DÄ internationalArchive17/2018Supplemental Information Necessary
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The article provides a good overview of causes, pathophysiology, symptoms, and treatment of polyneuropathy (1). Nonetheless, I would like to make some additional comments. The review overlooks post-actinic, severe plexus polyneuropathies as well as delayed damage from radiation (X-rays, cobalt, etc.) to the small vessels of the spinal cord and the nerves (neurons, medullary sheaths, myelin-sheath gaps, etc.), which are associated with massive pain, sensory and motor failures in the thoracic and pelvic areas, as well as tendency to edema (neuropathic, lymphogenic). With this in mind, mammary carcinomas, lymphomas, and solid tumors should be considered. As the frequently requested procedure of nerve biopsy is not risk-free, and as one would also expect specialists to show restraint in this, exclusion diagnostics should primarily be used.

With respect to therapy, the authors cite a meta-analysis (see reference [36] in the article) yet do not present a critical analysis of the often overwhelming massive side effects—which often lead to discontinuation of the preparations. The sometimes helpful high-frequency therapy or the implantation of an SCS (spinal cord stimulator) should be considered in patients whose peripheral spinal nerves are still intact.

DOI: 10.3238/arztebl.2018.0295c

Dr. med. Torsten Maurer

Dresden

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Sommer C, Geber C, Young P, Forst R, Birklein F, Schoser B: Polyneuropathies—etiology, diagnosis, and treatment options. Dtsch Arztebl Int 2018; 115: 83–90 VOLLTEXT
1.Sommer C, Geber C, Young P, Forst R, Birklein F, Schoser B: Polyneuropathies—etiology, diagnosis, and treatment options. Dtsch Arztebl Int 2018; 115: 83–90 VOLLTEXT

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