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Doneddu PE, Gentile L, Cocito D, Fazio R, Luigetti M, Briani C, Filosto M, Siciliano G, Benedetti L, Antonini G, Matà S, Marfia GA, Inghilleri M, Manganelli F, Cosentino G, Brighina F, Carpo M, Carta F, Mazzeo A, Peci E, Strano C, Romano A, Campagnolo M, Cotti-Piccinelli S, Viola DV, Germano F, Leonardi L, Sperti M, Mataluni G, Ceccanti M, Spina E, Vegezzi E, Di Stefano V, Nobile-Orazio E. Assessment of diagnostic criteria for multifocal motor neuropathy in patients included in the Italian database. Eur J Neurol 2024; 31:e16248. [PMID: 38376074 DOI: 10.1111/ene.16248] [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: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE This study aimed to assess the diagnostic criteria, ancillary investigations and treatment response using real-life data in multifocal motor neuropathy (MMN) patients. METHODS Clinical and laboratory data were collected from 110 patients enrolled in the Italian MMN database through a structured questionnaire. Twenty-six patients were excluded due to the unavailability of nerve conduction studies or the presence of clinical signs and symptoms and electrodiagnostic abnormalities inconsistent with the MMN diagnosis. Analyses were conducted on 73 patients with a confirmed MMN diagnosis and 11 patients who did not meet the diagnostic criteria. RESULTS The European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria were variably applied. AUTHOR When applying the American Association of Electrodiagnostic Medicine criteria, an additional 17% of patients fulfilled the criteria for probable/definite diagnosis whilst a further 9.5% missed the diagnosis. In 17% of the patients only compound muscle action potential amplitude, but not area, was measured and subsequently recorded in the database by the treating physician. Additional investigations, including anti-GM1 immunoglobulin M antibodies, cerebrospinal fluid analysis, nerve ultrasound and magnetic resonance imaging, supported the diagnosis in 46%-83% of the patients. Anti-GM1 immunoglobulin M antibodies and nerve ultrasound demonstrated the highest sensitivity. Additional tests were frequently performed outside the EFNS/PNS guideline recommendations. CONCLUSIONS This study provides insights into the real-world diagnostic and management strategies for MMN, highlighting the challenges in applying diagnostic criteria.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Dario Cocito
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Sede di Roma, Roma, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical center for Neuromuscular Diseases, Brescia, Italy
| | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giovanni Antonini
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza' University of Rome, Roma, Italy
| | - Sabrina Matà
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Girolama Alessandra Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Maurizio Inghilleri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Filippo Brighina
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | | | - Francesca Carta
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Erdita Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Camilla Strano
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Sede di Roma, Roma, Italy
| | - Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Stefano Cotti-Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical center for Neuromuscular Diseases, Brescia, Italy
| | - Divina Valeria Viola
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Luca Leonardi
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza' University of Rome, Roma, Italy
| | - Martina Sperti
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Giorgia Mataluni
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Vincenzo Di Stefano
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
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Al-Zuhairy A, Jakobsen J, Krarup C. Prevention of axonal loss after immediate dosage titration of immunoglobulin in multifocal motor neuropathy. Eur J Neurol 2024:e16305. [PMID: 38651498 DOI: 10.1111/ene.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND To evaluate whether ongoing axonal loss can be prevented in multifocal motor neuropathy (MMN) treated with immunoglobulin G (IgG), a group of patients with a median disease duration of 15.7 years (range: 8.3-37.8), treated with titrated dosages of immunoglobulins, was studied electrophysiologically at time of diagnosis and at follow-up. RESULTS At follow-up, the Z-score of the compound motor action potential amplitude of the median, fibular, and tibial nerves and the neurological performances were determined. In seven patients with a treatment-free period of 0.3 years (0.2-0.4), there was no progression of axonal loss (p = 0.2), whereas a trend toward further axonal loss by 1.3 Z-scores (0.9-17.0, p = 0.06) was observed in five patients with a treatment-free period of 4.0 years (0.9-9.0). The axonal loss in the group with a short treatment delay was significantly smaller than in the group with a longer treatment delay (p = 0.02). Also, there was an association between treatment delay and ongoing axonal loss (p = 0.004). The electrophysiological findings at follow-up were associated with the isokinetic strength performance, the neurological impairment score, and the disability, supporting the clinical relevance of the electrophysiological estimate of axonal loss. CONCLUSION Swift initiation of an immediately titrated IgG dosage can prevent further axonal loss and disability in continuously treated MMN patients.
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Affiliation(s)
- Ali Al-Zuhairy
- Department of Neurology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Johannes Jakobsen
- Department of Neurology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Christian Krarup
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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3
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Englezou C, Nazeer KK, Rajabally YA. Impact of social-functioning and sleep on quality of life in chronic inflammatory demyelinating polyneuropathy. Clin Neurol Neurosurg 2023; 234:108017. [PMID: 37866209 DOI: 10.1016/j.clineuro.2023.108017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION/AIMS The impact of impairment of social functioning and sleep on health-related quality of life (HR-QoL), is unknown in chronic inflammatory demyelinating polyneuropathy (CIDP). The value of the Chronic Acquired Polyneuropathy Patient-Reported Index (CAP-PRI) to identify potential social functioning and sleep issues is equally unknown. METHODS We performed a cross-sectional evaluation of social functioning and sleep using the "Scales for Outcomes in Parkinson's Disease" (SCOPA) in 40 subjects with clinically-stable CIDP through a structured questionnaire. We assessed HR-QoL through the CAP-PRI. Disability was evaluated through the Overall Neuropathy Limitation Score (ONLS). RESULTS SCOPA social functioning scores were impaired at least "a little" per averaged item in > 50 % of subjects, and at least "quite a bit" per averaged item in > 20 %. Most affected items were (i) difficulty with work/household/other chores (ii) difficulties with hobbies/sport/leisure activities. SCOPA sleep sub-scores indicated at least "a little concern" for night-time sleep in nearly 50 % of subjects. Abnormal sleep timing was rare. Associations were found between both SCOPA social-functioning and SCOPA sleep scores and the CAP-PRI. Linear regression demonstrated the SCOPA social-functioning score was independently associated with the CAP-PRI. The CAP-PRI showed high association with disability scores, good internal consistency, absence of ceiling effect, absence of significant floor-effect, and good criteria-related as well as construct-related validity. DISCUSSION Social functioning and night-time sleep are frequently affected in CIDP and impact on HR-QoL. In contrast to traditional disability scales, the CAP-PRI additionally allows adequately capturing these impairments and may represent an adequate holistic outcome measure.
