Rinsho Shinkeigaku (Clinical Neurology)

Original Article

Falls in peripheral neuropathy

Nobuyuki Oka, M.D., Ph.D.1), Hiroshi Sugiyama, M.D., Ph.D.2), Teruaki Kawasaki, M.D., Ph.D.3), Kotaro Mizutani, M.D., Ph.D.4) and Masaru Matsui, M.D., Ph.D.5)

1)Department of Rehabilitation Medicine and 2)Department of Neurology Minami-kyoto National Hospital
3)Department of Neurology, Takeda Hospital
4)Department of Neurology, Sakakibara Hakuho Hospital
5)Department of Neurology, Kyoto University Graduate School of Medicine

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.

(CLINICA NEUROL, 45: 207－210, 2005)
key words: falls, risk management, neuropathy, deep sensation

(Received: 11-Jun-04)