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J Gen Intern Med. 2006 Oct;21(10):1063-8.

Potential outcome factors in subacute combined degeneration: review of observational studies.

Author information

1
Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Abstract

BACKGROUND:

Subacute combined degeneration is an acquired myelopathy caused by vitamin B12 deficiency. Therapy with B12 leads to improvement in most but to complete recovery in only a few patients. Prognostic indicators in subacute combined degeneration are unknown; therefore, predicting complete recovery of neurologic deficits is challenging.

PURPOSE:

To identify potential correlates of outcome and to generate hypotheses concerning predictors of complete resolution of neurologic deficits in subacute combined degeneration.

DATA SOURCE:

We searched EMBASE (1974 to October 2005), MEDLINE (1968 to October 2005), and references from identified reports. REPORTS SELECTION: Reports of patients with subacute combined degeneration containing results of magnetic resonance imaging (MRI) and description of outcome and 1 patient treated by the authors.

DATA EXTRACTION, SYNTHESIS:

We extracted data from 45 reports and 57 patients (36 males, 21 females; age range: 10 to 81) with a diagnosis of subacute combined degeneration, and estimated the strength of association between clinical, laboratory, and radiological factors and complete resolution of signs and symptoms.

RESULTS:

Eight patients (14%) achieved clinical resolution and 49 (86%) improved with B12 therapy. The absence of sensory dermatomal deficit, Romberg, and Babinski signs were associated with a higher complete resolution rate. Patients with MRI lesions in < or = 7 segments and age less than 50 also appear to have higher rates of complete resolution.

CONCLUSIONS:

B12 therapy is reported to stop progression and improve neurologic deficits in most patients with subacute combined degeneration. However, complete resolution only occurs in a small percentage of patients and appears to be associated with factors suggestive of less severe disease at the time of diagnosis.

PMID:
16970556
PMCID:
PMC1831618
DOI:
10.1111/j.1525-1497.2006.00525.x
[Indexed for MEDLINE]
Free PMC Article

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