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Luigetti M, Giovannini S, Romano A, Bisogni G, Barbato F, Di Paolantonio A, Servidei S, Granata G, Sabatelli M. Small Fibre Involvement in Multifocal Motor Neuropathy Explored with Sudoscan: A Single-Centre Experience. Diagnostics (Basel) 2020; 10:diagnostics10100755. [PMID: 32993111 PMCID: PMC7599533 DOI: 10.3390/diagnostics10100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
Objective: Multifocal motor neuropathy (MMN) is a rare inflammatory neuropathy, clinically characterized by exclusive motor involvement. We wished to evaluate the possible presence of sensory dysfunction, including the evaluation of small fibres, after a long-term disease course. Patients and methods: seven MMN patients, regularly followed in our Neurology Department, underwent clinical evaluation, neurophysiological examination by nerve conduction studies (NCSs), and Sudoscan. We compared neurophysiological data with a group of patients with other disorders of the peripheral nervous system. Results: NCSs showed a reduction of sensory nerve action potential amplitude in 2/7 MMN patients. Sudoscan showed borderline electrochemical skin conductance (ESC) values in 3/7 MMN patients (two of them with abnormal sensory NCSs). Conclusions: Our results confirm that sensory involvement may be found in some MMN after a long-term disease course, and it could also involve the small fibres.
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Affiliation(s)
- Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
- Correspondence: ; Tel.: +39-063-0154-435
| | - Silvia Giovannini
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Riabilitazione, 00168 Rome, Italy
| | - Angela Romano
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
- Centro Clinico NEMO adulti, 00168 Rome, Italy;
| | | | - Francesco Barbato
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
| | - Andrea Di Paolantonio
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
| | - Serenella Servidei
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, 00168 Rome, Italy
| | - Giuseppe Granata
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, 00168 Rome, Italy
| | - Mario Sabatelli
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.G.); (A.R.); (F.B.); (A.D.P.); (S.S.); (G.G.); (M.S.)
- Centro Clinico NEMO adulti, 00168 Rome, Italy;
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Campagnolo M, Ruiz M, Falzone YM, Ermani M, Bianco M, Martinelli D, Cerri F, Quattrini A, Salvalaggio A, Castellani F, Comi G, Giannini F, Nobile-Orazio E, Fazio R, Riva N, Briani C. Limitations in daily activities and general perception of quality of life: Long term follow-up in patients with anti-myelin-glycoprotein antibody polyneuropathy. J Peripher Nerv Syst 2019; 24:276-282. [PMID: 31397934 DOI: 10.1111/jns.12342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/22/2019] [Accepted: 08/02/2019] [Indexed: 12/01/2022]
Abstract
In this study, we assessed the modifications over time of daily activities and quality of life (QoL) in 32 subjects with anti-myelin-glycoprotein (MAG) antibody neuropathy. A widespread panel including clinical scores and patient-reported questionnaires, in compliance of the terms by the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO), was employed at enrollment (T0) and at follow-up evaluation (T1) after a mean interval of 15.4 ± 5.7 months. The Sensory Modality Sum score (SMS) at four limbs showed a significant worsening over time (mean score 27.2 ± 3.9 at T0 vs 25.7 ± 3 at T1 at upper limbs, P = .03; 20.5 ± 4.8 at T0 vs 18.6 ± 5.9 at T1 at lower limbs, P = .04). The Visual Analogue Scale (VAS) for pain significantly worsened at upper limbs at T1 (mean values 0.84 ± 1.95 at T0 vs 1.78 ± 2.6 at T1, P = .03). All the other tests did not show significant differences between T0 and T1. In the subgroup who underwent rituximab (15/32 treated before T0, 3/32 patients treated between T0 and T1 with median interval of 1 year), no significant differences were observed between T0 and T1. Despite the quite long follow-up, statistical significance was not achieved either for the limited number of patients or for the lack of sensitive outcome measures. In our cohort, the significant worsening of the SMS and VAS after a median of 14 months can be considered as a reliable expression of the natural history of the disease, and suggest that these scales might represent possible outcome measures in anti-MAG antibody neuropathy.
