Nerve damage may occur after weight-loss surgery

Patients can develop potentially disabling neurological complications after gastric bypass surgery performed to treat morbid obesity, most likely due to deficiencies in certain nutrients, a new study shows.
While correcting these deficiencies can help patients, some are left with permanent damage, Dr. Katalin Juhasz-Pocsine and colleagues from the University of Arkansas for Medical Science in Little Rock report. Symptoms can strike many years after the surgery, they note, possibly because stores of certain nutrients may take this long to become depleted.
Some patients begin hallucinating and lose the ability to walk a couple of months after the surgery, Juhasz-Pocsine explained in an interview with Reuters Health. "After resolution of the acute symptoms they are quite weak, and it takes around a year to recover.
Some are permanently disabled," she said. Among patients who develop symptoms years down the road, the spinal cord typically is affected, resulting in falling, extreme coordination and gait problems, and severe spasticity, and some individuals need to use wheelchairs.
Juhasz-Pocsine and her team describe 26 cases of neurological problems that occurred in gastric bypass patients in the medical journal Neurology. Symptoms typically involved more than one portion of the neurological system.
While restoring nutritional deficiencies, which included lack of vitamin B12, thiamine, or copper, helped patients, many continued to have symptoms for months, while symptoms remained permanent in some patients, Juhasz-Pocsine and her team report. The patient who fared best was a woman who underwent surgery to reverse her gastric bypass after developing rapidly progressing symptoms that didn't respond to other treatment.
Gastric bypass patients and their doctors should be aware of the early signs and symptoms of neurological problems, and should know that these symptoms can strike many years after a person has had the surgery, Juhasz-Pocsine advises. Further research is needed, she added, on the risk of neurological problems in gastric bypass patients whose nutritional needs change dramatically, for example during pregnancy or breastfeeding or among individuals undergoing cancer treatment.
The researchers suggest that steps should be taken to help prevent gastric bypass patients from developing these problems in the first place by advising them to take vitamin and mineral supplements and to avoid "severe and rapid weight loss."
"Many of our patients were not instructed to take vitamin supplements, and postoperative follow-up visits with medical nutritionists were not emphasized," they note.
SOURCE: Neurology, May 22, 2007 online.