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Affiliation(s)
- Christina Englezou
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Kabir K Nazeer
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, United Kingdom; Aston Medical School, Aston University, Birmingham, United Kingdom
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, United Kingdom; Aston Medical School, Aston University, Birmingham, United Kingdom.
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4
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Foster MA, Lunn MP, Carr AS. First-line immunosuppression in neuromuscular diseases. Pract Neurol 2023:pn-2023-003708. [PMID: 37173131 DOI: 10.1136/pn-2023-003708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/15/2023]
Abstract
Autoimmune neuromuscular diseases are common and often treatable causes for peripheral nervous system dysfunction. If not optimally managed, they result in meaningful impairments and disability. The treating neurologist should aim to maximise clinical recovery with minimal iatrogenic risk. This requires careful patient and medication selection, appropriate counselling and close monitoring of clinical efficacy and safety. Here, we summarise our consensus departmental approach to first-line immunosuppression in neuromuscular diseases. We combine multispecialty evidence and expertise with a focus on autoimmune neuromuscular diseases to create guidance on starting, dosing and monitoring for toxic effects of the commonly used drugs. These include corticosteroids, steroid-sparing agents and cyclophosphamide. We also provide efficacy monitoring advice, as clinical response informs dosage and drug choice. The principles of this approach could be applied across much of the spectrum of immune-mediated neurological disorders where there is significant therapeutic crossover.
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Affiliation(s)
- Michael A Foster
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Division of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael Pt Lunn
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aisling S Carr
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
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5
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Keh RYS, Lilleker JB, Lavin T, Sive J, D'Sa S, Ramdharry G, Carr AS, Lunn MP. Rasch-built overall disability scale for POEMS syndrome (POEMS-RODS). J Peripher Nerv Syst 2022; 27:302-310. [PMID: 36190435 PMCID: PMC10092098 DOI: 10.1111/jns.12516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
Abstract
Patient-reported outcome measures engage patients in disease severity measurement and the metrics reported can be meaningful to their lives. The Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes syndrome (POEMS) is a complex multisystem disorder with disabling neuropathy which is distinct from other acquired inflammatory neuropathies. No current POEMS-specific validated disability scales exist. To address this, we have produced a Rasch-built overall disability scale (RODS) specific to POEMS. A 146-item preliminary questionnaire containing relevant activity and participation items for neuropathic disability was applied to 49 clinically stable patients with POEMS from the UK national POEMS cohort. A total of 123 items not fulfilling Rasch model expectations were sequentially removed. The final 23-item POEMS-RODS fulfilled Rasch model expectations and showed acceptable test-retest reliability. The 23-item POEMS-RODS is a disease-specific patient-reported outcome measure able to detect activity limitations within the range of ability demonstrated by the UK POEMS cohort. Larger international studies are needed to confirm the broader applicability and responsiveness of this scale in other countries.
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Affiliation(s)
- Ryan Yann Shern Keh
- Queen Square Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.,Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - James B Lilleker
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK.,Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tim Lavin
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Jonathan Sive
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gita Ramdharry
- Queen Square Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Neurology, University College London, London, UK
| | - Aisling S Carr
- Queen Square Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Neurology, University College London, London, UK
| | - Michael P Lunn
- Queen Square Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Neurology, University College London, London, UK
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6
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Keh RYS, Shah S, Lilleker JB, Lavin T, Morrow J, Carr AS, Lunn MP. Pragmatic guide to peripheral nerve disease and the role of clinical biomarkers. Pract Neurol 2022; 22:pn-2022-003438. [PMID: 35850979 DOI: 10.1136/pn-2022-003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
In clinical neurology practice, there are few sensitive, specific and responsive serological biomarkers reflecting pathological processes affecting the peripheral nervous system. Instead, we rely on surrogate multimodality biomarkers for diagnosis and management. Correct use and interpretation of the available tests is essential to ensure that appropriate treatments are used and adjusted in a timely fashion. The incorrect application or interpretation of biomarkers can result in misdiagnosis and delays in appropriate treatment. Here, we discuss the uses and limitations of such biomarkers and discuss possible future developments.
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Affiliation(s)
- Ryan Yann Shern Keh
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - James B Lilleker
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Division of Musculoskeletal and Dermatological, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tim Lavin
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Jasper Morrow
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Lysholm Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling S Carr
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Neurology, University College London, London, UK
| | - Michael P Lunn
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Neurology, University College London, London, UK
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Rajabally YA. Electrophysiology to identify disease mechanisms in CIDP: Reliability and value. Muscle Nerve 2022; 66:113-115. [PMID: 35596645 DOI: 10.1002/mus.27640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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8
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Goedee HS, Rajabally YA. Evidence base for investigative and therapeutic modalities in chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy. Neurodegener Dis Manag 2022; 12:35-47. [PMID: 35007438 DOI: 10.2217/nmt-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy, its variants and multifocal motor neuropathy belong to a spectrum of peripheral nerve disorders with complex dysimmune disease mechanisms. Awareness of the unique clinical phenotypes but also heterogeneity between patients is vital to arrive at early suspicion and ordering appropriate tests. This includes requirements for optimal electrodiagnostic protocol, aimed to capture sufficient electrophysiologic evidence for relevant abnormalities, a case-based approach on the eventual need to further expand the diagnostic armamentarium and correct reading of their results. Considerable phenotypical variation, diverse combinations of abnormalities found on diagnostic tests and heterogeneity in disease course and treatment response, all contribute to widespread differences in success rates on timely diagnosis and optimal treatment. We aim to provide a practical overview and guidance on relevant diagnostic and management strategies, including pitfalls and present a summary of the relevant novel developments in this field.
