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Gnonlonfoun DD, Sowanou A, Gnigone P, Gbessemehlan A, Choki B, Agbetou M, Houeze R, Agassounon R, Metogbe Hountovo A, Adoukonou T, Magne J, Boumediene F, Preux PM, Houinato D. Knowledge, attitudes and practices of general practitioners on peripheral neuropathies in Benin in 2021. Int J Neurosci 2024:1-9. [PMID: 38465511 DOI: 10.1080/00207454.2024.2328709] [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: 03/18/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE First healthcare actors in neurological diseases management, General Practitioners (GPs) still limited in the assessment of Peripheral Neuropathies (PN). This study assesses the knowledge, attitudes, practices (KAP) of GPs on PN in Benin in 2021 and identifying associated factors to low KAP. MATERIALS AND METHODS It was a cross-sectional study conducted from 20 November 2020 to 30 June 2021 which included GPs registered in the National Order of Physicians in Benin and interns in last year of medical studies (MS). An overall KAP score of 24 points was derived. KAP levels were low (score < 17), medium (17 to 19) and high (score ≥ 20). Multivariable regression models were performed to identify factors associated with low KAP. RESULTS 645/1,066 participants (60.5%) were included in the study with median age 28 years [Interquartile range IQR: 26-30 years], and 442 (68.5%) were male. The KAP level was low in 70.1%. 16.7% had a low knowledge of polyneuropathy manifestations, 35% perceived PN as an incurable disease. Lack of knowledge on PN before MS (adjusted Odds-ratio aOR = 1.6 [95% confidence interval CI: 1.1-2.3]), and no postgraduate training on PN (aOR = 1.8 [95% CI: 1.--3.0]) were associated with low overall KAP level. Working in rural area (aOR = 0.4 [95%CI: 0.2-0.7]), and being an intern (aOR = 0.6 [95%CI: 0.4-0.9]) were associated with better overall KAP level. CONCLUSION This study highlights the need for better training with strong emphasis on PN during the MS and the organization of postgraduate training for GPs; the cornerstone for improving the management of PN in Benin.
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Affiliation(s)
- Dieu Donné Gnonlonfoun
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Arlos Sowanou
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Pupchen Gnigone
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Antoine Gbessemehlan
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Blaise Choki
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | | | - Richard Houeze
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | - Rhodya Agassounon
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
| | | | | | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical areas, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
- University Neurology Clinic of the CNHU-HKM of Cotonou, Cotonou, Benin
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Preisner F, Pitarokoili K, Lueling B, Motte J, Fisse AL, Grüter T, Godel T, Schwarz D, Heiland S, Gold R, Bendszus M, Kronlage M. Quantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years. Ann Clin Transl Neurol 2024; 11:593-606. [PMID: 38111964 DOI: 10.1002/acn3.51978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To evaluate magnetic resonance neurography (MRN) for the longitudinal assessment of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Prospective examination of twelve CIDP patients by neurological assessment, MRN, and nerve conduction studies in 2016 and 6 years later in 2022. Imaging parameters were compared with matched healthy controls and correlated with clinical and electrophysiological markers. The MRN protocol included T2-weighted imaging, diffusion tensor imaging (DTI), T2 relaxometry, and magnetization transfer imaging (MTI). RESULTS Nerve cross-sectional area (CSA) was increased in CIDP patients compared to controls (plexus: p = 0.003; sciatic nerve: p < 0.001). Over 6 years, nerve CSA decreased in CIDP patients, most pronounced at the lumbosacral plexus (p = 0.015). Longitudinally, changes in CSA correlated with changes in the inflammatory neuropathy cause and treatment validated overall disability sum score (INCAT/ODSS) (p = 0.006). High initial nerve CSA was inversely correlated with changes in the INCAT/ODSS over 6 years (p < 0.05). The DTI parameter fractional anisotropy (FA) showed robust correlations with electrodiagnostic testing both cross-sectionally and longitudinally (p < 0.05). MTI as a newly added imaging technique revealed a significantly reduced magnetization transfer ratio (MTR) in CIDP patients (p < 0.01), suggesting underlying changes in macromolecular tissue composition, and correlated significantly with electrophysiological parameters of demyelination (p < 0.05). INTERPRETATION This study provides evidence that changes in nerve CSA and FA reflect the clinical and electrophysiological course of CIDP patients. Initial nerve hypertrophy might predict a rather benign course or better therapy response.
