Journal of Medicine and Life Science

Institute for Medical Science (제주대학교 의과학연구소)
권호 표지
DOI QR코드

DOI QR Code

Case series of pyridoxine-induced neuropathy

피리독신 유발 신경병증 증례군

  • Jihee Ko (Department of Neurology, Jeju National University Hospital) ;
  • Sa-Yoon Kang (Department of Neurology, Jeju National University College of Medicine)
  • 고지희 (제주대학교병원 신경과) ;
  • 강사윤 (제주대학교 의과대학 신경과학교실)
  • Received : 2023.11.12
  • Accepted : 2023.12.28
  • Published : 2024.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

Excess of pyridoxine, in contrast to other nutrients, may result in neuropathy. Case reports are sparse, and little is known about the clinical and electrophysiological findings. Eight patients with pyridoxine-induced neuropathy were investigated, and a review of the literature was undertaken. Nerve conduction studies showed axonal sensory or sensorimotor polyneuropathy. And the blood levels of vitamin B6 were markedly elevated. After discontinuation of vitamin supplements, all patients showed no significant improvement in clinical and electrophysiological findings. Supplementation with pyridoxine at doses greater than 50 mg/day for extended durations may be harmful and should be discouraged.

Keywords

Acknowledgement

This work was supported by the 2023 education, research and student guidance grant funded by Jeju National University.

References

  1. Mooney S, Leuendorf JE, Hendrickson C, Hellmann H. Vitamin B6: a long known compound of surprising complexity. Molecules 2009;14:329-51.
  2. Schaumburg H, Kaplan J, Windebank A, Vick N, Rasmus S, Pleasure D, et al. Sensory neuropathy from pyridoxine abuse. A new megavitamin syndrome. N Engl J Med 1983;309:445-8. https://doi.org/10.1056/NEJM198308253090801
  3. Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve 2020;62:13-29. https://doi.org/10.1002/mus.26783
  4. Berger AR, Schaumburg HH, Schroeder C, Apfel S, Reynolds R. Dose response, coasting, and differential fiber vulnerability in human toxic neuropathy: a prospective study of pyridoxine neurotoxicity. Neurology 1992;42:1367-70. https://doi.org/10.1212/WNL.42.7.1367
  5. Kulkantrakorn K. Pyridoxine-induced sensory ataxic neuronopathy and neuropathy: revisited. Neurol Sci 2014;35:1827-30. https://doi.org/10.1007/s10072-014-1902-6
  6. Sharp AA, Fedorovich Y. Teratogenic effects of pyridoxine on the spinal cord and dorsal root ganglia of embryonic chickens. Neuroscience 2015;289:233-41. https://doi.org/10.1016/j.neuroscience.2014.12.067
  7. Xu Y, Sladky JT, Brown MJ. Dose-dependent expression of neuronopathy after experimental pyridoxine intoxication. Neurology 1989;39:1077-83. https://doi.org/10.1212/WNL.39.8.1077
  8. Chen PY, Tsai YW, Chang AY, Chang HH, Hsiao YH, Huang CW, et al. Increased leptin-b expression and metalloprotease expression contributed to the pyridoxine-associated toxicity in zebrafish larvae displaying seizure-like behavior. Biochem Pharmacol 2020;182:114294.
  9. Hasannejad F, Ansar MM, Rostampour M, Fikijivar EM, Taleghani BK. Improvement of pyridoxine-induced peripheral neuropathy by Cichorium intybus hydroalcoholic extract through GABAergic system. J Physiol Sci 2019;69:465-76. https://doi.org/10.1007/s12576-019-00659-8
  10. Jungert A, Linseisen J, Wagner KH, Richter M; German Nutrition Society (DGE). Revised D-A-CH reference values for the intake of vitamin B6. Ann Nutr Metab 2020;76:213-22. https://doi.org/10.1159/000508618