Prognostic indicators of subacute combined degeneration from B12 deficiency: A systematic review
Objective A systematic review was conducted on published data of subacute combined degeneration (SCD) from B12 deficiency to investigate potential prognostic indicators of final ambulatory function in affected patients. Type Systematic review. Literature Survey Records published from 1999 through 20...
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| Veröffentlicht in: | PM & R 2022-04, Vol.14 (4), p.504-514 |
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| creator | Jhunjhnuwala, Dhruv Tanglay, Onur Briggs, Nancy E. Yuen, Margaret T. Y. Huynh, William |
| description | Objective
A systematic review was conducted on published data of subacute combined degeneration (SCD) from B12 deficiency to investigate potential prognostic indicators of final ambulatory function in affected patients.
Type
Systematic review.
Literature Survey
Records published from 1999 through 2018 were searched on the electronic databases MEDLINE, PUBMED, and SCOPUS. The publication language was restricted to English and French.
Methodology
Records that described cases of SCD from B12 deficiency in patients ≥16 years of age at onset were included. From a final total of 66 cases of SCD identified, ambulation scores were assigned based on the clinical descriptions reported. Patient characteristics, clinical manifestations, and ambulatory function were reported descriptively. Subanalyses on potential prognostic indicators were performed.
Synthesis
Greater ambulatory function at diagnosis was associated with recovery of normal ambulatory function at follow‐up (P |
| doi_str_mv | 10.1002/pmrj.12600 |
| format | Article |
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A systematic review was conducted on published data of subacute combined degeneration (SCD) from B12 deficiency to investigate potential prognostic indicators of final ambulatory function in affected patients.
Type
Systematic review.
Literature Survey
Records published from 1999 through 2018 were searched on the electronic databases MEDLINE, PUBMED, and SCOPUS. The publication language was restricted to English and French.
Methodology
Records that described cases of SCD from B12 deficiency in patients ≥16 years of age at onset were included. From a final total of 66 cases of SCD identified, ambulation scores were assigned based on the clinical descriptions reported. Patient characteristics, clinical manifestations, and ambulatory function were reported descriptively. Subanalyses on potential prognostic indicators were performed.
Synthesis
Greater ambulatory function at diagnosis was associated with recovery of normal ambulatory function at follow‐up (P < .001). Nearly 90% of patients walking unsupported at diagnosis made a complete recovery regardless of etiology. For patients initially walking with support, 22% of cases from impaired B12 digestion/absorption made a complete recovery compared with ≥50% of cases from other etiologies. For patients initially requiring a wheelchair, 33% of cases from impaired digestion/absorption were able to walk with support compared with ≥50% of cases from other etiologies. The total B12 administered over the course of treatment was correlated with improved ambulation (P = .024) for all patients, with a higher B12 replacement regimen associated with better outcomes in patients who were unable to walk unsupported at diagnosis (number needed to treat = 4).
Conclusions
Initial ambulatory function may be a useful clinical marker of the severity of spinal cord dysfunction and final functional outcome. Etiological risk factors influenced both clinical manifestations and final walking ability in SCD, suggesting a distinct pathophysiological mechanism among the causes. In addition, a more intensive B12 replacement regimen may improve ultimate ambulatory function in advanced cases of SCD.</description><identifier>ISSN: 1934-1482</identifier><identifier>EISSN: 1934-1563</identifier><identifier>DOI: 10.1002/pmrj.12600</identifier><identifier>PMID: 33780172</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Humans ; Magnetic Resonance Imaging ; Prognosis ; Subacute Combined Degeneration - diagnosis ; Vitamin B 12 - therapeutic use ; Vitamin B 12 Deficiency - complications ; Vitamin B 12 Deficiency - diagnosis ; Vitamin B 12 Deficiency - drug therapy</subject><ispartof>PM & R, 2022-04, Vol.14 (4), p.504-514</ispartof><rights>2021 American Academy of Physical Medicine and Rehabilitation.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3290-59ebdc7558a849c53d446e2763991af2ef69012ea98ba0a6c31b5d5f8aab2f6e3</citedby><cites>FETCH-LOGICAL-c3290-59ebdc7558a849c53d446e2763991af2ef69012ea98ba0a6c31b5d5f8aab2f6e3</cites><orcidid>0000-0002-2071-6909 ; 0000-0002-6504-8107 ; 0000-0001-6490-7232</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpmrj.12600$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpmrj.12600$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33780172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jhunjhnuwala, Dhruv</creatorcontrib><creatorcontrib>Tanglay, Onur</creatorcontrib><creatorcontrib>Briggs, Nancy E.</creatorcontrib><creatorcontrib>Yuen, Margaret T. Y.</creatorcontrib><creatorcontrib>Huynh, William</creatorcontrib><title>Prognostic indicators of subacute combined degeneration from B12 deficiency: A systematic review</title><title>PM & R</title><addtitle>PM R</addtitle><description>Objective
A systematic review was conducted on published data of subacute combined degeneration (SCD) from B12 deficiency to investigate potential prognostic indicators of final ambulatory function in affected patients.
