Spotlight on Hexacarbon neuropathy

Hexacarbons are present in many solvents and glues, and exposure is most commonly occupational. The neuropathy associated with hexacarbon exposure results in giant axonal swellings and distal slowing of conduction velocity. Hexacarbon neuropathy may continue to worsen for some time after cessation of exposure (coasting).

In this article, Dr. Michael Pulley of the University of Florida, Jacksonville reviews the clinical features of this interesting toxic neuropathy, which was fairly common in the past, related to recreational glue sniffing, but is primarily occupational currently. The axonal swellings seen in hexacarbon neuropathy are similar to those seen in carbon disulfide and acrylamide neuropathy.

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Spotlight on Charcot-Marie-Tooth disease type X

In this article, Dr. Steven Scherer of the University of Pennsylvania School of Medicine discusses X-linked Charcot-Marie-Tooth disease (CMT1X), the second most common form of inherited neuropathy. Patients develop a progressive distal weakness and atrophy that results from length-dependent axonal loss. More than 400 different mutations in GJB1, the gene that encodes the gap junction protein connexin32, cause CMT1X. Most mutations result in defective function of the gap junctions formed by Cx32. In addition to the demyelinating neuropathy, many patients have subclinical CNS findings, and a few GJB1 mutations are associated with striking, transient CNS manifestations.

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Spotlight on Neuropathic pain: treatment

Treatment of neuropathic pain is an ongoing challenge for clinicians. In this article, Dr. Yi Pan and Dr. Florian P Thomas, both of St. Louis University, summarize pharmacological management based on published clinical trials. Not all medications mentioned in this article have been investigated in placebo-controlled, double-blind, randomized trials. The aim of this article is to provide a variety of updated information so clinicians can choose an optimal treatment for an individual patient.

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Spotlight on Drug-induced neuropathies

Although uncommon, medication-induced neuropathies are critical to identify because of potential reversibility and limitation of toxicity. Numerous medications have well-established neuropathy links, but many others have only occasional temporal associations. Neuropathy-inducing medications are continually approved, including some that are not known to cause neuropathy prior to release, for example, the rheumatoid arthritis drug leflunomide and tumor necrosis alpha inhibitors. The importance of some, such as phenytoin, is likely overestimated. Peripheral neuropathy from chronic drug exposure is more problematic to establish, and the association with idiopathic neuropathy and statin drugs is a prime example.

In this article, Dr. Louis Weimer of Columbia University discusses the best evidence available for neuropathy and many commonly used medications.

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