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Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Benjamin Lueling
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
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Poser PL, Sajid GS, Beyer L, Hieke A, Schumacher A, Horstkemper L, Karl AS, Grüter T, Sgodzai M, Pitarokoili K, Gerwert K, Gold R, Fisse AL, Gisevius B, Motte J. Serum neurofilament light chain does not detect self-reported treatment-related fluctuations in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16023. [PMID: 37539836 DOI: 10.1111/ene.16023] [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: 04/10/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Serum neurofilament light chain (sNfL) is a marker for axonal degeneration. Patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) often report a fluctuation of symptoms throughout one treatment cycle with intravenous immunoglobulins (IVIG). The aim of this study was to determine whether sNfL is suitable to quantify patient-reported symptom fluctuations. METHODS Twenty-nine patients with the diagnosis of CIDP or a CIDP-variant under treatment with IVIG were recruited in this study and underwent examination before IVIG infusion, in the middle of the treatment interval, and before their next IVIG infusion. Patients were surveyed regarding symptom fluctuations at the last visit and divided into two groups: those with and without fluctuations of symptoms. At the first visit, sociodemographic and disease-specific data were collected. Clinical scores were assessed at every examination. sNfL values were compared between both groups at the different time points after conversion into Z-scores-adjusted for age and body mass index. RESULTS Patients with CIDP show elevated sNfL Z-scores (median at baseline: 2.14, IQR: 1.0). There was no significant change in sNfL Z-scores or questionnaire scores within the treatment cycle in either group. There was no significant difference in sNfL levels between the patients with and without symptom fluctuations. CONCLUSIONS CIDP patients show elevated sNfL levels. However, sNfL is not suitable to reflect patient-reported fluctuations of symptoms. This indicates that symptom fluctuations during treatment with IVIG in patients with CIDP are not caused by a neuroaxonal injury. Furthermore, repeated sNfL measurements within one treatment cycle with IVIG seem to have no benefit for symptom monitoring.
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Affiliation(s)
- Philip Lennart Poser
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Gulchan Shazadi Sajid
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Léon Beyer
- Department of Biophysics, Faculty of Biology and Biophysics, Ruhr-University Bochum, Bochum, Germany
- Center for Protein Diagnostics (Prodi), Ruhr-University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Lea Horstkemper
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna-Sophia Karl
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Klaus Gerwert
- Department of Biophysics, Faculty of Biology and Biophysics, Ruhr-University Bochum, Bochum, Germany
- Center for Protein Diagnostics (Prodi), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Barbara Gisevius
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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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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Lee SC, Lee YC, Chiu EC. Psychometric validation of the Cognitive Abilities Screening Instrument using Rasch analysis in people with dementia. Medicine (Baltimore) 2023; 102:e34093. [PMID: 37565843 PMCID: PMC10419804 DOI: 10.1097/md.0000000000034093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/02/2023] [Indexed: 08/12/2023] Open
Abstract
This study aimed to examine unidimensionality of the Cognitive Abilities Screening Instrument (CASI) using Rasch analysis and estimate Rasch person reliability in people with dementia. CASI data of people with dementia was collected from medical records of one general hospital in northern Taiwan. A total of 506 people with dementia were recruited from the Department of Neurology. The confirmatory factor analysis was first conducted to verify the fitness of one-factor model of the CASI. Unidimensionality was confirmed through 2 assumptions: the infit and outfit mean square were 0.5 to 1.5, and residual variance of the first principal component in principal component analysis was ≤20%. Rasch person reliability was estimated after undimensionality was supported. The results of one-factor model had shown that the Comparative Fit Index = 0.99, Tucker Lewis Index = 0.99, Root Means Square Error of Approximation = 0.015, and Standardized Root Mean Square Residual = 0.067, representing a good fit to the model. Both the infit and outfit mean square were ranged 0.87 to 1.37 and 0.86 to 1.42, respectively, and low residual variance of the first principal component (12.3%). Rasch person reliability result of 0.58 was satisfactory. The person-item map indicated the difference between item difficulty and person ability was within the acceptable limits (0.22 logits). Differential Item Function was found between -0.48 to 0.44 logits for gender, indicating the CASI functioned similarly for both genders. The 46 items of the CASI showed a unidimensional construct. The CASI had been demonstrated as a valid and reliable screening tool for assessing overall cognitive function in people with dementia, capturing their cognitive functions effectively.