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Affiliation(s)
- Hendrik Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology & Neurosurgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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9
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Keh RYS, Selby DA, Jones S, Gosal D, Lavin T, Lilleker JB, Carr AS, Lunn MP. Predicting long-term trends in inflammatory neuropathy outcome measures using latent class modelling. J Peripher Nerv Syst 2021; 27:84-93. [PMID: 34936164 DOI: 10.1111/jns.12481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immunoglobulin (Ig) is used to treat chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy with conduction block (MMNCB). Regular infusions may be used for symptom control. Disease activity is monitored with clinical outcome measurements. We examined outcome measure variation during clinically stable periods in Ig-treated CIDP and MMNCB patients. We explored utility of serial outcome measurement in long-term outcome prediction. METHODS Retrospective longitudinal analysis of a single neuroscience centre's Ig-treated CIDP and MMNCB patients, 2009-2020, was performed. Mean and percentage change for grip strength, Rasch-built overall disability scales (RODS) and MRC sum scores (MRC-SS) during periods of clinical stability were compared to score-specific minimal clinically important differences (MCID). Latent class mixed modelling (LCMM) was used to identify longitudinal trends and factors influencing long-term outcome. RESULTS We identified 85 CIDP and 23 MMNCB patients (1,423 datapoints; 5635 treatment-months). Group-averaged outcome measures varied little over time. Intra-individual variation exceeded MCID for RODS in 44.2% CIDP and 16.7% MMNCB datapoints, grip strength in 10.6% (CIDP) and 8.8%/27.2% (MMNCB right/left hand) and MRC-SS in 43.5% (CIDP) and 20% (MMNCB). Multivariate LCMM identified subclinical trends toward improvement (32 patients) and deterioration (73 patients) in both cohorts. At baseline, CIDP 'deteriorators' were older than 'improvers' (66.2 versus 57 years, p=0.025). No other individual factors predicted categorisation. The best model for 'deteriorator' identification was contiguous sub-MCID decline in more than one outcome measure (CIDP: sensitivity 74%, specificity 59%; MMNCB: sensitivity 73%, specificity 88%). DISCUSSION Outcome measure interpretation determines therapeutic decision-making in Ig-dependent neuropathy patients, but intra-individual variation is common, often exceeding MCID. Here we show sub-MCID contiguous changes in more than one outcome measurement are a better predictor of long-term outcome. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ryan Yann Shern Keh
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK.,MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Antony Selby
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Sam Jones
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - David Gosal
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Timothy Lavin
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - James B Lilleker
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK.,Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Aisling S Carr
- MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael P Lunn
- MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Neurology, University College London, London, UK
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10
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Immunoglobulin shortage: Practice modifications and clinical outcomes in a reference centre. Rev Neurol (Paris) 2021; 178:616-623. [PMID: 34872746 DOI: 10.1016/j.neurol.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/06/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Growing numbers of indications for intravenous immunoglobulins (IVIg) in recent years has resulted in an increase in the consumption of these products. A lack of raw material has led to IVIg shortage. The objective of this work was to evaluate the impact of this situation on patient care in one French referral centre considering practice modifications and clinical impact. METHODS All patients treated with IVIg for chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and myasthenia gravis from October 2017 to October 2018 were included. RESULTS Out of 142 patients, 111 (78%) had a modification of their IVIg treatment. We noted that 75 (68%) patients had a delay in IVIg treatment, 41 (37%) patients had a decrease in IVIg doses and 31 (28%) experienced IVIg treatment interruption. Thirty percent of patients for whom IVIg treatment was discontinued were switched to other treatments mainly plasma exchange (16%) or corticosteroids (13%). Switches to plasma exchange or corticosteroids were carried out in order to save immunoglobulins for patients who had no other alternatives. Fifty-eight (52%) patients presented a deterioration of their clinical score after IVIg treatment changes including 31 (28%) patients who had a moderate or a clinically significant deterioration. Concerning practice modifications, we noted a substantial though not significant decrease in median IVIg dose for myasthenia gravis and a significant increase in the delay between IVIg courses for chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy (P=0.011 and P=0.018 respectively). CONCLUSION Our study showed a rather important number of changes in IVIg treatment related to IVIg shortage during the period considered. These changes had a negative impact on the clinical status of some patients.
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11
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The risks of using non-specific outcome measures to capture activities of daily living in myotonic dystrophy type 2. Neuromuscul Disord 2021; 31:367-368. [PMID: 33741224 DOI: 10.1016/j.nmd.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022]
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12
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Kapoor M, Reilly MM, Manji H, Lunn MP, Aisling S, Carr. Dramatic clinical response to ultra-high dose IVIg in otherwise treatment resistant inflammatory neuropathies. Int J Neurosci 2020; 132:352-361. [PMID: 32842835 DOI: 10.1080/00207454.2020.1815733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIg) has short and long-term efficacy in both chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy with conduction block (MMNCB). There is potential for under and over-treatment if trial regimens are strictly adhered to in clinical practice where titrating dose to clinical response is recommended. METHODS We report the response to high-dose IVIg (>2 g/kg/6 weeks) in a subgroup of patients with definite CIDP or MMNCB who were unresponsive to 'usual' dosing. IVIg frequency and dosing was determined for each individual by subjective and objective outcome measures for impairment, grip strength, and activity and participation. RESULTS Six patients (three with chronic inflammatory demyelinating polyneuropathy (CIDP), three with MMN) were included. Two patients (one CIDP and one MMNCB) returned to full-time work on fractionated IVIg doses of 5 g/kg/month and 9 g/kg/month. Patient three (CIDP) failed numerous other immunosuppressants but responded to short-term fractionated 4 g/kg/month of IVIg. Patient four has severe, refractory, childhood-onset CIDP, remains stable but dependent currently on 6.9 g/kg/month of IVIg. Patients five and six, both with MMNCB, required short term 4.5-5 g/kg/month to recover significant bilateral hand strength. No IVIg-related adverse events occurred in any individual. CONCLUSIONS These six cases demonstrate the safety and effectiveness of a treatment approach that includes individualised but evidence-based clinical assessment and, when necessary, high-doses of IVIg to restore patients' strength and ability to participate in activities of daily activities. Careful patient selection is important.
