Falls in peripheral neuropathy

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Rinsho Shinkeigaku. 2005 Mar;45(3):207-10.

Falls in peripheral neuropathy

Oka N, Sugiyama H, Kawasaki T, Mizutani K, Matsui M.

Department of Rehabilitation Medicine, Minami-kyoto National Hospital.

Falling accidents are predisposing factors in worsening the quality

of life. Causes of falls included gait and balance problems, visual

disorder, cognitive impairment and drugs. However, falls in

neuropathic patients are not often investigated.

We studied the actual condition and causes of falls associated with

neuropathy. One hundred and ninety-three patients (122 males and 71

females, ages 57 +/- 15 years) with neuropathy were selected for

evaluation.

In all patients, more than half a year had passed since the onset of

symptoms and the present condition was considered comparatively

stable. We divided the patients into 2 groups: falling or non-

falling. Patients experiencing accident accompanied by external

injury once or more in the past year, or patients who answered " often

fell " (1 time or more per month) on flat ground or in their residence

comprised the fall group.

The severity of disease was evaluated by modified Rankin Scale (0 to

5). The relationship between falls and neuropathic symptoms (proximal

muscle weakness, distal muscle weakness, aching or numbness, and the

position and vibration sensory loss) was statistically examined. The

distribution of patients in the fall group according to modified

Rankin Scale of neuropathy was scale 5: 0/0 (0%), scale 4: 5/36

(14%), scale 3: 24/72 (33%), scale 2: 7/56 (13%), and scale 1: 1/19

(5%). There were six fractures among all patients.

Regarding the etiology, the fall group showed a high level of axonal

neuropathies (44%). On analysis according to condition and symptoms

in the patients with a score of 2, 3, or 4 who demonstrated a high

rate of falls, there was a strong correlation between deep sensory

loss and fall (p < 0.05).

However, as independent factors, there were no correlations between

falling and proximal muscle weakness, distal muscle weakness or

aching numbness, respectively. We thought it necessary to add ataxic

gait resulting from deep sensory loss to one of the fall risks.