crohn's and the brain
I am researching links between chron's and mental function/symptoms and found the below excerpt from Neuropathy and the Gastrointestinal System by Russell L. Chin, MD at this link. http://www.neuropathy.org/site/DocServer/nutritionGI-RussellCMD.pdf?docID=1601
sorry the table does not show as formatted.
V. Inflammatory bowel disease (IBD)
IBD refers to a group of chronic, recurrent intestinal disorders, which are represented mainly by Crohn’s disease and ulcerative colitis (UC). The extraintestinal manifestations of Crohn’s disease and UC are diverse. The overall incidence of neurologic complications has been reported to range from 0.2-19.3% (Elsehety and Bertorini, 1997; Gendelman et al, 1982; Lossos et al, 1995) with the incidence of PN varying from 0.9-3.6% in the two largest retrospective series (Lossos et al, 1995; Elsehety and Bertorini, 1997).
The clinical and electrodiagnostic features of 33 patients with IBD (18 with Crohn’s and 15 with UC) were described in the largest case series to date of PN in IBD (Gondim et al, 2005). (See Table 2.0.) The patients were categorized into three PN phenotypes with some significant differences noted between the groups. The variety of PN phenotypes probably reflected ascertainment at different stages of IBD evolution and the complex interaction between a variety of IBD effects on the nervous system (i.e. extra-intestinal inflammation, immune-mediated disorder, nutritional imbalances or drug-induced changes).
Patients with small and large fiber sensory axonal PN had a shorter interval duration between IBD and neuropathy compared with those with large fiber sensorimotor PN. Onset of demyelinating PN in relation to IBD was variable. Only 6/33 patients had metronidazole exposure. No clear relationship between the exposure and neuropathy onset was detected and neuropathy symptoms progressed despite discontinuation of the medication.
7
Fifty-six percent of Crohn’s disease patients and 67% of the UC patients received immunomodulatory therapy at some point during the disease course. All the patients in either group who had demyelinating PN had moderate or major improvement in response to immune therapies. Even patients with axonal neuropathies in whom the response could be adequately evaluated (5 Crohn’s; 5 UC) typically had a beneficial response (graded mild to moderate).
Table 2.0
Crohn’s disease (N=18)
Ulcerative colitis (N=15)
Neuropathy phenotype
1. Demyelinating
5 (2 with MMN)
4
2. Large fiber neuropathy
11(4=sensory;7=SM)
7 (1=sensory;6=SM)
3. Small fiber
2
4
Neuropathy sx onset (in yrs after onset of primary condition)
11.8 + 4 yrs
26.3 + 5.6 yrs
Metronidazole exposure
5 patients
1 patient
Improvement in response to immunotherapy
(Assessable in 9 CD and 9 UC patients)
Major:38%
Moderate: 38%
Mild: 13%
None:13%
Major: 11%
Moderate: 56%
Mild: 33%
None: 0%
From Gondim et al, 2005
The controversial metronidazole-related PN
Metronidazole has been associated with PN but the frequency appears to be extremely rare considering the vast numbers of patients regularly treated with this medication.
Gondim et al performed an extensive literature review and divided patients into three groups: 1) patients with Crohn’s treated with metronidazole (N=74 patients; 14 papers),
2) patients with IBD not treated with metronidazole (N=166; 77 with Crohn’s, 89 with UC; 32 papers), and 3) patients without IBD treated with metronidazole (N=13 patients; 11 papers). No clear dose effect was observed in Group #1. Group #s 1 & 2 were difficult to distinguish from each other. The minimum dose reported to result in PN in group #3 was 12 grams (Gondim et al, 2005). [A recent case report described an acute painful sensory PN following an even lower minimum dose of 3.6 grams received over three days (Sarma and Kamath, 2005).] The predominantly sensory PN partially or completely resolved following drug discontinuation when not associated with other medical complications. However, if associated with other medical complications, resolution after drug discontinuation was variable or did not occur at all.
One study of Crohn’s patients found no clinical or electrodiagnostic features that differentiated between patients under active treatment, patients who were previously treated, or patients who were never treated with metronidazole. Parethesias and increased threshold for temperature (documented by quantitative sensory testing) were equally frequent (Stahlberg et al, 1991).