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Affiliation(s)
- Mahima Kapoor
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK.,National Hospital of Neurology and Neurosurgery (NHNN), London, UK
| | - Hadi Manji
- National Hospital of Neurology and Neurosurgery (NHNN), London, UK
| | - Michael P Lunn
- National Hospital of Neurology and Neurosurgery (NHNN), London, UK.,Department of Neuroimmunology, UCL Queen Square Institute of Neurology, London, UK
| | | | - Carr
- National Hospital of Neurology and Neurosurgery (NHNN), London, UK.,Department of Neuroimmunology, UCL Queen Square Institute of Neurology, London, UK
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13
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Herraets I, van Rosmalen M, Bos J, van Eijk R, Cats E, Jongbloed B, Vlam L, Piepers S, van Asseldonk JT, Goedee HS, van den Berg L, van der Pol WL. Clinical outcomes in multifocal motor neuropathy: A combined cross-sectional and follow-up study. Neurology 2020; 95:e1979-e1987. [PMID: 32732293 DOI: 10.1212/wnl.0000000000010538] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/17/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the clinical course of multifocal motor neuropathy (MMN) in a large cohort of patients and to identify predictive factors of a progressive disease course. METHODS Between May 2015 and February 2016, we collected clinical data from 100 patients with MMN, of whom 60 had participated in a nationwide cross-sectional cohort study in 2007. We documented clinical characteristics using standardized questionnaires and performed a standardized neurologic examination. We used multiple linear regression analysis to identify factors that correlated with worse outcome. RESULTS We found that age at diagnosis (45.2 vs 48.6 years, p < 0.02) was significantly increased between 2007 and 2015-2016, whereas diagnostic delay decreased by 15 months. Seven out of 10 outcome measures deteriorated over time (all p < 0.01). Patients who had a lower Medical Research Council (MRC) sumscore and absence of 1 or more reflexes at the baseline visit showed a greater functional loss at follow-up (p = 0.007 and p = 0.016). CONCLUSIONS Our study shows that MMN is a progressive disease. Although 87% of patients received maintenance treatment, muscle strength, reflexes, vibration sense, and the Self-Evaluation Scale score significantly deteriorated over time. Lower MRC sumscore and absence of reflexes predicted a more progressive disease course. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that lower MRC sumscore and the absence of reflexes predict a more progressive disease course in patients with MMN.
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Affiliation(s)
- Ingrid Herraets
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Marieke van Rosmalen
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Jeroen Bos
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Ruben van Eijk
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Elies Cats
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Bas Jongbloed
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Lotte Vlam
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Sanne Piepers
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Jan-Thies van Asseldonk
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Leonard van den Berg
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands.
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14
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Herraets IJT, Goedee HS, Telleman JA, van Eijk RPA, Verhamme C, Saris CGJ, Eftimov F, van Alfen N, van Asseldonk JT, Visser LH, van den Berg LH, van der Pol LW. Nerve ultrasound for diagnosing chronic inflammatory neuropathy: A multicenter validation study. Neurology 2020; 95:e1745-e1753. [PMID: 32675082 DOI: 10.1212/wnl.0000000000010369] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/06/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To validate the diagnostic accuracy of a previously described short sonographic protocol to identify chronic inflammatory neuropathy (CIN), including chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis Sumner syndrome, and multifocal motor neuropathy (MMN), and to determine the added value of nerve ultrasound to detect treatment-responsive patients compared to nerve conduction studies (NCS) in a prospective multicenter study. METHODS We included 100 consecutive patients clinically suspected of CIN in 3 centers. The study protocol consisted of neurologic examination, laboratory tests, NCS, and nerve ultrasound. We validated a short sonographic protocol (median nerve at forearm, upper arm, and C5 nerve root) and determined its diagnostic accuracy using the European Federation of Neurological Societies/Peripheral Nerve Society criteria of CIDP/MMN (reference standard). In addition, to determine the added value of nerve ultrasound in detecting treatment-responsive patients, we used previously published diagnostic criteria based on clinical, NCS, and sonographic findings and treatment response (alternative reference standard). RESULTS Sensitivity and specificity of the sonographic protocol for CIN according to the reference standard were 87.4% and 67.3%, respectively. Sensitivity and specificity of this protocol according to the alternative reference standard were 84.6% and 72.8%, respectively, and of NCS 76.1% and 93.4%. With addition of nerve ultrasound, 44 diagnoses of CIN were established compared to 33 diagnoses with NCS alone. CONCLUSIONS A short sonographic protocol shows high diagnostic accuracy for detecting CIN. Nerve ultrasound is able to detect up to 25% more patients who respond to treatment. CLASSIFICATION OF EVIDENCE This multicenter study provides Class IV evidence that nerve ultrasound improves diagnosis of CIN.
