Link found between gastric bypass and several serious neurological conditions

A decade-long study by neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock has found a link between the increasingly popular weight-loss surgery known as gastric bypass and several serious neurological conditions.

Katalin Juhasz Pocsine, M.D., associate professor in the UAMS Department of Neurology, is lead author of the study, which was published online May 22 in the medical journal Neurology ( http://www.neurology.org/cgi/content/abstract/68/21/1843). The study concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and may develop a variety of neurological symptoms.

“The frequency of operations for treatment of obesity is rapidly growing in the United States,” Juhasz Pocsine said. “These procedures are usually successful in reducing weight, but they are not without risk. Many of the complications patients experience affect the nervous system, and they are often disabling and irreversible.”

More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients, a link between the surgery and their neurological condition was found.

All of the patients involved in the study had previously undergone the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.

Additional authors include UAMS Department of Neurology faculty members Sami I. Harik, M.D., department chairman and professor of neurology; Stacy A. Rudnicki, M.D., associate professor of neurology; and Robert L. “Lee” Archer, M.D., associate professor of neurology.

The 26 people involved in the study were followed for several years by UAMS physicians and represent the largest compilation of gastric bypass patients with neurological complications ever reported.

“As is evident from our findings, the neurological complications of bariatric surgery involve most parts of the nervous system, and frequently more than one,” Juhasz Pocsine said. “The conditions experienced by our patients spanned most regions of the nervous system from the cerebral cortex to the peripheral nerves.”

Symptoms of the patients in the study included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.

Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.

“Attention should be given to long-term intake of vitamin and mineral supplements to prevent some of these complications and to avoid severe and rapid weight loss,” Juhasz Pocsine said. “Patients should be made aware of the symptoms that herald these neurological complications, and physicians should attend to the wide-based nutritional deficiencies as early as possible.”

UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state's largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit http://www.uams.edu .