Lumbosacral Radiculoplexus Neuropathy: Neurological Outcomes and Survival in a Population-based Study
Objective:To determine whether community Lumbosacral Radiculoplexus Neuropathy (LRPN) patients have milder neuropathy than referral patients, we characterize the outcomes and survival of population-based compared to referral-based LRPN cohorts .Background:Previously, we found that the incidence of LRPN is 4.16/100,000/year, a frequency greater than other inflammatory neuropathies. The survival of LRPN is uncharacterized.Materials/Methods:62 episodes in 59 LRPN patients were identified over 16 years (2000-2015). Clinical findings were compared to previous referral-based LRPN cohorts. Survival data were compared to age-gender matched controls.Results:At LRPN diagnosis, median age was 70 years, median neuropathy impairment score (NIS) 22 points, 92% had pain, 95% weakness, 23% were wheelchair-bound and median modified Rankin scale (mRS) was 3 (1-4). At last follow-up, median NIS improved to 17 points (p<0.001) with 56% having ≥4 points improvement, 16% were wheelchair-bound, and median mRS was 2. Compared to referral-based LRPN cohorts, community LRPN had less impairment, less bilateral disease (37% vs 92%) and less wheelchair usage (23% vs 49%). LRPN survival was 86% at 5 years and 55% at 10 years. Compared to age-gender matched controls, LRPN patients had 76% increased risk of death (p=0.016). In multivariate analysis, diabetes mellitus, age, stroke, chronic kidney disease, peripheral artery disease, and coronary artery disease were significant mortality risk factors but LRPN was not.Conclusions:LRPN is a painful, paralytic, asymmetric, monophasic, sometimes bilateral pan-plexopathy that improves over time but leaves patients with impairment. Although having LRPN increases mortality, this increase is probably due to comorbidities (diabetes mellitus) rather than LRPN itself.