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Affiliation(s)
- Shu-Chun Lee
- Department of Occupational Therapy, Taipei City Hospital Songde Branch, Taipei, Taiwan
- Department of Recreation and Sports Management, University of Taipei, Taipei, Taiwan
- Department of Occupational Therapy, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Rajabally YA, Afzal S, Ghasemi M. Minimal important differences and self‐identifying treatment response in chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2021; 64:37-42. [DOI: 10.1002/mus.27250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Yusuf A. Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology University Hospitals Birmingham Birmingham UK
- Aston Medical School Aston University Birmingham UK
| | - Saadia Afzal
- Inflammatory Neuropathy Clinic, Department of Neurology University Hospitals Birmingham Birmingham UK
| | - Majid Ghasemi
- Inflammatory Neuropathy Clinic, Department of Neurology University Hospitals Birmingham Birmingham UK
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7
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Allen JA, Merkies ISJ, Lewis RA. Monitoring Clinical Course and Treatment Response in Chronic Inflammatory Demyelinating Polyneuropathy During Routine Care: A Review of Clinical and Laboratory Assessment Measures. JAMA Neurol 2021; 77:1159-1166. [PMID: 32338716 DOI: 10.1001/jamaneurol.2020.0781] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Identifying clinical change in many neurologic diseases, including chronic inflammatory demyelinating polyneuropathy (CIDP), can be challenging. At the same time, how change is defined heavily influences a patient's diagnostic and treatment pathway. It can be especially problematic when equivocal subjective observations are interpreted as clinically meaningful and then used to make diagnostic and treatment decisions. Change in clinical trials is strictly defined by a preselected metric, but there is a perception that formal outcomes collection during routine clinical care is neither feasible nor necessary. Given the importance placed on how change is interpreted, there is a need to select assessments that can be applied to routine care that are representative of the neurologic disease state. Observations For an outcome measure to be useful during clinical trials, it must have good reliability, validity, be responsive to change, and have clinical meaning. To be useful during routine clinical care, the assessment must additionally be easy to collect without the need for extensive training or equipment and should provide an immediately available result that can be rapidly quantified and interpreted. Chronic inflammatory demyelinating polyneuropathy is clinically heterogeneous and so is best evaluated with a diverse group of assessment tools. Assessing strength impairment, disability, and quality of life is ideally suited for everyday practice when caring for patients with CIDP. While electrophysiologic studies, imaging, cerebrospinal fluid, and nodal/paranodal antibodies can provide diagnostic data, they are less practical and helpful longitudinal assessment tools. Conclusions and Relevance Sound clinimetric outcome measures in CIDP are widely available and have the potential to help clinicians objectify treatment response and disease progression. Such data are critically important when justifying the need for ongoing or periodic immunotherapy, documenting relapse or deterioration, or providing reassurance of disease improvement, stability, or remission.
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Affiliation(s)
- Jeffrey A Allen
- Department of Neurology, University of Minnesota, Minneapolis
| | - Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Neurology, St Elisabeth Hospital, Willemstad, Curaçao
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
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Fisse AL, Motte J, Grüter T, Sgodzai M, Pitarokoili K, Gold R. Comprehensive approaches for diagnosis, monitoring and treatment of chronic inflammatory demyelinating polyneuropathy. Neurol Res Pract 2020; 2:42. [PMID: 33324942 PMCID: PMC7722337 DOI: 10.1186/s42466-020-00088-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common chronic inflammatory neuropathy. CIDP is diagnosed according to the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria, which combine clinical features with the electrophysiological evidence of demyelination. However, firstly, diagnosis is challenging, as some patients e.g. with severe early axonal damage do not fulfil the criteria. Secondly, objective and reliable tools to monitor the disease course are lacking. Thirdly, about 25% of CIDP patients do not respond to evidence-based first-line therapy. Recognition of these patients is difficult and treatment beyond first-line therapy is based on observational studies and case series only. Individualized immunomodulatory treatment does not exist due to the lack of understanding of essential aspects of the underlying pathophysiology. Novel diagnostic imaging techniques and molecular approaches can help to solve these problems but do not find enough implementation. This review gives a comprehensive overview of novel diagnostic techniques and monitoring approaches for CIDP and how these can lead to individualized treatment and better understanding of pathophysiology.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Sadjadi R, Peric S, Gwathmey K, Bozovic I, Aleksa P, Bjelica B, Burns T, Basta I. Psychometric longitudinal evaluation of the Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) in patients with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2020; 63:84-88. [PMID: 33043466 DOI: 10.1002/mus.27089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND We studied the performance of a 15-item, health-related quality-of-life polyneuropathy scale in a longitudinal study of patients with chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS Sixty-one patients with CIDP completed the Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) scale and Patient Impression of Change (PIC) at baseline and follow-up visits. Clinicians completed Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores at baseline and follow-up visits. Conventional and modern psychometric analyses were performed on the completed forms. RESULTS CAPPRI was psychometrically stable between visits without significant difference in response pattern between visits 1 and 2 (paired t-test P = .72). There was strong correlation between changes in INCAT and changes in CAPPRI scores between two visits (rho = 0.6, P < .001). In addition, we showed robust CAPPRI effect sizes between PIC categories. CONCLUSIONS We demonstrated psychometric stability and construct longitudinal validity of CAPPRI.