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Affiliation(s)
- Marta Campagnolo
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Marta Ruiz
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Yuri M Falzone
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Ermani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Mariangela Bianco
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Milan University, IRCCS Humanitas Clinical and Research Institute, Milan, Italy
| | - Daniele Martinelli
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cerri
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Università Vita e Salute San Raffaele, Milan, Italy
| | - Fabio Giannini
- Department of Medical and Surgical Sciences and Neurosciences, Siena University, Siena, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Milan University, IRCCS Humanitas Clinical and Research Institute, Milan, Italy
| | - Raffaella Fazio
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
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Bjelica B, Peric S, Bozovic I, Kacar A, Cobeljic M, Dejanovic I, Stevic Z, Basta I. One-year follow-up study of neuropathic pain in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2019; 24:180-186. [PMID: 30973184 DOI: 10.1111/jns.12318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/30/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Abstract
We sought to gather information about frequency and features of neuropathic pain (NeP) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients and to investigate course of NeP during 1-year follow-up. Study included 105 patients diagnosed with CIDP. Patients with diabetes (N = 26) were excluded. NeP was diagnosed by the official guidelines and painDETECT questionnaire (PD-Q). Medical Research Council Sum Score (MRC-SS), INCAT disability and sensory scores, and Beck Depression Inventory were also measured. PD-Q showed presence of NeP in 16 (20%) of 79 CIDP patients and their mean pain was moderate (5.1 ± 3.0 of 10). Diagnostic delay in CIDP patients with NeP was prolonged compared to CIDP patients without NeP (21 ± 28 vs 9 ± 12 months, P < .05). Slowly progressive course of the disease was more frequent in patients with NeP (81% vs 52%, P < .05). Patients with NeP had worse INCAT sensory score (P < .01), INCAT disability score (P < .05), MRC-SS, as well as worse disease outcome at time of testing (P < .05). Depression was more common in patients with NeP (69% vs 17%, P < .01). During 1-year follow-up, majority of our CIDP patients had good control of NeP with gabapentinoids or amitriptyline. NeP was common in our cohort of non-diabetic CIDP patients. It was associated with worse functional disability, worse sensory deficit, and depression. Special attention should be paid to CIDP patients with NeP because they request additional symptomatic therapy that appeared efficacious in our cohort.
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Affiliation(s)
- Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Kacar
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mina Cobeljic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Dejanovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorica Stevic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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Rajabally YA, Delmont E, Hiew FL, Aubé-Nathier AC, Grapperon AM, Cassereau J, Attarian S. Prevalence, correlates and impact of pain and cramps in anti-MAG neuropathy: a multicentre European study. Eur J Neurol 2017; 25:135-141. [DOI: 10.1111/ene.13459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Y. A. Rajabally
- School of Life and Health Sciences, Aston Brain Centre; Aston University; Birmingham UK
- Regional Neuromuscular Clinic, Queen Elizabeth Hospital; University Hospitals of Birmingham; Birmingham UK
| | - E. Delmont
- Reference Centre for Neuromuscular Diseases and ALS; Centre Hospitalier Universitaire La Timone; Marseille France
| | - F. L. Hiew
- Regional Neuromuscular Clinic, Queen Elizabeth Hospital; University Hospitals of Birmingham; Birmingham UK
| | - A.-C. Aubé-Nathier
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
| | - A.-M. Grapperon
- Reference Centre for Neuromuscular Diseases and ALS; Centre Hospitalier Universitaire La Timone; Marseille France
| | - J. Cassereau
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
| | - S. Attarian
- Reference Centre for Neuromuscular Diseases and ALS; Centre Hospitalier Universitaire La Timone; Marseille France
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Pruppers MHJ, Draak THP, Vanhoutte EK, Van der Pol WL, Gorson KC, Léger JM, Nobile-Orazio E, Lewis RA, van den Berg LH, Faber CG, Merkies ISJ. Outcome measures in MMN revisited: further improvement needed. J Peripher Nerv Syst 2016; 20:306-18. [PMID: 26115442 DOI: 10.1111/jns.12124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/23/2015] [Accepted: 06/10/2015] [Indexed: 11/27/2022]
Abstract
The objectives of this study were to provide an overview of the outcome measures (OMs) applied in clinical trials in multifocal motor neuropathy (MMN) and to determine the responsiveness of a core set of selected OMs as part of the peripheral neuropathy outcome measures standardization (PeriNomS) study. The following OMs were serially applied in 26 patients with newly diagnosed or relapsing MMN, receiving intravenous immunoglobulin (assessments: T0/T3/T12 months): 14 muscle pairs MRC (Medical Research Council) scale, the Neuropathy Impairment Scale motor-subset, a self-evaluation scale, grip strength, and MMN-RODS© (Rasch-built overall disability scale). All data, except the grip strength, were subjected to Rasch analyses before determining responsiveness. For grip strength, responsiveness was examined using a combined anchor- (SF-36 question-2) and distribution-based (½ × SD) minimum clinically important difference (MCID) techniques, determining the proportion of patients exceeding both the identified cut-offs. For the remaining scales, the magnitude of change for each patient on each scale was determined using the MCID related to the individual SE (responder definition: MCID-SE ≥ 1.96). Overall, a great assortment of measures has been used in MMN trials with different responsiveness definitions. For the selected OMs, responsiveness was poor and only seen in one fourth to one third of the patients, the grip strength being more responsive. Despite the efforts taken to standardize outcome assessment, further clinimetric responsiveness studies are needed in MMN.