I am researching links between chron's and mental function/symptoms and found the below excerpt from Neuropathy and the Gastrointestinal System by Russell L. Chin, MD at this link. http://www.neuropathy.org/site/DocServer/nutritionGI-RussellCMD.pdf?docID=1601
sorry the table does not show as formatted.
V. Inflammatory bowel disease (IBD)
IBD refers to a group of chronic, recurrent intestinal disorders, which are represented mainly by Crohn’s disease and ulcerative colitis (UC). The extraintestinal manifestations of Crohn’s disease and UC are diverse. The overall incidence of neurologic complications has been reported to range from 0.2-19.3% (Elsehety and Bertorini, 1997; Gendelman et al, 1982; Lossos et al, 1995) with the incidence of PN varying from 0.9-3.6% in the two largest retrospective series (Lossos et al, 1995; Elsehety and Bertorini, 1997).
The clinical and electrodiagnostic features of 33 patients with IBD (18 with Crohn’s and 15 with UC) were described in the largest case series to date of PN in IBD (Gondim et al, 2005). (See Table 2.0.) The patients were categorized into three PN phenotypes with some significant differences noted between the groups. The variety of PN phenotypes probably reflected ascertainment at different stages of IBD evolution and the complex interaction between a variety of IBD effects on the nervous system (i.e. extra-intestinal inflammation, immune-mediated disorder, nutritional imbalances or drug-induced changes).
Patients with small and large fiber sensory axonal PN had a shorter interval duration between IBD and neuropathy compared with those with large fiber sensorimotor PN. Onset of demyelinating PN in relation to IBD was variable. Only 6/33 patients had metronidazole exposure. No clear relationship between the exposure and neuropathy onset was detected and neuropathy symptoms progressed despite discontinuation of the medication.
7
Fifty-six percent of Crohn’s disease patients and 67% of the UC patients received immunomodulatory therapy at some point during the disease course. All the patients in either group who had demyelinating PN had moderate or major improvement in response to immune therapies. Even patients with axonal neuropathies in whom the response could be adequately evaluated (5 Crohn’s; 5 UC) typically had a beneficial response (graded mild to moderate).
Table 2.0
Crohn’s disease (N=18)
Ulcerative colitis (N=15)
Neuropathy phenotype
1. Demyelinating
5 (2 with MMN)
4
2. Large fiber neuropathy
11(4=sensory;7=SM)
7 (1=sensory;6=SM)
3. Small fiber
2
4
Neuropathy sx onset (in yrs after onset of primary condition)
11.8 + 4 yrs
26.3 + 5.6 yrs
Metronidazole exposure
5 patients
1 patient
Improvement in response to immunotherapy
(Assessable in 9 CD and 9 UC patients)
Major:38%
Moderate: 38%
Mild: 13%
None:13%
Major: 11%
Moderate: 56%
Mild: 33%
None: 0%
From Gondim et al, 2005
The controversial metronidazole-related PN
Metronidazole has been associated with PN but the frequency appears to be extremely rare considering the vast numbers of patients regularly treated with this medication.
Gondim et al performed an extensive literature review and divided patients into three groups: 1) patients with Crohn’s treated with metronidazole (N=74 patients; 14 papers),
2) patients with IBD not treated with metronidazole (N=166; 77 with Crohn’s, 89 with UC; 32 papers), and 3) patients without IBD treated with metronidazole (N=13 patients; 11 papers). No clear dose effect was observed in Group #1. Group #s 1 & 2 were difficult to distinguish from each other. The minimum dose reported to result in PN in group #3 was 12 grams (Gondim et al, 2005). [A recent case report described an acute painful sensory PN following an even lower minimum dose of 3.6 grams received over three days (Sarma and Kamath, 2005).] The predominantly sensory PN partially or completely resolved following drug discontinuation when not associated with other medical complications. However, if associated with other medical complications, resolution after drug discontinuation was variable or did not occur at all.
One study of Crohn’s patients found no clinical or electrodiagnostic features that differentiated between patients under active treatment, patients who were previously treated, or patients who were never treated with metronidazole. Parethesias and increased threshold for temperature (documented by quantitative sensory testing) were equally frequent (Stahlberg et al, 1991).