title: Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis).
abstract: BACKGROUND
  Neuralgic amyotrophy (also know as Parsonage-Turner syndrome or brachial plexus neuritis) is a distinct peripheral nervous system disorder characterised by episodes (attacks) of extreme neuropathic pain and rapid multifocal weakness and atrophy in the upper limbs. Neuralgic amyotrophy has both an idiopathic and hereditary form, with similar clinical symptoms but generally an earlier age of onset and more episodes in the hereditary form. The current hypothesis is that the episodes are caused by an immune-mediated response to the brachial plexus. Recovery is slow, in months to years, and many patients are left with residual pain and decreased exercise tolerance of the affected limb(s). Anecdotal evidence suggests that corticosteroids may relieve pain or help improve functional recovery.
  
  
  OBJECTIVE
  The objective was to provide a systematic review of all randomised clinical trials of treatment in neuralgic amyotrophy.
  
  
  METHODS
  We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2 2009), MEDLINE (January 1966 to April 2 2009), EMBASE (January 1980 to April 2 2009), CINAHL (January 1982 to April 2 2009), and LILACS (January 1982 to April 2 2009) for randomised controlled trials of treatment for neuralgic amyotrophy.
  
  
  METHODS
  Any randomised or quasi-randomised trial of any intervention for neuralgic amyotrophy would be included in the review.
  
  
  METHODS
  Two review authors extracted the data (RH, NvA) and two authors assessed study quality and performed data extraction independently (NvA, BvE).
  
  
  RESULTS
  No randomised or quasi-randomised trials were identified. In 30 articles anecdotal evidence was found on treatment for neuralgic amyotrophy. Only three of these articles contained more than 10 treated cases, with one providing sufficient details to calculate the primary and secondary outcome measures for this review.
  
  
  CONCLUSIONS
  At this moment there is no evidence from randomised trials on any form of treatment for neuralgic amyotrophy. Evidence from one open-label retrospective series suggests that oral prednisone given in the first month after onset can shorten the duration of the initial pain and leads to earlier recovery in some patients. Randomised clinical trials are needed to establish the efficacy of treatment with corticosteroids or other immune-modulating therapies.
authors: Department of Neurology and Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, c/o 920 KNF, PO Box 9101, Nijmegen, Netherlands, 6500 HB.
authors: Nens
authors: N
authors: van Alfen
authors: Baziel G M
authors: BG
authors: van Engelen
authors: Richard A C
authors: RA
authors: Hughes
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D020968:Brachial Plexus Neuritis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D011239:Prednisolone / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011239:Prednisolone