by The Welthi Bureau | 23 MAY 2018

nerve care forum 2018 with over 26 of indians affected peripheral neuropathy is a rising concern
 Image used for representational purpose only

More than 100 City Experts discuss Peripheral Neuropathy at the 2nd edition of Merck Nerve Care Forum held in Hyderabad

Forum aims to provide latest research and guidance to healthcare professionals on various aspects of Peripheral Neuropathy


Hyderabad, May 23rd , 2018: More than 100 city experts including leading neurologists, endocrinologists and diabetologists got together at a ‘Merck Nerve Care Forum’  to discuss about the management of Peripheral Neuropathy (PN), acondition in which the nerves in the body are affected or damaged.


      Diabetics at the highest risk of developing PN

      In Southern India, 32.2% of the population get affected with DPN1


      Screening of high-risk individuals, early detection, proper management of 

            DPN in patients with T2DM is urgently needed


     Alternative treatment options such as neurotropic B vitamins and alpha-lipoic

          acid, crucial in the treatment of PN and nerve health restoration



In India, Peripheral Neuropathy is on the rise; various community studies reveal that the overall prevalence of PN varied from 5 to 2400 per 10,000 population. The older population is affected more (30-40%) as compared to younger population (2-8%) due to higher prevalence of other diseases, medication intake, and other cumulating factors which are associated with the ageing process.


Says Dr. Sudhir Kumar, Neurophysician, Apollo Hospital, Hyderabad, “A significant number of PN cases in India go under-diagnosed by physicians due tothe negligence of mild and nagging symptoms or the lack of awareness around the condition and its associated risks amongst patients. Additionally, we have seen that a large number of patients suffer from PN without any identifiable cause (idiopathic neuropathy) which further complicates effective management for the treating physician. Poor understanding of the disease, its causes, timely diagnosis, its impact and fatal complications is another hurdle in India which creates a burden for physicians. Though we have seen therapeutic advancements in this field, owing to the lack of guidelines/consensus among physicians the treatment gets compromised.”


In order to better understand the causes and management of PN in India and to develop a multi-disciplinary expert consensus document providing guidance to HCPs (especially for General Practitioners (GPs) & Consulting Physicians (CPs) which are first point of contact for most of the patients in India)for the diagnosis and treatment of PN in India, Merck’s, Consumer Health division, India initiated ‘Nerve Care Forums (NCF)’. The Nerve Care Forum organized in Hyderabadbrought together international and local experts to discuss the underlying causes, current clinical practice(s) for diagnosis, treatment guidelines and alternative treatment options for PN in India. Prof. Dr. Wilfred Nix - Director of the Academy of Continuing Medical Education from Mainz, Germany, a globally recognized expert in the PN,highlightedthe importance of early diagnosis and treatment of PN and the leading role of primary care physicians.


Peripheral neuropathy poses a high disease burden in India as compared to developed countries, owing to higher prevalence of diabetes cases, nutritional deficiencies, infectious diseases, alcohol misuse and exposure to toxins.


Says Dr. R N Mehrotra, Senior Consultant Endocrinology, Apollo Hospitals, Hyderabad, “Peripheral neuropathy affects 50% to 70% of all diabetic patients in India. This condition is termed Diabetic Peripheral Neuropathy (DPN) where the high blood sugar levels can damage the nerves leading to reduced quality of life & increasing the risk of amputation. Therefore, it is imperative that Diabetic patients have increased awareness of DPN.”


With increasing numbers of diabetic patients, which is expected to increase to 134 million in Y’2045 from 73 million in Y’2017, experts expect the incidence of PN to increase in the following years in India.4To help shed some light on this subject, the expert committee gathered at the Nerve Care Forum,delved on how primary care physicians should carefully evaluate underlying causes by documenting complete patient history and utilizing available diagnostic facilities to confirm diagnosis of PN. Discussions were held on how management should focus on treating the underlying cause and symptomatic relief, followed by restoration of nerve health.


“Metformin which is a gold standard first line therapy for Diabetes, has been shown in studies to cause Vitamin B12 deficiency or ‘Metformin Induced Cobalamin Deficiency (MICD). This drug-induced deficiency makes it necessary to ensure that treating physicians take appropriate measures to prevent and/ or treat MICD so that it does not lead to Neuropathy, including adequate supplementation of B vitamins in patients who are long-term users of Metformin,” added Dr.Mehrotra.


“Neurotropic B vitamins are helpful in the treatment of PN, considering their role in nerve regeneration. I have seen improvements in my patients when they are given Vitamin B supplements,” added Dr. Sudhir Kumar.


Speaking at the Hyderabad forum, Prof. Dr. Wilfred Nix highlighted the importance of timely diagnosis to be able to treat patients with utmost care. “It was great to meet and interact with leading experts of Hyderabad on Peripheral Neuropathy.With rising cases of Peripheral Neuropathy worldwide, this disease is still underdiagnosed, relatively unknown and not sufficiently treated. Causes, signs and symptoms of PN can be various. It is important that a proper diagnostic approach, starting with a careful investigation of the patient by primary care physicians is done. This should then be supplemented by an individualized decision on further diagnostic procedures and treatment for each patient. Medical education forums like the Nerve Care Forum play an important role in bringing together the Indian community of experts to discuss and deliberate over individualized forms of treatment and diagnosis of Peripheral Neuropathy.”


About Peripheral Neuropathy:


The peripheral Nervous system allows the brain and spinal cord to receive and send information to other areas of the body, the arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin. It allows us to react to stimuli in our environment and any damage can lead to symptoms like tingling, prickling sensation, numbness and pain in various parts of the body and can lead to impairment and damage of nerves (which is called as Neuropathy).


Peripheral neuropathy can result from common conditions like Diabetes Mellitus, alcoholism, aging, Vitamin B12 Deficiency, untreated hypothyroidism and rarely injuries, infections, inherited causes and exposure to toxins.


In patients with uncontrolled blood sugar, there is a subsequent damage to end organs like Nerves, Heart, Kidneys and eyes and in majority of patients it is the nerve that gets affected or damaged first. Diabetic Peripheral Neuropathy (DPN) if not treated causes a lot of discomfort in patients and can lead to serious complications such as un-healing wounds, gangrene and amputation.


About Merck Nerve Care Forum:


Neuropathy is a complex condition, which often presents with a wide range of symptoms. Though early detection is key to effective management, it is often diagnosed too late when already irreparable neurological harm and serious pain has occurred. With the “Nerve Care” concept, the core of this scientific forum, Merck wants to emphasize the importance of adequate monitoring, diagnosis and care of peripheral nervous system health before it is too late and before it causes serious disability significantly impacting patients' quality of life.


To address this, Merck has developed a high quality and diverse scientific program to promote a better understanding of the early, varied and unrecognized symptoms of neuropathy, and to highlight those patients at particular risk, for example, patients with diabetes and vitamin B deficiency. Since neuropathy is a distressing condition, improving communication in its diagnosis and treatment is essential. These scientific forums, conducted nationally across India, provide important insights into the on-going needs of patients with neuropathy, especially Diabetic Peripheral Neuropathy (DPN). Not only does it provide a platform to highlight the multifaceted challenges facing physicians in the management of this difficult condition in India but also potential solutions to both treat and even prevent peripheral neuropathy progression.

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