J Neurol. 2026 Aug 3;273(8):503. doi: 10.1007/s00415-026-14048-w.
ABSTRACT
BACKGROUND: There is a global epidemic of obesity and in this context, the development of novel agents for weight loss has been timely. There have been emerging reports of peripheral nerve complications and this study aimed to systematically review all reported cases associated with medications used for weight loss.
METHODS: A systematic search of PubMed, Embase and CINAHL databases from inception to 30 June 2026 was performed to identify studies that report new-onset or worsening peripheral nerve complications. Independent screening was conducted by two authors. Data including demographics, medications, weight-loss parameters, neurological presentation and investigations. Descriptive statistics were used.
RESULTS: There were 19 studies, comprising 31 cases and one cohort (103 individuals) identified. All bar one were published from 2024. Of 31 individual cases median weight loss achieved was 20.4 kg (IQR 15.2) or 21.8% (IQR 16.4) of starting body weight. Median rate of weight loss was 3.7 kg/month (IQR 1.7), with symptom onset at 150 days (IQR 135). Semaglutide or tirzepatide were implicated in the majority (83%), and 67% had pre-diabetes/diabetes. Neurological presentations included fibular neuropathy (n = 10), lumbosacral radiculoplexus neuropathy (n = 9) and distal symmetric polyneuropathy (n = 7). Electrodiagnostic and imaging data were supportive of diagnosis.
CONCLUSIONS: There is a recent increase in peripheral nerve disorders associated with medical treatment of diabetes and obesity. To reduce the risk, it is recommended to ensure adequate nutritional status and avoid ultrarapid HbA1c and weight loss. Prospective studies are needed to determine incidence and confirm safe rates of weight loss and glycemic correction.
PMID:42547656 | DOI:10.1007/s00415-026-14048-w