Type
Systematic review.
Literature Survey
Records published from 1999 through 2018 were searched on the electronic databases MEDLINE, PUBMED, and SCOPUS. The publication language was restricted to English and French.
Methodology
Records that described cases of SCD from B12 deficiency in patients ≥16 years of age at onset were included. From a final total of 66 cases of SCD identified, ambulation scores were assigned based on the clinical descriptions reported. Patient characteristics, clinical manifestations, and ambulatory function were reported descriptively. Subanalyses on potential prognostic indicators were performed.
Synthesis
Greater ambulatory function at diagnosis was associated with recovery of normal ambulatory function at follow‐up (P < .001). Nearly 90% of patients walking unsupported at diagnosis made a complete recovery regardless of etiology. For patients initially walking with support, 22% of cases from impaired B12 digestion/absorption made a complete recovery compared with ≥50% of cases from other etiologies. For patients initially requiring a wheelchair, 33% of cases from impaired digestion/absorption were able to walk with support compared with ≥50% of cases from other etiologies. The total B12 administered over the course of treatment was correlated with improved ambulation (P = .024) for all patients, with a higher B12 replacement regimen associated with better outcomes in patients who were unable to walk unsupported at diagnosis (number needed to treat = 4).
Conclusions
Initial ambulatory function may be a useful clinical marker of the severity of spinal cord dysfunction and final functional outcome. Etiological risk factors influenced both clinical manifestations and final walking ability in SCD, suggesting a distinct pathophysiological mechanism among the causes. In addition, a more intensive B12 replacement regimen may improve ultimate ambulatory function in advanced cases of SCD.</description><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Prognosis</subject><subject>Subacute Combined Degeneration - diagnosis</subject><subject>Vitamin B 12 - therapeutic use</subject><subject>Vitamin B 12 Deficiency - complications</subject><subject>Vitamin B 12 Deficiency - diagnosis</subject><subject>Vitamin B 12 Deficiency - drug therapy</subject><issn>1934-1482</issn><issn>1934-1563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtPAjEURhujEUQ3_gDTpTEB-5h2pu6Q-AxGYnQ9djq3pISZYjsj4d8LAi5d3S83J2dxEDqnZEAJYdeLKswGlElCDlCXKp70qZD8cL-TjHXQSYwzQmRCM3mMOpynGaEp66LPSfDT2sfGGezq0hnd-BCxtzi2hTZtA9j4qnA1lLiEKdQQdON8jW3wFb6lbP21zjiozeoGD3FcxQYqvdEF-HawPEVHVs8jnO1uD33c372PHvvj14en0XDcN5wp0hcKitKkQmQ6S5QRvEwSCSyVXCmqLQMrFaEMtMoKTbQ0nBaiFDbTumBWAu-hy613EfxXC7HJKxcNzOe6Bt_GnAkiBUmlVGv0aoua4GMMYPNFcJUOq5ySfFM03xTNf4uu4Yudty0qKP_QfcI1QLfA0s1h9Y8qn7y8PW-lP1OOgeY</recordid><startdate>202204</startdate><enddate>202204</enddate><creator>Jhunjhnuwala, Dhruv</creator><creator>Tanglay, Onur</creator><creator>Briggs, Nancy E.</creator><creator>Yuen, Margaret T. Y.</creator><creator>Huynh, William</creator><general>John Wiley & Sons, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2071-6909</orcidid><orcidid>https://orcid.org/0000-0002-6504-8107</orcidid><orcidid>https://orcid.org/0000-0001-6490-7232</orcidid></search><sort><creationdate>202204</creationdate><title>Prognostic indicators of subacute combined degeneration from B12 deficiency: A systematic review</title><author>Jhunjhnuwala, Dhruv ; Tanglay, Onur ; Briggs, Nancy E. ; Yuen, Margaret T. Y. ; Huynh, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3290-59ebdc7558a849c53d446e2763991af2ef69012ea98ba0a6c31b5d5f8aab2f6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Prognosis</topic><topic>Subacute Combined Degeneration - diagnosis</topic><topic>Vitamin B 12 - therapeutic use</topic><topic>Vitamin B 12 Deficiency - complications</topic><topic>Vitamin B 12 Deficiency - diagnosis</topic><topic>Vitamin B 12 Deficiency - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jhunjhnuwala, Dhruv</creatorcontrib><creatorcontrib>Tanglay, Onur</creatorcontrib><creatorcontrib>Briggs, Nancy E.