Pattern, causes and functional outcome of peripheral neuropathies in the Amazon region

by Nathalie Deschamps, Mathieu Nacher, Pierre-Marie Preux, Valérie Takam, Romain Blaizot, Beatrice Cenciu, Nadia Sabbah, Bertrand De Toffol

Peripheral neuropathies have a wide variety of causes and pathophysiologies. Assuming that there are local particularities in the Amazon region, the aim of this study was to describe the characteristics of patients by determining the factors associated with functional severity.

This was a retrospective observational study at Cayenne Hospital between January 2015 and May 2023. We included patients from the French hospital activity monitoring database “Programme de médicalisation des systèmes d’information” by searching for the keywords "neuropathy" "Guillain-Barre syndrome"(GBS) "multineuritis" "polyneuritis". The Peripheral Neuropathy Disability (PND) score was determined to quantify the functional severity of patients.

A total of 754 patients were included, with a mean age of 60 years (SD = 14.6) and a predominance of women (53.6%). Gait disorders were present in 16.3% of patients (PND between 2 and 4). Mortality was 14.3% at 3 years. The most common causes of neuropathy were diabetes (58.2%), chemotherapy induced polyneuropathy toxicity (21.5%), Guillain-Barre syndrome (6.0%), unlabeled (3.2%), and infectious causes (2.0%). Infectious causes mainly included HIV in 13 patients (43.3%) and leprosy in 8 patients (26.7%). Only GBS was significantly associated with functional severity but all patients with a deficiency had a severe score. But, after excluding GBS, infectious causes were significantly associated with a severe PND score (aOR = 3.69 [1.18–11.58]).

The characteristics of French Guiana combine those found in developed and developing countries, with an over-representation of infections (notably HIV and leprosy), and diabetes. The causes often result from social inequalities in health.

This is the first comprehensive study of the diverse causes of neuropathy in a territory undergoing epidemiologic transition in the Amazon region.