Ruxandra Georgescu

Background/Objectives: Treatment-induced neuropathy of diabetes (TIND) is an under-recognized iatrogenic neuropathy that follows a rapid fall in glycated hemoglobin (HbA1c). We aimed to systematically summarize the published cases of TIND and to compare them with two patients evaluated at our center. Methods: We evaluated two patients at our center and systematically reviewed PubMed, Scopus, Web of Science and Google Scholar, following PRISMA 2020, for primary clinical studies of TIND. Data were synthesized descriptively. Results: Both patients developed painful neuropathy with autonomic symptoms after HbA1c falls of 15.3 and 6.4 percentage points and improved substantially, but incompletely, over two years. Moreover, the review included 47 publications (219 patients) and painful neuropathy with autonomic dysfunction predominated. In case reports, the median HbA1c fall was 7.3 percentage points, and onset occurred within 8 weeks in 26 of 47 publications. Recovery was complete in 8 and partial in 21 of 32 case reports with documented outcomes. Follow-up data were missing for 136 of 219 patients. Conclusions: Published cases show a recurrent temporal association between TIND and rapid HbA1c reduction, but cannot establish causality or prognosis. TIND should be recognized early, and gradual, monitored glycemic correction may be reasonable in high-risk patients.

Background/Objectives: This study investigated the frequency and timing of optic neuritis (ON) episodes in relation to the onset of multiple sclerosis (MS) and examined the occurrence of Uhthoff’s phenomenon and Lhermitte’s sign to understand their roles in early diagnosis and disease progression. Methods: A longitudinal study was conducted with 127 MS patients. Clinical data, including ophthalmological examinations for ON, were collected and questionnaires assessed the presence of Uhthoff’s phenomenon and Lhermitte’s sign. Results: Results showed that 37% of patients experienced demyelinating retrobulbar ON, with 25.53% having ON as the initial symptom of MS. Residual visual acuity impairment (below 20/40) and dyschromatopsia were reported by 25.53% and 17.02% of patients, respectively. Uhthoff’s phenomenon and Lhermitte’s sign were present in 26.77% and 36.22% of patients, respectively. The findings underscore the importance of early ophthalmological assessments in diagnosing MS, as ON can be an initial indicator of the disease. Conclusions: The study highlights the need for precise diagnostic tools and personalized therapeutic strategies focused on specific biomarkers and pathways involved in neuroinflammation and demyelination. Early diagnosis through vigilant ophthalmologic evaluation can lead to interventions that significantly alter disease progression, improving patient outcomes and quality of life.