[tnthomas]

Hello,

I have been recently diagnosed as having hepatitis c...a big shock to be sure. I have not received treatments yet, but am being monitored- so far my doc says that there's no real rush on getting tx. Anyway, I do have PN which was pretty low level for about 15 years, but has become much more pronounced this past year. I'm wondering if there's a connection with the hep c and the PN.

My gastro doctor says "no", but Google says.... maybe.

Anyone here have knowledge / experience on this?

[mrsD]

There are papers on PubMed about this...

Example:
http://www.ncbi.nlm.nih.gov/pubmed/16930357

Eur J Neurol. 2006 Sep;13(9):937-41.
Polyneuropathy with demyelinating features in mixed cryoglobulinemia with hepatitis C virus infection.
Boukhris S, Magy L, Senga-mokono U, Loustaud-ratti V, Vallat JM.
Source

Department of Neurology, Dupuytren University Hospital, Limoges, France. samiboukhris@netscape.net
Abstract

Peripheral neuropathy can arise from various mechanisms during hepatitis C virus (HCV) infection, mainly involving associated mixed cryoglobulinemia. The frequency of demyelinating polyneuropathy is probably underestimated in these patients. We report two cases of demyelinating polyneuropathy in HCV-infected patients. The first case concerned a 76-year-old woman followed for hepatitis C associated with a mixed cryoglobulinemia (type II), who developed a chronic progressive distal motor weakness and sensory disturbances concomitant with a raise in serum aspartate aminotransferase (GOT/AST) and alanine aminotransferase (GPT/ALT) levels. Other laboratory studies were normal except for a decrease in the hemolytic fraction of complement to 75 IU (n = 400-520). The second case was a 68-year-old woman followed for hepatitis C associated with a mixed cryoglobulinemia (type II), who had sensory disturbances in the lower limbs. Laboratory studies were otherwise unremarkable. Cerebrospinal fluid studies showed a normal protein content without pleocytosis in both patients. In both cases nerve conduction studies were suggestive of a mixed axonal and demyelinating sensorimotor neuropathy. Sural nerve biopsy showed segmental demyelination and severe loss of large myelinated fibers as well as some onion bulb formation in both cases. The two patients subsequently improved, the first with an antiviral treatment and the second with oral steroids.

PMID:
16930357
[PubMed - indexed for MEDLINE]

Most are from European countries I've noticed.
These are considered "anecdotal" by doctors.

When people are infected by viruses, sometimes those viruses cause increased antibodies in the body which then become problematic. These may attack the nervous system, instead of the virus itself. Some bacterial infections do this too... Camplyobacter, a food poisoning agent, can cause PN as well. It can come from undercooked chicken.

[tnthomas]

MrsD,

Thanks for your reply, I have seen reference to cryoglobulins but as you mentioned- mostly from sources outside of the U.S.

I recently visited my primary care DR regarding the little "mini cramps" that I have been experiencing in my legs at night; he put me on a 5 week regimen of Nortriptyline(10mg) which does gives me relief.

I hear that for many afflicted with PN the "electric" pain stabbing/prickling sensations are the main concern. For me it's mostly just a bizarre surface numbness, and some touch sensitivity; my feet/toes feel more normal when wearing some loose fitting cotton socks.

I had been hoping to put off treatment until the Hep C treatment by Pharmasset (without interferon) is approved and available, but with this PN worsening, and the possibility that it being linked to the Hep C, I may not be able to wait much longer.

[hopeful]

Originally Posted by mrsD

There are papers on PubMed about this...

Example:
http://www.ncbi.nlm.nih.gov/pubmed/16930357


Most are from European countries I've noticed.
These are considered "anecdotal" by doctors.

When people are infected by viruses, sometimes those viruses cause increased antibodies in the body which then become problematic. These may attack the nervous system, instead of the virus itself. Some bacterial infections do this too... Camplyobacter, a food poisoning agent, can cause PN as well. It can come from undercooked chicken.

Hi Mrs. D, The more I read what you write, it completely amazes me what can cause PN
Hopeful

[tnthomas]

Well, my Methyj B-12 order showed up today, directions say to use[a lozenge] with a meal every 3 or 4 days. I wonder if there will be some noticeable benefit, before the 60 count bottle goes empty...

[glenntaj]

--the methyl B12 lozenges with a meal, but rather very far apart from meals.

The cobalamin molecule (B12) is the largest molecule the body regularly processes and uses; as such, it is very easy to interfere with its absorption. Most of us take our B12 apart from anything else, at least one hour before eating, or two hours after, to maximize the absorption, which is especially important for those who are older of who may have decreased stomach acid or lack of instrinsic factor.

[mrsD]

I have yet to see any manufacturer or doctor for that matter, understand B12 and its absorption and metabolism.

Ignore the label.

What strength did you purchase? The amount of B12 absorbed orally goes up as the dose increases.

Here is a link to a table one researcher made for oral administration:

http://neurotalk.psychcentral.com/post810435-232.html

pay particular attention to the link there which I will copy here:
http://www.ncbi.nlm.nih.gov/pmc/arti...able/T1/#TF1-4

Notice for 1000mcg oral expect perhaps 13 micrograms to be absorbed. At least in that paper it was true. No mention of empty stomach here, but with an empty stomach maybe more will be absorbed successfully, a bit more.

[tnthomas]

This is the Jarrow 5000 MCG B-12 supplement that iherb.com sells; supposedly is 83,330% of the DV(daily value?).

Who establishes the "daily value", certainly not the FDA....?

[mrsD]

The daily value RDA is based on studies done long ago.

The average absorbed from food is quite small daily... that is why intrinsic factor is needed to carry the cobalamin broken out from the protein eaten to the blood stream. Without instrinsic factor's action, only high doses of B12 can passively cross the GI membranes into the body. This is why empty stomach and intestine is best. Since everyone is different, absorption will vary from person to person.

Recommendations today are around 2.5micrograms a day, from animal based foods. eggs, dairy, meat and seafood.

[tnthomas]

Thanks mrsD, I had heard of intrinsic factor over the years, but never thought that it would touch my life.

Dosing 3-4 days OK, or more often desirable?