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Affiliation(s)
- Ingrid J T Herraets
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan A Telleman
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruben P A van Eijk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Verhamme
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christiaan G J Saris
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Filip Eftimov
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nens van Alfen
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J Thies van Asseldonk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leo H Visser
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludo W van der Pol
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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15
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Fournier CN, Bedlack R, Quinn C, Russell J, Beckwith D, Kaminski KH, Tyor W, Hertzberg V, James V, Polak M, Glass JD. Development and Validation of the Rasch-Built Overall Amyotrophic Lateral Sclerosis Disability Scale (ROADS). JAMA Neurol 2020; 77:480-488. [PMID: 31886839 DOI: 10.1001/jamaneurol.2019.4490] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance A new outcome measure for overall disability level with improved responsiveness is needed for amyotrophic lateral sclerosis (ALS) clinical trials. Objective To describe the creation and development of a new self-reported ALS disability scale with improved item targeting and psychometric properties that used a mathematically rigorous Rasch methodology. Design, Setting, and Participants A preliminary ALS disability questionnaire with 119 questions was created based on literature review, clinical judgement of an expert panel, and patient input. Patients with ALS were recruited from January 2017 to June 2019 from the Emory University and Atlanta VA Medical Center ALS clinics, both in Atlanta, Georgia, during regularly scheduled clinic appointments to complete the draft questionnaire and standard ALS outcome measures. All consecutive patients seen at the Emory University and Atlanta VA Medical Center ALS clinics during the recruitment period with a diagnosis of ALS who were able to provide informed consent were invited to participate in the study. Rasch analyses were performed, and items were systematically removed based on missing data, model fit, disordered thresholds, item bias, and clinical judgment. A total of 509 patients with ALS were seen at the 2 sites during the recruitment period, and 264 patients provided informed consent. Interventions Participants completed the draft Rasch questionnaire and the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). Main Outcomes and Measures Rasch analyses and standard scale metrics were performed to create the new scale, and Rasch analyses were performed on the ALSFRS-R for comparison. Results Overall, 243 participants with ALS completed the draft questionnaire, and 230 participants were included for Rasch analyses. The mean (SD) age for study participants was 61.9 (11.1) years, 146 (60.1%) were men, and site of onset was 23.0% bulbar (n = 56), 36.2% upper extremity (n = 88), and 39.5% lower extremity (n = 96). A 28-question Rasch-Built Overall ALS Disability Scale (ROADS) was constructed with each item scored 0, 1, or 2. The ROADS fulfilled Rasch model requirements, demonstrated improved item targeting compared with the ALSFRS-R, and had test-retest reliability of 0.97. Individual question fit statistics demonstrated infit values from 0.68 to 1.37 and outfit values from 0.66 to 1.43. The difference between the empirical variance explained by the measures and the modeled variance was 0.1%. The ALSFRS-R violated Rasch model expectations and demonstrated disordered thresholds for 9 of 12 questions; 13 of 48 answer choices on the ALSFRS-R were never the most probable answer choice for any overall disability level. Conclusions and Relevance In this study, the 28-question, self-reported ROADS, which is linearly weighted, had improved item targeting compared with the ALSFRS-R, had high test-retest reliability, and was validated. ROADS may serve as a valuable and easily accessible outcome measure for use in ALS trials and in the clinic with improved responsiveness compared with the ALSFRS-R.
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Affiliation(s)
| | | | | | | | | | | | - William Tyor
- Atlanta VA Medical Center, Atlanta, Georgia.,Emory University, Atlanta, Georgia
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16
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Doneddu PE, Mandia D, Gentile F, Gallia F, Liberatore G, Terenghi F, Ruiz M, Nobile-Orazio E. Home monitoring of maintenance intravenous immunoglobulin therapy in patients with chronic inflammatory neuropathy. J Peripher Nerv Syst 2020; 25:238-246. [PMID: 32470190 DOI: 10.1111/jns.12396] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
To evaluate the utility of different outcome measures to monitor dose adjustment of intravenous immunoglobulin (IVIg) therapy in patients with chronic inflammatory neuropathy (CIN). We assessed the adjustment of IVIg maintenance therapy in 20 patients (10 CIDP and 10 MMN) by regularly monitoring grip strength (GS) using a Martin Vigorimeter, RODS, and quality of life using the SF-36 questionnaire. These measures were regularly performed by the patient at home. We also assessed the extended MRC sumscore (eMRC sumscore) at each outpatient visit for IVIg infusion. We also enrolled 30 healthy controls to measure any possible training effect of GS with time and to analyze random fluctuation of GS. Clinically relevant change was detected by eMRC sumscore in 14 (93%) patients, by RODS in 11 (73%) patients, and by GS in 8 (53%) patients. Early sensitivity was greatest for RODS (73%), followed by GS (53%), and eMRC sumscore (27%). This differed from CIDP, with an early change in RODS in 100% of patients, and MMN with an early change in GS in 75%. None of the outcome measures alone was sufficient to detect clinically significant changes in all patients. Home monitoring of outcome measures objectively assisted clinical decision during individualization of IVIg treatment. We recommend a multimodal approach using different outcome measures to monitor the individual patient with CIN.
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Affiliation(s)
| | | | | | | | | | | | - Marta Ruiz
- Humanitas Clinical and Research Institute, Milan, Italy
| | - Eduardo Nobile-Orazio
- Humanitas Clinical and Research Institute, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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17
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Doneddu PE, Hadden RDM. Daily grip strength response to intravenous immunoglobulin in chronic immune neuropathies. Muscle Nerve 2020; 62:103-110. [PMID: 32319099 DOI: 10.1002/mus.26898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Monitoring grip strength at home may detect improvement between intravenous immunoglobulin (IVIg) treatments in patients with chronic inflammatory neuropathies (CINs). METHODS Fifteen patients recorded grip strength each day, from one IVIg treatment until the next. We analyzed grip strength changes comparing thresholds of 8 kPa and 14 kPa. "Random" fluctuations of grip strength were distinguished from treatment response by smoothing the data. RESULTS "Random" fluctuations of at least 8 kPa occurred in 27% of patients. Smoothed daily grip strength increased by at least 8 kPa above baseline in 11 (73%) patients. Grip strength increased by at least 8 kPa for 3 consecutive days in 9 (60%) patients, and 5-day block mean increased by at least 8 kPa in 10 (67%) patients. DISCUSSION Home monitoring of grip strength confirmed treatment response in most patients with CINs on IVIg. To detect improvement in an individual patient, we suggest a threshold of at least 8 kPa on 3 consecutive days or on 5-day block mean.