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Affiliation(s)
- Reza Sadjadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kelly Gwathmey
- Neuromuscular Division, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Palibrk Aleksa
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ted Burns
- Department of Neurology, The University of Virginia, Charlottesville, Virginia, USA
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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10
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Gwathmey K. Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Its Variants. Continuum (Minneap Minn) 2020; 26:1205-1223. [PMID: 33002999 DOI: 10.1212/con.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and its variants comprise a group of immune-mediated neuropathies with distinctive clinical presentations and electrodiagnostic features. Prompt recognition of these treatable disorders is mandatory as delays result in significant disability and morbidity. This article highlights the clinical presentation, pathophysiology, diagnostic evaluation, and treatment approach of these polyneuropathies. RECENT FINDINGS The spectrum of CIDP is expanding with the recent characterization of neuropathies associated with nodal and paranodal antibodies. These neuropathies are distinguished by their unique presentations and are often refractory to IV immunoglobulin (IVIg) therapy. Subcutaneous immunoglobulins have recently been approved as a treatment option for CIDP and join corticosteroids, IVIg, and plasma exchange as first-line treatment. SUMMARY CIDP is characterized by progressive symmetric proximal and distal weakness, large fiber sensory loss, and areflexia, with clinical nadir reached more than 8 weeks after symptom onset. Autoimmune demyelinating neuropathies fall on a continuum, with differences in the type of nerve fibers affected and pattern of deficits. Distinguishing between typical CIDP and its variants allows for selection of the most appropriate treatment.
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Okhovat AA, Gholamalizadeh S, Nafissi S, Fatehi F. Evaluation of Quality of Life in Patients With Chronic Inflammatory Demyelinating Polyneuropathy in Iran. J Clin Neuromuscul Dis 2019; 21:77-83. [PMID: 31743250 DOI: 10.1097/cnd.0000000000000272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In addition to the physical disability in chronic inflammatory demyelinating polyneuropathy (CIDP), various aspects of quality of life (QoL) are affected by the disease. Our goal was to evaluate the QoL in Iranian patients with CIDP and to study the association of clinical and demographic factors with QoL parameters. METHODS Twenty-six Iranian patients with CIDP were asked to complete a standardized Persian version of SF-36, and the association of demographic and functional parameters with QoL parameters was assessed. RESULTS Sex, living place, and income had no significant effect on QoL. Mean physical composite score was 37.7 ± 9.4, and mean mental composite score was 37.2 ± 15.2 that was lower than similar studies. There was a positive correlation between QoL and muscle strength of different muscle groups [hand (r = 0.41, P = 0.04); hip (r = 0.44, P = 0.02); and foot (r = 0.41, P = 0.04); total manual muscle testing (r = 0.46, P = 0.02)] and a significant negative correlation between the duration of illness and mean physical composite score (r = -0.61, P = 0.00). CONCLUSIONS Our patients achieved low scores in both the physical and mental aspects of QoL compared with other studies. We found a significant correlation between the physical domain of the SF-36 score and muscle strength of the hand, hip, and foot muscle group and with total manual muscle testing, suggesting that physical disability is the most crucial factor affecting QoL. Also, there was a significant negative association between the duration of the disease and the physical domain.
