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Evaluation of prednisone treatment in the acute phase of neuralgic amyotrophy: An observational study
  1. Jeroen J J van Eijk (j.vaneijk{at}neuro.umcn.nl)
  1. Radboud University Nijmegen Medical Centre, Netherlands
    1. Nens van Alfen (n.vanalfen{at}neuro.umcn.nl)
    1. Radboud University Nijmegen Medical Centre, Netherlands
      1. Marvin Berrevoets (mberrevoets2{at}hotmail.com)
      1. Radboud University Nijmegen Medical Centre, Netherlands
        1. Gert jan van der Wilt (g.vanderwilt{at}ebh.umcn.nl)
        1. Radboud University Nijmegen Medical Centre, Netherlands
          1. Sigrid Pillen (s.pillen{at}cukz.umcn.nl)
          1. Radboud University Nijmegen Medical Centre, Netherlands
            1. Baziel G M van Engelen (b.vanengelen{at}neuro.umcn.nl)
            1. Radboud University Nijmegen Medical Centre, Netherlands

              Abstract

              Introduction: Effective treatment for neuralgic amyotrophy (NA), a disabling brachial plexus syndrome of supposed immuno-mediated origin, is currently lacking. Given the circumstantial evidence of a beneficial effect of prednisolone on pain and paresis, this report evaluates the effects of prednisolone treatment administered in the acute phase in a retrospective case series of 50 NA patients.

              Methods: Baseline variables (e.g. age, sex, type of NA, and number of attacks), treatment variables (e.g. time until treatment, regimen, and use of analgesics), and outcome measures (e.g. duration and severity of pain, time course and severity of paresis, and functional outcome) were statistically analyzed and compared to an historical control group of 203 untreated NA patients.

              Results: The baseline characteristics of the two patient groups were comparable. Median time until initial pain relief was lower in the study group (12.5 days vs. 20.5 days) and a significantly higher percentage already recovered strength in the first month of treatment (18% vs. 6.3 %; p= 0.011). Twelve percent had fully recovered within one year while this was 1% for the controls (p<0.001), with the proportion reporting a ‘good’ 12-month outcome also being higher (44% vs. 10.7 %; p<0.001). Side effects were reported by 20%, but none led to a discontinuation of treatment.

              Conclusion: Oral prednisolone seems effective in the acute phase of neuralgic amyotrophy with the current results supporting previous case reports. A regimen of oral prednisolone is therefore recommended in the acute phase of the syndrome pending a prospective, randomized trial verifying the results obtained.

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