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Affiliation(s)
- Pietro E Doneddu
- Department of Neurology, King's College Hospital, King's College London, London, UK
| | - Robert D M Hadden
- Department of Neurology, King's College Hospital, King's College London, London, UK
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18
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Rajabally YA, Goedee HS, Attarian S, Hartung HP. Management challenges for chronic dysimmune neuropathies during the COVID-19 pandemic. Muscle Nerve 2020; 62:34-40. [PMID: 32311114 PMCID: PMC7264511 DOI: 10.1002/mus.26896] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/29/2022]
Abstract
Since March 2020, the COVID-19 pandemic has led to the need to re-think the delivery of services to patients with chronic dysimmune neuropathies. Telephone/video consultations have become widespread but have compounded concerns about objective evaluation. Therapeutic decisions need, more than ever before, to be considered in the best interests of both patients, and society, while not denying function-preserving/restoring treatment. Immunoglobulin therapy and plasma exchange, for those treated outside of the home, expose patients to the hazards of hospital or outpatient infusion centers. Steroid therapy initiation and continuation pose increased infectious risk. Immunosuppressant therapy similarly becomes highly problematic, with the risks of treatment continuation enhanced by uncertainties regarding duration of the pandemic. The required processes necessitate considerable time and effort especially as resources and staff are re-deployed to face the pandemic, but are essential for protecting this group of patients and as an integral part of wider public health actions.
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Affiliation(s)
- Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Birmingham, United Kingdom.,Aston Medical School, Aston University, Birmingham, United Kingdom
| | - H Stephan Goedee
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Shahram Attarian
- Reference Centre for Neuromuscular Diseases and ALS, Centre Hospitalier Universitaire La Timone, 264 rue Saint-Pierre, 13385, Marseille, France.,Aix-Marseille University, Inserm, GMGF, Marseille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and Center of Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine University, Düsseldorf, Germany
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19
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Herraets IJT, Goedee HS, Telleman JA, van Eijk RPA, van Asseldonk JT, Visser LH, van den Berg LH, van der Pol WL. Nerve ultrasound improves detection of treatment-responsive chronic inflammatory neuropathies. Neurology 2020; 94:e1470-e1479. [PMID: 31959710 DOI: 10.1212/wnl.0000000000008978] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/07/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To examine the diagnostic accuracy of nerve ultrasound in a prospective cohort of consecutive patients with a clinical suspicion of chronic inflammatory neuropathies, including chronic inflammatory demyelinating polyneuropathy, Lewis-Sumner syndrome, and multifocal motor neuropathy, and to determine the added value in the detection of treatment-responsive patients. METHODS Between February 2015 and July 2018, we included 100 consecutive incident patients with a clinical suspicion of chronic inflammatory neuropathy. All patients underwent nerve ultrasound, extensive standardized nerve conduction studies (NCS), and other relevant diagnostic investigations. We evaluated treatment response using predefined criteria. A diagnosis of chronic inflammatory neuropathy was established when NCS were abnormal (fulfilling criteria of demyelination of the European Federation of Neurological Societies/Peripheral Nerve Society) or when the degree of nerve enlargement detected by sonography was compatible with chronic inflammatory neuropathy and there was response to treatment. RESULTS A diagnosis of chronic inflammatory neuropathy was established in 38 patients. Sensitivity and specificity of nerve ultrasound and NCS were 97.4% and 69.4% and 78.9% and 93.5%, respectively. The added value of nerve ultrasound in detection of treatment-responsive chronic inflammatory neuropathy was 21.1% compared to NCS alone. CONCLUSIONS Nerve ultrasound and NCS are complementary techniques with superior sensitivity in the former and specificity in the latter. Addition of nerve ultrasound significantly improves the detection of chronic inflammatory neuropathies. Therefore, it deserves a prominent place in the diagnostic workup of chronic inflammatory neuropathies. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that nerve ultrasound is an accurate diagnostic tool to detect chronic inflammatory neuropathies.
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Affiliation(s)
- Ingrid J T Herraets
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Johan A Telleman
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Ruben P A van Eijk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - J Thies van Asseldonk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Leo H Visser
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
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20
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Corazza G, Le Corroller T, Grapperon AM, Salort-Campana E, Verschueren A, Attarian S, Delmont E. Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy. Muscle Nerve 2019; 61:325-329. [PMID: 31792993 DOI: 10.1002/mus.26773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conduction blocks (CB) are the diagnostic hallmark of multifocal motor neuropathy (MMN). Conventional nerve conduction studies cannot detect CB above Erb's point. Our purpose was to compare the performance of the motor evoked potential with triple stimulation technique (MEP-TST) and MRI in the detection of abnormalities of the brachial plexus. METHODS Examinations were performed on 26 patients with MMN (11 definite, 6 probable, 9 possible), of whom 7 had no CB. RESULTS MEP-TST detected proximal CB in 19/26 patients. Plexus MRI showed T2 hyperintensity in 18/26 patients, with nerve enlargement in 14/18. A combination of both techniques increased the detection rate of brachial plexus abnormalities to 96% of patients (25/26). CONCLUSIONS MEP-TST and MRI have high sensitivities for detecting brachial plexus abnormalities. A combination of the two techniques increases the detection rate of supportive criteria for the diagnosis of MMN.