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Affiliation(s)
- Ali Asghar Okhovat
- Neurology Department, Shariati Hospital, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahriar Nafissi
- Neurology Department, Shariati Hospital, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Neurology Department, Shariati Hospital, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hartung H, Mallick R, Bril V, Lewis RA, Sobue G, Lawo J, Mielke O, Durn BL, Cornblath DR, Merkies ISJ, van Schaik IN. Patient‐reported outcomes with subcutaneous immunoglobulin in chronic inflammatory demyelinating polyneuropathy: the PATH study. Eur J Neurol 2019; 27:196-203. [DOI: 10.1111/ene.14056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Affiliation(s)
- H.‐P. Hartung
- Department of Neurology UKD and Center for Neurology and Neuropsychiatry LVR Klinikum Medical Faculty Heinrich Heine University Düsseldorf Germany
| | | | - V. Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases Division of Neurology Department of Medicine University Health Network University of Toronto Toronto Canada
- Institute for Research and Medical Consultations Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia
| | - R. A. Lewis
- Department of Neurology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - G. Sobue
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | | | | | | | - D. R. Cornblath
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
| | - I. S. J. Merkies
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Department of Neurology St Elizabeth Hospital Willemstad Curacao
| | - I. N. van Schaik
- Department of Neurology Amsterdam University Medical Centres University of Amsterdam Amsterdam The Netherlands
- Spaarne Gasthuis Haarlem The Netherlands
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Bozovic I, Peric S, Basta I, Kacar A, Nikolic A, Belanovic B, Lavrnic D, Rakocevic-Stojanovic V, Stevic Z. Quality of life in patients with multifocal motor neuropathy from Serbia. J Neurol Sci 2019; 399:151-154. [DOI: 10.1016/j.jns.2019.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/26/2019] [Accepted: 02/19/2019] [Indexed: 11/25/2022]
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Abstract
Since the discovery of an acute monophasic paralysis, later coined Guillain-Barré syndrome, almost 100 years ago, and the discovery of chronic, steroid-responsive polyneuropathy 50 years ago, the spectrum of immune-mediated polyneuropathies has broadened, with various subtypes continuing to be identified, including chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN). In general, these disorders are speculated to be caused by autoimmunity to proteins located at the node of Ranvier or components of myelin of peripheral nerves, although disease-associated autoantibodies have not been identified for all disorders. Owing to the numerous subtypes of the immune-mediated neuropathies, making the right diagnosis in daily clinical practice is complicated. Moreover, treating these disorders, particularly their chronic variants, such as CIDP and MMN, poses a challenge. In general, management of these disorders includes immunotherapies, such as corticosteroids, intravenous immunoglobulin or plasma exchange. Improvements in clinical criteria and the emergence of more disease-specific immunotherapies should broaden the therapeutic options for these disabling diseases.
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Kacar A, Bjelica B, Bozovic I, Peric S, Nikolic A, Cobeljic M, Petrovic M, Stojanov A, Djordjevic G, Vukojevic Z, Dominovic-Kovacevic A, Stojanovic M, Stevic Z, Rakocevic-Stojanovic V, Lavrnic D, Basta I. Neuromuscular disease-specific questionnaire to assess quality of life in patients with chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2018; 23:11-16. [PMID: 29360221 DOI: 10.1111/jns.12251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
Abstract
To date, generic questionnaires have been used to investigate quality of life (QoL) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. Although these measures are very useful, they are not usually precise enough to measure all specific characteristics of the disease. Our aim was to investigate QoL using the neuromuscular disease-specific questionnaire (individualized neuromuscular quality of life, INQoL) in a large cohort of patients with CIDP. Our study comprised 106 patients diagnosed with CIDP. INQoL questionnaire, Medical Research Council (MRC) sum score, Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, Visual Analogue Pain Scale, Beck Depression Inventory, and Krupp's Fatigue Severity Scale were used in our study. Physical domains of INQoL were more affected than mental, and the overall score was 57 ± 25. Significant predictors of higher INQoL score in our patients with CIDP were severe fatigue (β = 0.35, p < 0.01), higher INCAT disability score at time of testing (β = 0.29, p < 0.01), and being unemployed/retired (β = 0.22, p < 0.05). QoL was reduced in our cohort of CIDP patients, which was more pronounced in physical segments. Patients with fatigue, more severe disability, and unemployed/retired need special attention of neurologists because they could be at greater risk to have worse QoL.
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Affiliation(s)
- Aleksandra Kacar
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Nikolic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mina Cobeljic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milutin Petrovic
- Neurology Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | | | | | - Zoran Vukojevic
- Neurology Clinic, Clinical Center Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | | | | | - Zorica Stevic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Dragana Lavrnic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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