Hello Dr. Agar,
I wanted to get your thoughts on a problem I have been facing of late. About a year ago, I had one episode of a seizure. It was not during dialysis (I am on daily nocturnal home hemodialysis). I also had symptoms such as biting of my tongue during sleep and sudden jerking of my arms while asleep.
I consulted a neurologist who put me on Levitracetam 500 mg twice daily.
Subsequently I had a lot of numbness and pain in my left hand especially the middle finger. I was then put on Duloxetine 20 mg at bed time.
The symptoms reduced.
About a week back, there was a problem in my dialysate sodium and I suspect that I went into hyponatremia which resulted in another seizure along with hypotension. My neurologist has since increased the Leviteracatem dose to 750 mg twice daily and Duloxetine to 30 mg at bed time.
I was diagnosed with Peripheral Neuropathy long back and have been on Pregabalin 75 mg twice daily for a long time now.
I wanted to get your thoughts on what this could mean? Is this nerve damage in general? What is the prognosis for such a condition in long term hemodialysis patients?
Is there any risk of this affecting the brain eventually? Dementia? Cognitive decline? Etc.?
Thanks so much Dr. Agar!
Dear Kamal
This is a bit of a tricky one … the causes of peripheral neuropathy are many and varied, and not all are related to or necessarily a result of your renal disease or your now mounting ‘vintage’ on dialysis … though that said, equally it might be. One would have to be your nephrologist or neurologist ‘on the ground’ in India to do the neurological examinations and tests needed to work that one out.
So, as such, I am a little distant to be able (and confident) of giving an answer that might help. As for your last questions - again, (and I am sorry I need to say this) that depends … and one would have to be there and able to test and examine to answer those questions.
Even in the renal-driven neuropathies, while the outlooks vary depending upon the neurological findings, the prognosis and outcome is so variable as to be a one on one management issue that you will need to follow through with your advisors there.
I hate to duck the issue … but I am forced to do that here. I can only encourage you to forge a good relationship with your team there - both nephrological and neurological - and work through to answer those parts of your questions where answers are possible. And - to be brutally honest, even those answers will fall short (as they likely would here if you were here and on the ground in Australia).
Dear Kamal
This is a bit of a tricky one … the causes of peripheral neuropathy are many and varied, and not all are related to or necessarily a result of your renal disease or your now mounting ‘vintage’ on dialysis … though that said, equally it might be. One would have to be your nephrologist or neurologist ‘on the ground’ in India to do the neurological examinations and tests needed to work that one out.
So, as such, I am a little distant to be able (and confident) of giving an answer that might help. As for your last questions - again, (and I am sorry I need to say this) that depends … and one would have to be there and able to test and examine to answer those questions.
Even in the renal-driven neuropathies, while the outlooks vary depending upon the neurological findings, the prognosis and outcome is so variable as to be a one on one management issue that you will need to follow through with your advisors there.
I hate to duck the issue … but I am forced to do that here. I can only encourage you to forge a good relationship with your team there - both nephrological and neurological - and work through to answer those parts of your questions where answers are possible. And - to be brutally honest, even those answers will fall short (as they likely would here if you were here and on the ground in Australia).
Totally understand Dr. Agar. I was just wondering if these things were fairly standard. Looks like they aren’t. I will be meeting my nephrologist soon to review the neurologist’s recommendations. Thanks!