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Affiliation(s)
- Giovanni Corazza
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Thomas Le Corroller
- Department of Radiology, Institute for Locomotion, Hôpital Sainte-Marguerite, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | | | - Annie Verschueren
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France.,Aix-Marseille University, Timone Neuroscience Institute, UMR CNRS 7289, Marseille, France
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21
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Chia PK, Hung SKY, Hiew FL. Clinical and functional change in multifocal motor neuropathy treated with IVIg. J Clin Neurosci 2019; 69:114-119. [DOI: 10.1016/j.jocn.2019.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
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22
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Al‐Zuhairy A, Sindrup SH, Andersen H, Jakobsen J. A population‐based and cross‐sectional study of the long‐term prognosis in multifocal motor neuropathy. J Peripher Nerv Syst 2019; 24:64-71. [DOI: 10.1111/jns.12311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/09/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - Søren H. Sindrup
- Department of NeurologyOdense University Hospital Odense Denmark
| | - Henning Andersen
- Department of NeurologyAarhus University Hospital Aarhus Denmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
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23
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Léger JM, Alfa Cissé O, Cocito D, Grouin JM, Katifi H, Nobile-Orazio E, Ouaja R, Pouget J, Rajabally YA, Sevilla T, Merkies ISJ. IqYmune® is an effective maintenance treatment for multifocal motor neuropathy: A randomised, double-blind, multi-center cross-over non-inferiority study vs Kiovig®-The LIME Study. J Peripher Nerv Syst 2018; 24:56-63. [PMID: 30456899 PMCID: PMC6590491 DOI: 10.1111/jns.12291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022]
Abstract
Intravenous immunoglobulin (IVIg) is the gold‐standard for maintenance treatment of multifocal motor neuropathy (MMN). This phase III, randomised, double‐blind, multi‐centre, active‐control, crossover study, aimed to evaluate the non‐inferiority of IqYmune® relative to Kiovig®, primarily based on efficacy criteria. Twenty‐two adult MMN patients, treated with any brand of IVIg (except Kiovig® or IqYmune®) at a stable maintenance dose within the range of 1 to 2 g/kg every 4 to 8 weeks, were randomised to receive either Kiovig® followed by IqYmune®, or IqYmune® followed by Kiovig®. Each product was administered for 24 weeks. The primary endpoint was the difference between IqYmune® and Kiovig® in mean assessments of modified Medical Research Council (MMRC) 10 sum score (strength of 5 upper‐limb and 5 lower‐limb muscle groups, on both sides, giving a score from 0 to 100) during the evaluation period (non‐inferiority margin of Δ = 2). A linear mixed model analysis demonstrated the non‐inferiority of IqYmune® relative to Kiovig®, independently of the covariates (value at baseline, treatment period, and treatment sequence). The estimated “IqYmune® − Kiovig®” difference was −0.01, with a 95% confidence interval (CI) −0.51 to 0.48. The number of adverse reactions (ARs) and the percentage of patients affected were similar for the two products: 39 ARs in 10 patients with IqYmune® vs 32 ARs in 11 patients with Kiovig®. No thromboembolic events nor haemolysis nor renal impairment were observed. In this first clinical trial comparing two IVIg brands for maintenance treatment of MMN, efficacy and tolerability of both brands were similar.
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Affiliation(s)
- Jean-Marc Léger
- National Referral Center for Neuromuscular Diseases, University Hospital Pitié-Salpétrière, Paris, France
| | | | - Dario Cocito
- Department of Neurosciences, Molinette Hospital, Università degli Studi di Torino, Torino, Italy
| | | | - Haider Katifi
- Wessex Neurological Centre, Southampton General Hospital, Southampton, UK
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Center, Milan University, Milan, Italy
| | - Rabye Ouaja
- Global Medical Affairs, LFB, Les Ulis, France
| | - Jean Pouget
- National Referral Center for Neuromuscular Diseases, University Hospital La Timone, Marseille, France
| | - Yusuf A Rajabally
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK
| | - Teresa Sevilla
- Neurology Department, La Fe University Hospital, Centro de investigación Biomédica en red de enfermedades raras (CIBERER), University of Valencia, Valencia, Spain
| | - Ingemar S J Merkies
- Maastricht University Medical Center, Maastricht, The Netherlands.,St. Elisabeth Hospital, Willemstad, Curacao
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24
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Rasch model-based testing of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy (QLQ-CIPN20) using Alliance for Clinical Trials in Oncology (Alliance) A151408 study data. Support Care Cancer 2018; 27:2599-2608. [PMID: 30460399 DOI: 10.1007/s00520-018-4553-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To test the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy (QLQ-CIPN20) using Rasch-based methods. METHODS A secondary data analysis was performed using pooled QLQ-CIPN20 data from patients (N = 1008) who had participated in any of four multi-site chemotherapy-induced peripheral neuropathy (CIPN) treatment and prevention trials. QLQ-CIPN20 responses were evaluated using a polytomous Rasch partial credit model. Data were assessed for person-item fit using the chi-square statistic, item scaling based on response proportions, threshold ordering using item characteristic curves and logit threshold locations, differential item response (DIF) (i.e., response bias) using likelihood ratio tests, and unidimensionality using cluster analysis. RESULTS A statistically significant chi-square test indicated poor fit of the observed to the expected responses. More than 70% of the respondents reported a complete absence of six symptoms, reflecting significant floor effects and poor item scaling. Disordered/non-ordinal or narrow response thresholds were found for 11 of the 20 items. Item responses were significantly different by gender (p < 0.0001) and chemotherapy type (p < 0.0001). Cluster analysis findings suggest that the QLQ-CIPN20 is a unidimensional scale due to the absence of item clusters. CONCLUSIONS Rasch model testing revealed psychometric weaknesses that could be addressed by revising the QLQ-CIPN20's problematic items and response options. Alternatively, perhaps the new gold standard CIPN measurement approach in future intervention trials should involve use of only the best items, which would also allow comparisons across previous trials that utilized the QLQ-CIPN20.
