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Brain, Vol. 109, No. 2, 307-323, 1986
© 1986 Oxford University Press

research-article

EFFECT OF PROTEIN CALORIE MALNUTRITION ON PERIPHERAL NERVES

A CLINICAL, ELECTROPHYSIOLOGICAL AND HISTOPATHOLOGICAL STUDY

JAGJIT S. CHOPRA1,, UPINDER K. DHAND1, SAROJ MEHTA2, VILAKSHNA BAKSHI1, SATYAVATI RANA1 and JAGJIVAN MEHTA1

1Departments of Neurology, Postgraduate Institute of Medical Education and Research Chandigarh 160012, India 2Departments of Paediatrics, Postgraduate Institute of Medical Education and Research Chandigarh 160012, India

Correspondence to: Reprint requests and correspondence to Professor J. S Chopra, Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Forty-three children (aged 7 to 62 months) with protein calorie malnutrition (PCM) were studied; 13 had mild to moderate PCM and 30 severe PCM. A reduction of motor nerve conduction velocity and abnormalities of sensory conduction were present in both groups. The abnormality of motor nerve conduction was directly related to the seventy of PCM and the presence of hypotonia and/or hyporeflexia Sural nerve biopsies from both groups were studied for myelinated fibre density, fibre size spectrum, relationship of internodal length with diameter and qualitative light microscopic changes The biopsies from children with mild to moderate PCM were characterized by a normal developmental change in myelinated fibres with an increasing proportion of medium and large size fibres, a transition from a unimodal to a bimodal distribution and an appropriate relationship of internodal length to fibre diameter Evidence of mild segmental demyelination was observed in only one patient of this group. In contrast, in the biopsies from children with severe PCM, the normal developmental pattern for myelinated fibre size distribution was impaired with a persistence of small myelinated fibres, and there was a failure of internodal segments on large fibres to elongate with increase in age and significant segmental demyelination in about 50 per cent of cases. Retarded myelination and segmental demyelination probably form the morphological basis for impaired peripheral nerve function in PCM Short internodes on large diameter fibres may also contribute to this effect.

Received December 18, 1984. Revised July 9, 1985. Accepted July 16, 1985.


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