Disorders of the Nervous System Arising out of Nutritional Insufficiency after Bariatric Surgery

Czech version

Authors: Z. Kadaňka
Authors‘ workplace: Neurologická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2014; 77/110(4): 419-422
Category: Review Article

Podpořeno MZ ČR – RVO (FNBr, 65269705).

Overview

In developed countries, nutritional deficiency only rarely causes polyneuropathy or other disorders of the nervous system. When it does occur, it appears in alcoholics or in the malnourished –⁠ people with long-term psychiatric disorders, with gastro-intestinal system disorders or on extreme diets. Paradoxically, certain initially obese patients may become malnourished. Pathological obesity is addressed in various ways, with the shared target of restricting food intake. Bariatric surgery is one of the options. However, such a profound diminution of nutrition may induce unpredictable imbalance or insufficiency in nutrients important for normal functioning of the nervous system. The number of bariatric operations is steadily increasing, both in the Czech Republic and elsewhere; in the USA, they already outnumbered cholecystectomies. Complications associated with bariatric surgery include polyneuropathy, plexopathy, radiculopathy, myelopathy, encephalopathy and optic neuropathy, all of which may appear both early as well as many years later. The aetiology of these disorders remains unclear, although vitamin insufficiency (thiamine, B12, E), copper deficiency and hypoglycaemia are often held responsible. However, many factors remain hidden and supplementation of the “missing” factors sometimes fails to affect the course of the disease. Damage to the immune system or inflammation may contribute to the aetiology. Weight loss, gastro-intestinal complaints, albumin and transferrin decrease and rehospitalisation for digestive symptoms are considered risk factors. Regular post-surgical monitoring in nutrition centres together with specific treatment of complications is recommended.

Key words:
bariatric surgery –⁠ nutritional insufficiency –⁠ polyneuropathy

Sources

1. Vest AR, Heneghan HM, Aqarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart 2012; 98(24): 1763 –⁠ 1777. doi: 10.1136/ heartjnl ‑⁠ 2012 –⁠ 301778.

2. Sjöström L, Peltonen M, Jacobson P, Sjöström CD,Karason K, Wedel H et al. Bariatric surgery and long‑term cardiovaskular events. JAMA 2012; 307(1): 56 –⁠ 65. doi: 10.1001/ jama.2011.1914.

3. Kasalický M. Laparoskopické bariatrické operace. Endoskopie 2009; 18(1): 22.

4. Juhasz ‑⁠ Pocsine K, Rudnicki SA, Archer RL, Harik SI.Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 2007; 68(21): 1843 –⁠ 1850.

5. American Society for Bariatric Surgery. Longitudinal Assessment of Bariatric Surgery (LABS) [online] Available from URL: http:/ / www.win.niddk.nih.gov/ publications/ labs.htm.

6. Pigeyre M, Seguy D, Arnalsteen L, Pattou F, Romon M. Laparoscopic gastric bypass complicated by portal venous thrombosis and severe neurological complications. Obes Surg 2008; 18(9): 1203 –⁠ 1207. doi: 10.1007/ s11695 -⁠ 008 -⁠ 9467 -⁠ 1.

7. Thaisetthawatkul P, Collazo ‑⁠ Clavell ML, Sarr MG, Norell JE, Dyck PJ. A controlled study of peripheral neuropathy after bariatric surgery. Neurology 2004; 63(8): 1462 –⁠ 1470.

8. Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg 2013; 23(8): 1333 –⁠ 1340. doi: 10.1007/ s11695-013 -⁠ 0913 -⁠ 3.

9. DiNardo MM, Korytkowski MT, Siminerio LS. The importance of normoglycemia in critically ill patients. Crit Care Nurs Q 2004; 27(2): 126 –⁠ 134.

10. Philippi N, Vinzio S, Collongues N, Vix M, Boehm N,Tranchant C et al. Peripheral neuropathies after bariatric surgery. Rev Neurol (Paris) 2011; 167(8 –⁠ 9): 607 –⁠ 614. doi: 10.1016/ j.neurol.2011.01.011.

11. Carvajal T, Franco DL, Martínez A, Peña IM. Wernicke’s encephalopathy and polyneuropathy associated with vitamin B complex deficiency after a bariatric surgery. Biomedica 2012; 32(4): 474 –⁠ 484. doi: 10.1590/ S0120 -⁠ 41572012000400002.

12. Jethava A, Dasanu CA. Acute Wernicke encephalopathy and sensorineural hearing loss complicating bariatric surgery. Conn Med 2012; 76(10): 603 –⁠ 605.

13. Ba F, Siddiqi ZA. Neurologic complications of bariatric surgery. Rev Neurol Dis 2010; 7(4): 119 –⁠ 124.

14. Folope V, Coëffier M, Déchelotte P. Nutritional deficiencies associated with bariatric surgery. Gastroenterol Clin Biol 2007; 31(4): 369 –⁠ 371.

15. Ando Y. Transthyretin –⁠ its function and pathogenesis. Rinsho Byori 2006; 54(5): 497 –⁠ 502.

16. Koike H, Iijima M, Mori K, Hattori N, Ito H, Hirayama M et al. Postgastrectomy polyneuropathy with thiamine deficiency is identical to beriberi neuropathy. Nutrition 2004; 20(11 –⁠ 12): 961 –⁠ 966.

17. Ueda N, Suzuki Y, Rino Y, Takahashi T, Imada T,Takanashi Y et al. Correlation between neurological dysfunction with vitamin E deficiency and gastrectomy. J Neurol Sci 2009; 287(1 –⁠ 2): 216 –⁠ 220. doi: 10.1016/ j.jns.2009.07.020.

18. Brolin RE, Leung M. Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg 1999; 9(2): 150 –⁠ 154.

19. Thaisetthawatkul P, Collazo ‑⁠ Clavell ML, Sarr MG, Norell JE, Dyck PJ. Good nutritional control may prevent polyneuropathy after bariatric surgery. Muscle Nerve 2010; 42(5): 709 –⁠ 714. doi: 10.1002/ mus.21802.