</creatorcontrib><creatorcontrib>Yuen, Margaret T. Y.</creatorcontrib><creatorcontrib>Huynh, William</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>PM & R</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jhunjhnuwala, Dhruv</au><au>Tanglay, Onur</au><au>Briggs, Nancy E.</au><au>Yuen, Margaret T. Y.</au><au>Huynh, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic indicators of subacute combined degeneration from B12 deficiency: A systematic review</atitle><jtitle>PM & R</jtitle><addtitle>PM R</addtitle><date>2022-04</date><risdate>2022</risdate><volume>14</volume><issue>4</issue><spage>504</spage><epage>514</epage><pages>504-514</pages><issn>1934-1482</issn><eissn>1934-1563</eissn><abstract>Objective
A systematic review was conducted on published data of subacute combined degeneration (SCD) from B12 deficiency to investigate potential prognostic indicators of final ambulatory function in affected patients.
Type
Systematic review.
Literature Survey
Records published from 1999 through 2018 were searched on the electronic databases MEDLINE, PUBMED, and SCOPUS. The publication language was restricted to English and French.
Methodology
Records that described cases of SCD from B12 deficiency in patients ≥16 years of age at onset were included. From a final total of 66 cases of SCD identified, ambulation scores were assigned based on the clinical descriptions reported. Patient characteristics, clinical manifestations, and ambulatory function were reported descriptively. Subanalyses on potential prognostic indicators were performed.
Synthesis
Greater ambulatory function at diagnosis was associated with recovery of normal ambulatory function at follow‐up (P < .001). Nearly 90% of patients walking unsupported at diagnosis made a complete recovery regardless of etiology. For patients initially walking with support, 22% of cases from impaired B12 digestion/absorption made a complete recovery compared with ≥50% of cases from other etiologies. For patients initially requiring a wheelchair, 33% of cases from impaired digestion/absorption were able to walk with support compared with ≥50% of cases from other etiologies. The total B12 administered over the course of treatment was correlated with improved ambulation (P = .024) for all patients, with a higher B12 replacement regimen associated with better outcomes in patients who were unable to walk unsupported at diagnosis (number needed to treat = 4).
Conclusions
Initial ambulatory function may be a useful clinical marker of the severity of spinal cord dysfunction and final functional outcome. Etiological risk factors influenced both clinical manifestations and final walking ability in SCD, suggesting a distinct pathophysiological mechanism among the causes. In addition, a more intensive B12 replacement regimen may improve ultimate ambulatory function in advanced cases of SCD.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>33780172</pmid><doi>10.1002/pmrj.12600</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-2071-6909</orcidid><orcidid>https://orcid.org/0000-0002-6504-8107</orcidid><orcidid>https://orcid.org/0000-0001-6490-7232</orcidid></addata></record> |
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| identifier | ISSN: 1934-1482 |
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| issn | 1934-1482 1934-1563 |
| language | eng |
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| source | MEDLINE; Wiley Online Library |
| subjects | Humans Magnetic Resonance Imaging Prognosis Subacute Combined Degeneration - diagnosis Vitamin B 12 - therapeutic use Vitamin B 12 Deficiency - complications Vitamin B 12 Deficiency - diagnosis Vitamin B 12 Deficiency - drug therapy |
| title | Prognostic indicators of subacute combined degeneration from B12 deficiency: A systematic review |
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