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Abstract
PURPOSE OF REVIEW This article reviews the chronic demyelinating neuropathies, with a focus on the diagnosis and treatment of immune-mediated neuropathies and the features that can help differentiate immune-mediated neuropathies from other chronic demyelinating peripheral nerve conditions. RECENT FINDINGS Advances in clinical phenotyping and outcomes assessment have enabled neurologists to improve disease recognition, treatment, and disease monitoring. Our understanding of the immunopathogenesis of demyelinating neuropathies is evolving. Identification of new antibodies and recognition that node of Ranvier dysfunction may be an early pathogenic feature may herald further diagnostic and treatment advancements. SUMMARY The chronic demyelinating polyneuropathies are heterogeneous. The clinical and diagnostic features are sometimes overlapping, and the specific disorders are variable in pathogenesis, treatment, and prognosis. This heterogeneity underscores the importance of achieving diagnostic accuracy and implementing disease-specific treatment approaches.
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27
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Neuropatie motorie multifocali con blocco della conduzione. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)85563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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What is new in 2015 in dysimmune neuropathies? Rev Neurol (Paris) 2016; 172:779-784. [PMID: 27866728 DOI: 10.1016/j.neurol.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022]
Abstract
This review discusses and summarizes the concept of nodopathies, the diagnostic features, investigations, pathophysiology, and treatment options of chronic inflammatory demyelinating polyradiculoneuropathy, and gives updates on other inflammatory and dysimmune neuropathies such as Guillain-Barré syndrome, sensory neuronopathies, small-fiber-predominant ganglionitis, POEMS syndrome, neuropathies associated with IgM monoclonal gammopathy and multifocal motor neuropathy. This field of research has contributed to the antigenic characterization of the peripheral motor and sensory functional systems, as well as helping to define immune neuropathic syndromes with widely different clinical presentation, prognosis and response to therapy.
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29
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Katzberg HD, Rasutis V, Bril V. Subcutaneous immunoglobulin for treatment of multifocal motor neuropathy. Muscle Nerve 2016; 54:856-863. [DOI: 10.1002/mus.25107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 03/03/2016] [Accepted: 03/10/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Hans D. Katzberg
- Division of Neurology; University Health Network Toronto General Hospital; 200 Elizabeth Street, 5ES-306 Toronto Ontario M5G 2C4 Canada
- University of Toronto; Toronto Ontario Canada
| | - Vilija Rasutis
- Division of Neurology; University Health Network Toronto General Hospital; 200 Elizabeth Street, 5ES-306 Toronto Ontario M5G 2C4 Canada
| | - Vera Bril
- Division of Neurology; University Health Network Toronto General Hospital; 200 Elizabeth Street, 5ES-306 Toronto Ontario M5G 2C4 Canada
- University of Toronto; Toronto Ontario Canada
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30
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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] [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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Lunn MP, Van den Bergh PYK. Outcome measures in neuromuscular disease: is the world still flat? J Peripher Nerv Syst 2016; 20:255-9. [PMID: 26114965 DOI: 10.1111/jns.12119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 12/31/2022]
Abstract
Valid, responsive, and meaningful outcome measures for the measurement of the impairment, activity limitations, and quality of life in patients with neuromuscular disease are crucial to identify the natural history of disease and benefits of therapy in clinical practice and trials. Although understanding of many aspects of neuromuscular diseases has advanced dramatically, the development of outcome measures has received less attention. The scales developed from Rasch theory by the PeriNomS Group represent the biggest significant shift in thought in neuromuscular outcome measures for decades. There remain problems with many of them, and further developments are required. However, incorporating them into our outcome sets for daily use and in clinical trials will lead to the more efficient capture of meaningful change and will result in better assessment of individuals and groups of patients in both clinical trials and neurological practice.
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Affiliation(s)
- Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
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Erratum. J Peripher Nerv Syst 2016; 21:55. [PMID: 26930222 DOI: 10.1111/jns.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Draak THP, Vanhoutte EK, van Nes SI, Gorson KC, Van der Pol WL, Notermans NC, Nobile-Orazio E, Lewis RA, Léger JM, Van den Bergh PYK, Lauria G, Bril V, Katzberg H, Lunn MPT, Pouget J, van der Kooi AJ, Hahn AF, van den Berg LH, van Doorn PA, Cornblath DR, Faber CG, Merkies ISJ. Comparing the NIS vs. MRC and INCAT sensory scale through Rasch analyses. J Peripher Nerv Syst 2015; 20:277-88. [DOI: 10.1111/jns.12127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
Affiliation(s)
- 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
| | - Sonja I. van Nes
- Department of Neurology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Kenneth C. Gorson
- Department of Neurology, St. Elizabeth's Medical Center; Tufts University School of Medicine; Boston MA USA
| | - W.-Ludo Van der Pol
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - Nicolette C. Notermans
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - 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
| | - Jean-Marc Léger
- Department of Neurology; Hôpital de la Salpêtrière; Paris France
| | | | - Giuseppe Lauria
- Department of Clinical Neurosciences; Neuromuscular Diseases Unit National Neurological Institute “Carlo Besta”; 3rd Neurology Unit Milan Italy
| | - Vera Bril
- Department of Neurology; Toronto General Hospital; Toronto ON Canada
| | - Hans Katzberg
- Department of Neurology; Toronto General Hospital; Toronto ON Canada
| | - Michael P. T. Lunn
- Department of Neurology, Centre for Neuromuscular Disease; National Hospital for Neurology and Neurosurgery; Queen Square London UK
| | - Jean Pouget
- Department of Neurology; Centre de Référence des Maladies Neuromusculaires et de la SLA; Hôpital de La Timone Marseille France
| | | | - Angelika F. Hahn
- Department of Neurology; London Health Science Center; London ON Canada
| | - Leonard H. van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - Pieter A. van Doorn
- Department of Neurology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - David R. Cornblath
- Department of Neurology; Johns Hopkins School of Medicine; Baltimore MD USA
| | - 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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Van den Bergh PYK, Lunn MP. Future needs in peripheral neuropathy outcome measures. J Peripher Nerv Syst 2015; 20:341-6. [PMID: 26306616 DOI: 10.1111/jns.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
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