1
|
Hodzelmans JJA, Janssen MLF, Reulen JPH, Blijham PJ, Koster A, Stehouwer CDA, Mess WH, Sutedja NA. Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population-based cohort: Associations with demographic and anthropometric characteristics-The Maastricht study. Muscle Nerve 2024; 69:588-596. [PMID: 38459960 DOI: 10.1002/mus.28076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION/AIMS Nerve conduction studies (NCSs) are widely used to support the clinical diagnosis of neuromuscular disorders. The aims of this study were to obtain reference values for peroneal, tibial, and sural NCSs and to examine the associations with demographic and anthropometric factors. METHODS In 5099 participants (aged 40-79 years) without type 2 diabetes of The Maastricht Study, NCSs of peroneal, tibial, and sural nerves were performed. Values for compound muscle action potential (CMAP) and sensory nerve action potential amplitude, nerve conduction velocity (NCV), and distal latency were acquired. The association of age, sex, body mass index (BMI), and height with NCS values was determined using uni- and multivariate linear regression analyses. RESULTS Detailed reference values are reported per decade for men and women. Significantly lower NCVs and longer distal latencies were observed in all nerves in older and taller individuals as well as in men. In these groups, amplitudes of the tibial and sural nerves were significantly lower, whereas a lower peroneal nerve CMAP was only significantly associated with age. BMI showed a multidirectional association. After correction for anthropometric factors in the multivariate analysis, the association between sex and NCS values was less straightforward. DISCUSSION These values from a population-based dataset could be used as a reference for generating normative values. Our findings show the association of NCS values with anthropometric factors. In clinical practice, these factors can be considered when interpreting NCS values.
Collapse
Affiliation(s)
- Jurriaan J A Hodzelmans
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Jos P H Reulen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul J Blijham
- Department of Clinical Neurophysiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nadia A Sutedja
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
2
|
Romano A, Guglielmino V, Bisogni G, Di Paolantonio A, Truini A, Minnella AM, Sciarrone MA, Vitali F, Maceroni M, Galosi E, Sabatelli M, Luigetti M. Early detection of nerve involvement in presymptomatic TTR mutation carriers: exploring potential markers of disease onset. Neurol Sci 2024; 45:1675-1684. [PMID: 37938457 PMCID: PMC10942905 DOI: 10.1007/s10072-023-07177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) amyloidosis is a heterogeneous, progressive, multisystemic disease with a life-threatening course if left untreated. Given the current availability of effective therapies, close follow-up of presymptomatic TTR mutation carriers is essential to recognize disease onset at the earliest sign. In addition to routine techniques, in recent years several novel tools have been proposed, although a consensus on their use has not been reached yet. In this paper, we aimed to evaluate possible markers of neuropathic disease onset intended to discriminate clinically asymptomatic carriers from early symptomatic patients, thus allowing timely treatment initiation. METHODS Thirty-eight presymptomatic carriers were enrolled. Clinical and electrophysiological findings at first evaluation and follow-up were collected. All carriers underwent an extensive clinical and instrumental evaluation according to the standard clinical practice. One or more non-routine investigations, whose use in this field is not yet validated (henceforth "unconventional"), were additionally assessed in a subgroup of individuals. RESULTS Based on the exclusive use of routine investigations, it was possible to define disease onset in 4/38 carriers during the follow-up. Employing additionally one or more "unconventional" tests, abnormal findings, indicative of a possible "conversion" to symptomatic disease, were detected in further 12 cases. More than half of our study cohort showed findings suggestive of small nerve fiber (SF) involvement at either invasive or non-invasive tests. CONCLUSIONS A close, multidisciplinary monitoring of presymptomatic TTR mutation carriers is fundamental, and diagnostic workup should include both routine and "unconventional" tests. Assessment of SF involvement is important also in non-endemic countries.
Collapse
Affiliation(s)
- Angela Romano
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Valeria Guglielmino
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Bisogni
- Centro Clinico NeMO Adulti, Fondazione Serena Onlus-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Angelo Maria Minnella
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Francesca Vitali
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Maceroni
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Mario Sabatelli
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico NeMO Adulti, Fondazione Serena Onlus-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
3
|
Røikjer J, Croosu SS, Hansen TM, Frøkjær JB, Brock C, Mørch CD, Ejskjaer N. The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain. Acta Diabetol 2023; 60:777-785. [PMID: 36881186 DOI: 10.1007/s00592-023-02062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
AIMS To investigate the co-existence of diabetic peripheral neuropathy (DPN), painful diabetic peripheral neuropathy (PDPN), and cardiac autonomic neuropathy (CAN) and to establish a model to predict CAN based on peripheral measurements. METHODS Eighty participants (20 type 1 diabetes (T1DM) + PDPN, 20 T1DM + DPN, 20 T1DM-DPN (without DPN), and 20 healthy controls (HC)) underwent quantitative sensory testing, cardiac autonomic reflex tests (CARTs), and conventional nerve conduction. CAN was defined as ≥ 2 abnormal CARTs. After the initial analysis, the participants with diabetes were re-grouped based on the presence or absence of small (SFN) and large fibre neuropathy (LFN), respectively. A prediction model for CAN was made using logistic regression with backward elimination. RESULTS CAN was most prevalent in T1DM + PDPN (50%), followed by T1DM + DPN (25%) and T1DM-DPN and HC (0%). The differences in prevalence of CAN between T1DM + PDPN and T1DM-DPN/HC were significant (p < 0.001). When re-grouping, 58% had CAN in the SFN group and 55% in the LFN group, while no participants without either SFN or LFN had CAN. The prediction model had a sensitivity of 64%, a specificity of 67%, a positive predictive value of 30%, and a negative predictive value of 90%. CONCLUSION This study suggests that CAN predominantly co-exists with concomitant DPN.
Collapse
Affiliation(s)
- Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 18-22. 9000, Aalborg, Denmark.
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Suganthiya Santhiapillai Croosu
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 18-22. 9000, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine Maria Hansen
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Christina Brock
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 18-22. 9000, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Carsten Dahl Mørch
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg, Denmark
- Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 18-22. 9000, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
4
|
Burke D. Conduction studies on the sural nerve. Clin Neurophysiol Pract 2021; 7:23-24. [PMID: 36590821 PMCID: PMC9794524 DOI: 10.1016/j.cnp.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/19/2021] [Indexed: 01/04/2023] Open
|
5
|
Krøigård T, Andersen KV, Tankisi H, Beniczky S, Kristensen AG. Reply to "Conduction studies on the sural nerve". Clin Neurophysiol Pract 2021; 7:25-26. [PMID: 35079667 PMCID: PMC8777115 DOI: 10.1016/j.cnp.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 10/30/2022] Open
Affiliation(s)
- Thomas Krøigård
- Research Unit for Neurology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | | | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Danish Epilepsy Centre (Member of the ERN EpiCARE), Dianalund, Denmark
| | | |
Collapse
|