The African Journal of Neurological Sciences
Vol 14 No.2 1995
Painful neuropathy in H.I.V. patients: its response to oral prednisolone
A.M.Adam
Code Number: NS95008
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SUMMARY
Painful neuropathies due to any diseases, cause a lot of morbidity
since in most cases they respond poorly to various therapies. It was
decided to study the clinical features, electrophysiology and response to a
short course of oral prednisolone in H.I.V. patients.
Between 1988 and 1992 seven cases of neuropathies presenting primarily as a
painful syndrome in Human Immunodeficiency Virus positive patients were
seen in Nairobi, Kenya there were five males and two females. Their age
ranged from 45 to 57 years. Four patients had their H.I.V. diseases
presenting for the first time as a painful neoropathy. They did not have
any clinical feature to suggest related acquired Immunodeficiy state. The
other three patients were known H.I.V. related acquired immunodeficiency
cases (AIDS). Two of these AIDS cases had neurophysiological evidence of
diffuse sensory neuropathy of axonal type. In the rest of the patients
nerve conduction studies were normal. All patients had been given various
analgesics with carbamazephine and amytryptilline without response. None
were given narcotic analgesics. All patients were first given placebo for
one week followed by Oral prednisolone at 0.6mg/kg daily. There was no
response to placebo but there was remarkable resolution of pain within one
week of oral prednisolone.
Therefore a short course of oral prednisolone is useful in the short term
management of painful H.I.V. neuropathy.
RESUME
Les neuropathies douloureuses liees a certaines maladies sont la cause
d'une morbidite importante, et repondent mal a de nombreuses therapies. Il
a ete decide d'etudier les caracteristiques cliniques,
electrophysiologiques et les reponses a un traitement de courte duree par
la prednisolone chez les patients seropositifs pour le VIH.
Entre 1988 et 1992, 7 cas de VIH (5 hommes et 2 femmes) presentant une
neuropathie douloureuse ont ete suivis a Nairobi, Kenya. Leu age variait
entre 45 et 57 ans; chez 4 de ces patients le premier signe de la maladie
etait une neuropathie douloureuse; il n'existait aucune caracteristique
povant suggerer le stade du sydrome d'immunodeficience acquise (SIDA). Les
3 autres patients etaient connus comme ayant un SIDA; 2 de ces patients
avaient une neuropathie sensitive diffuse de type axonal, caracteristique a
l'examen neurophysiologique. Les enregistrements des vitesses de conduction
etaient normaux chez les autres patients. Tous les patients ont ete traites
par des analgesiques associes a la carbamazepine et a l'amytryptilline,
mais sans resultat favorable. Aucun n'a pris d'analgesique narcotique. Tous
les patients ont d'abord ete traites par placebo pendant une semaine, puis
par un traitement oral de prednisolone a la dose de 0,6 mg/kg/jour. Il n'y
a pas eu de reponse favorable au placebo, mais une remarquable resolution
de la douleur avant la fin de la premiere semaine de traitement oral par la
prednisolone.
Par consequent, un court traitement oral par la prednisolone est utile a
court terme dans la prise en charge de la neuropathie douloreuse du VIH.
Key Words: Neuropathy - HIV - PAIN - PREDNISOLONE
Copyright 1995 Pan African Association of Neurological Sciences
