NeuroTalk Support Groups - Metronidazole induced SFN

NeuroTalk Support Groups (https://www.neurotalk.org/)

- Peripheral Neuropathy (https://www.neurotalk.org/peripheral-neuropathy/)

- - Metronidazole induced SFN (https://www.neurotalk.org/peripheral-neuropathy/217617-metronidazole-induced-sfn.html)

There is some evidence--

--that increased intraepidermal nerve fiber density as measured through staining may represent an early phase of small-fiber damage, as the body attempts to fight the process through increased branchings. Of course, it may be hard to distinguish this in a skin-biopsy "snapshot" from nerve regeneration.

A good electron microscope analysis can often distinguish these increased branchings from regeneration by looking for evidence of fiber deterioration, notably in the form of fiber swellings. But one needs to have such things looked for, and by an experienced micro-pathologist.

Take a look at this, which sort of summarizes this obervational difficulty:

http://www.medscape.org/viewarticle/563262_5

Fortunately, skin biopsy, while it generally cannot reveal a cause for neuropathy, is reproducable over time, so density and condition of nerve fibers in the same body areas can be repeatedly sampled and often that is a better indicator if neuropathy is progressing, healing, or merely stable.

Thank you Glenn for that clarification, i couldn't click on the link though. Do you think it could be possible that the Metronidazole caused this? I took two lots just before onset of symptoms?

Metronidazole and its newer cousin have been shown to cause neuropathy:

Quote:

J Child Neurol. 2006 May;21(5):429-31.
Metronidazole: newly recognized cause of autonomic neuropathy.
Hobson-Webb LD1, Roach ES, Donofrio PD.
Author information
Abstract

Metronidazole is a commonly used antibiotic prescribed for the treatment of anaerobic and protozoal infections of the gastrointestinal and genitourinary tracts. It is associated with numerous neurologic complications, including peripheral neuropathy. Neuropathy is typically detected in patients on chronic therapy, although it has been documented in those taking large doses for acute infections. Numerous case reports have been published describing motor and sensory neuropathy, yet autonomic neuropathy has not been described with metronidazole use. A previously healthy 15-year-old girl presented with complaints of burning pain in her feet following a short course of metronidazole for vaginitis. She could obtain pain relief only by submerging her feet in ice water. Examination revealed cold and swollen lower extremities that became erythematous and very warm when removed from the ice water. Temperature perception was reduced to the upper third of the shin bilaterally. Deep tendon reflexes and strength were preserved. Nerve conduction studies demonstrated a peripheral neuropathy manifested by reduced sensory nerve and compound muscle action potentials. Reproducible sympathetic skin potential responses could not be obtained in the hand and foot, providing evidence of a concurrent autonomic neuropathy. A thorough evaluation revealed no other cause for her condition. Repeated nerve conduction studies and sympathetic skin potentials returned to normal over the course of 6 months, paralleling the patient's clinical improvement. Metronidazole is a potential cause of reversible autonomic neuropathy.

PMID:
16901452
[PubMed - indexed for MEDLINE]

from http://www.ncbi.nlm.nih.gov/pubmed/16901452

While it is considered by some to be reversible, it also causes lesions in the brain, and we have had some posters here where the peripheral neuropathy did not reverse. So it may be a trigger for those who are CMT candidates.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963744/

Metronidazole shares some metabolic pathways with alcohol...so that it suggests use of Thiamine or benfotiamine may help with repair from it use.
The build up of aldehydes in the body may be causing the burning pain for some people.

Quote:

Originally Posted by LouLou1978 (Post 1130390)

I don't know if glenn is a neurologist but from reading the site he seems to know his stuff.

I hope the results mean that maybe something irritated my nerves and my nerves are trying to sort themselves out.

Well, that's what i'm trying to tell myself and I am hoping and praying that they will one day.

thank you again everyone, you have all been very kind and helpful.

Loulouxx

Hi Lou Lou, I believe that we saw the same Professor for our skin biopsy. He said in advance of my test that there is the possibility that the nerves will be inflamed or affected by inflammation and will therefore show signs of 'splitting', he also used the words regeneration. I think he meant that if they are splitting they will appear to be regenerating as there will be more fibres due to the splitting of the original ones. So you aren't mad, this is exactly what he explained to me. It seems really feasible that there would be splitting and therfore more fibres as a result of that. Just hope that helps you with any treatment for the underlying cause.

Thank you Mrs D and Joanna, when I have looked up metronidazole it seems to be a length dependent thing for sfn,i haven't read anything about it being non-length dependent. also I only used it twice before symptom onset.

Metronidazole given after surgery

Thanks again Mrs D
Although I had some symptoms of PN prior to an emergency appendectomy in Oct 2014, I was wondering why it had suddenly increased and spread over my entire body since. Have just checked the medical notes from the surgery and found I was given Metronidazole while in hospital, (first time taking it). Yet another possible cause to mention to the neuro when I finally get an appt. With the amount of info I've learned from this site I'll need to be careful not to annoy the doctor - especially if he gives a diagnosis of idiopathic PN - which from what I've read here seems to be the answer they give when they either don't know or can't be bothered looking further.