepsis with multiple organ dysfunction syndrome, hyperglycemia, or in those requiring muscle relaxants, corticosteroids, or parenteral nutrition. This may occur in up to 80% of critically ill patients, usually in the form of quadriplegia or quadriparesis, with abolished tendon reflexes and no pathologic changes in the CSF.2
The neurophysiologic study shows primary axonal degeneration of motor and sensory fibers with preservation of conduction velocity, normal distal latency, and potential fall of motor response. Moreover, it is important to demonstrate denervation in the muscles as an expression of the sharpness of the process, as evidenced by the EMG onset of fibrillation potentials and positive waves.3
There no effective treatment for this condition because identifying the problem and establishing early physiotherapy are the most appropriate measures for its management. However, identification of risk factors should prompt a close metabolic control of septic patients, especially avoiding hyperglycemia and hyperosmolarity. In addition, patients should avoid the use of muscle relaxants.4
In serious cases, persistence of immobility and quality of life deterioration at 2 years after diagnosis was reported in almost all patients. Prolonged intensive care unit stay, longer duration of sepsis, and weight loss are the 3 conditions associated with poorer recovery.5
Considering the incidence and clinical implications, critical illness polyneuropathy should be included in the differential diagnosis of polyneuropathies.
Disclosures
The authors report no disclosures.
Authors Respond:
We thank the authors of the correspondence for their summary of critical illness polyneuropathy, which acts as a worthy addition to our article.
Disclosures
See original article for full disclosure list.
- Copyright © 2011 by AAN Enterprises, Inc.
The Nerve!: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