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Affiliation(s)
- Mariëlle H J Pruppers
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Thomas H P Draak
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Els K Vanhoutte
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W-Ludo Van der Pol
- Department of Neurology, Rudolf Magnus Institute of Neuroscience University Medical Center, Utrecht, The Netherlands
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Jean-Marc Léger
- Department of Neurology, Hôpital de la Salpêtrière, Paris, France
| | - Eduardo Nobile-Orazio
- Department of Neurological Sciences, Milan University, Humanitas Clinical Institute, Rozzano, Milan, Italy
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leonard H van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience University Medical Center, Utrecht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands
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Chuquilin M, Dhand UK. Erythromelalgia-like presentation of chronic acquired demyelinating polyneuropathy in a setting of past alcohol abuse. Neuromuscul Disord 2016; 26:176-80. [DOI: 10.1016/j.nmd.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/22/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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Segal BM, Pogatchnik B, Henn L, Rudser K, Sivils KM. Pain severity and neuropathic pain symptoms in primary Sjögren's syndrome: a comparison study of seropositive and seronegative Sjögren's syndrome patients. Arthritis Care Res (Hoboken) 2013; 65:1291-8. [PMID: 23335582 DOI: 10.1002/acr.21956] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/07/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare clinical characteristics and patient-reported outcomes in seropositive versus seronegative primary Sjögren's syndrome (SS) patients and to investigate the effect of serologic status on the prevalence of chronic pain, comorbidity, and health quality. METHODS Pain severity and neuropathic pain symptoms, comorbidity, and health status were assessed in 108 primary SS patients. Differences between patient groups were assessed by t-test and chi-square test, as well as adjusted pain-affect associations. The effect of predictor variables on pain severity was examined with multivariate regression. RESULTS Pain severity was greater (P = 0.003) and physical function (P = 0.023) was reduced in the seronegative patients. Prevalence of neuropathic pain, depression, anxiety, and disability was similar between groups. Chronic pain, defined as daily pain for >3 months, was reported by 65% of seropositive (n = 65) and 75% of seronegative (n = 40) patients. After adjustment for age, sleep quality, and psychological distress, the difference in pain severity between seropositive and seronegative patients remained significant. CONCLUSION Chronic pain is pervasive in both seropositive and seronegative primary SS patients, while pain severity and functional impairment are greater in seronegative patients. Neuropathic pain is equally prevalent and is the predominant pain phenotype in patients with moderate to severe pain. Accurate assessment of pain phenotypes is needed for more effective management of chronic pain in primary SS. The focus of future research should be to standardize assessment of pain and to identify the factors contributing to more severe pain in seronegative patients.
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Affiliation(s)
- Barbara M Segal
- Hennepin County Medical Center and University of Minnesota, Minneapolis, MN 55415, USA.
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Lucchetta M, Pazzaglia C, Padua L, Briani C. Exploring neuropathic symptoms in a large cohort of Italian patients with different peripheral nervous system diseases. Neurol Sci 2011; 32:423-6. [PMID: 21365294 DOI: 10.1007/s10072-011-0498-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 02/16/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Marta Lucchetta
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128 Padova, Italy
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