Clinical Spectrum and Prognosis in Patients With Acute Nutritional Axonal Neuropathy.

Area of Science:

• Neurology
• Nutritional Science

Background:

• Acute Nutritional Axonal Neuropathy (ANAN) encompasses a range of neurological deficits.
• Risk factors include alcohol use disorder, bariatric surgery, and anorexia nervosa.

Purpose of the Study:

• To delineate the clinical, electrophysiologic, and micronutrient profiles of ANAN patients.
• To assess the prognosis and recovery patterns in individuals with ANAN.

Main Methods:

• Retrospective review of 40 ANAN patients (1999-2020) using EMG and electronic health records.
• Categorization by neuropathy type (sensory, sensorimotor, motor) and risk factor.
• Analysis of micronutrient levels (thiamine, B6, B12, E, folate, copper) and follow-up data on ambulation and pain.

Main Results:

• Thiamine deficiency was prevalent (85%), followed by B6 (77%) and folate (50%).
• No clear association between specific risk factors or neuropathy types and particular micronutrient deficiencies.
• Prognosis was guarded: only 35% walked independently and 22% were pain-free at a mean follow-up of 22 months.

Conclusions:

• ANAN exhibits a broad clinical spectrum, from pure sensory to pure motor axonal neuropathies.
• Micronutrient deficiencies and risk factors do not reliably predict neuropathy subtype.
• The guarded prognosis necessitates early recognition and intervention for patients at risk of ANAN.