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Zhang W, Tao W, Wang J, Nie P, Duan L, Yan L. A study on the role of serum uric acid in differentiating acute inflammatory demyelinating polyneuropathy from acute-onset chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16222. [PMID: 38356316 DOI: 10.1111/ene.16222] [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: 09/18/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE Clinical symptoms and laboratory indices for acute inflammatory demyelinating polyneuropathy (AIDP), a variant of Guillain-Barré syndrome, and acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) were analyzed to identify factors that could contribute to early differential diagnosis. METHODS A retrospective chart review was performed on 44 AIDP and 44 A-CIDP patients looking for any demographic characteristics, clinical manifestations or laboratory parameters that might differentiate AIDP from acutely presenting CIDP. RESULTS In Guillain-Barré syndrome patients (N = 63), 69.84% (N = 44) were classified as having AIDP, 19.05% (N = 12) were found to have acute motor axonal neuropathy, 6.35% (N = 4) were found to have acute motor and sensory axonal neuropathy, and 4.76% (N = 3) were found to have Miller Fisher syndrome. Serum uric acid (UA) was higher in A-CIDP patients (329.55 ± 72.23 μmol/L) than in AIDP patients (221.08 ± 71.32 μmol/L) (p = 0.000). Receiver operating characteristic analyses indicated that the optimal UA cutoff was 283.50 μmol/L. Above this level, patients were more likely to present A-CIDP than AIDP (specificity 81.80%, sensitivity 81.80%). During the follow-up process, serum samples were effectively collected from 19 AIDP patients during the rehabilitation phase and 28 A-CIDP patients during the remission stage, and it was found that UA levels were significantly increased in A-CIDP (remission) (298.9 ± 90.39 μmol/L) compared with AIDP (rehabilitation) (220.1 ± 108.2 μmol/L, p = 0.009). CONCLUSION These results suggest that serum UA level can help to differentiate AIDP from A-CIDP with high specificity and sensitivity, which is helpful for early diagnosis and guidance of treatment.
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Affiliation(s)
- Weiyun Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wen Tao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Wang
- Key Lab of Modern Toxicology, Ministry of Education, and Department of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Nie
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lihui Duan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lanyun Yan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Rigal J, Quarto E, Boue L, Balabaud L, Thompson W, Cloché T, Bourret S, Le Huec JC. Original Surgical Treatment and Long-term Follow-up for Chronic Inflammatory Demyelinating Polyradiculoneuropathy Causing A Compressive Cervical Myelopathy. Neurospine 2022; 19:472-477. [PMID: 35588760 PMCID: PMC9260558 DOI: 10.14245/ns.2143232.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic relapsing disease of unknown aetiology. The diagnosis of this disease is still very complicated. The treatment is medical but, in some cases, a surgical decompression might be required. In rare cases it develops a radicular hypertrophy that can cause a cervical myelopathy; this pathology should be put in differential diagnosis with neurofibromatosis 1 (NF-1) and Charcot Marie Tooth (CMT) syndromes. The cases of CIDP cervical myelopathy reported in the literature are rare and even more rarely a surgical decompression was described. Here we report a first and unique case of CIDP cervical myelopathy treated with an open-door laminoplasty technique with 10-years post-operative follow-up (FU). The surgical decompression revealed to be effective in stopping the progression of myelopathy without destabilizing the spine. The patient that before surgery presented a severe tetra-paresis could return to walk and gained back his self-care autonomy. At 10-years FU he didn't complain of neck pain and didn't develop a cervical kyphosis. In case of cervical myelopathy caused by radicular hypertrophy CIDP should be kept in mind in the differential diagnosis and an open-door laminoplasty is indicated to stop myelopathy progression.
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Affiliation(s)
- Julien Rigal
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Emanuele Quarto
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Lisa Boue
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Laurent Balabaud
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Wendy Thompson
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Thibault Cloché
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Stephane Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
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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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4
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Akita J, Miller LHG, Mello FMC, Barreto JA, Moreira AL, Salgado MH, Kirchner DR, Garbino JA. Comparison between nerve conduction study and high-resolution ultrasonography with color doppler in type 1 and type 2 leprosy reactions. Clin Neurophysiol Pract 2021; 6:97-102. [PMID: 33869903 PMCID: PMC8047122 DOI: 10.1016/j.cnp.2021.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Identifying leprosy reactions is important to prevent disability. HRUS with CD can be useful compared to NCS to diagnose acute inflammatory activity. HRUS with CD helps reactions diagnosis in minimal and complete NCS abnormalities.
Objective To analyze the role of high-resolution ultrasonography with color Doppler (HRUS with CD) to diagnose inflammatory activity (IA) in nerves of leprosy patients under type 1 (RT1) and 2 (RT2) reactions compared to Nerve Conduction Studies (NCS). Methods Leprosy patients with signs or symptoms suggestive of neuritis (RT1 and RT2) without corticosteroids use were selected. They were evaluated by NCS and subsequently by HRUS with CD. Subacute segmental demyelination and the presence of blood flow, respectively, were considered signs of IA. The two methods were compared for their ability to diagnose patients with leprosy reactions. Results A total of 257 nerves from 35 patients were evaluated. NCS and HRUS with CD diagnosed IA in 68% and 74% of patients, respectively. When both methods were used concomitantly, the diagnosis rate was 91.4%. HRUS with CD was particular helpful when there was minimal neurophysiological compromise in NCS or when motor potentials were not detected. Conclusion HRUS with CD was able to detect leprosy reactions, especially when combined with NCS. It was especially useful in two opposite situations: nerves with only minor changes and those without motor response in NCS. Significance Our data shows the usefulness of HRUS and CD, similar to NCS, as a tool to diagnose leprosy reactions.
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Affiliation(s)
- J Akita
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - L H G Miller
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - F M C Mello
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - J A Barreto
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - A L Moreira
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - M H Salgado
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - D R Kirchner
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
| | - J A Garbino
- Neurophysiology Division, Lauro de Souza Lima Institute, Brazil
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Shimabukuro TT, Su JR, Marquez PL, Mba-Jonas A, Arana JE, Cano MV. Safety of the 9-Valent Human Papillomavirus Vaccine. Pediatrics 2019; 144:e20191791. [PMID: 31740500 PMCID: PMC6935554 DOI: 10.1542/peds.2019-1791] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The 9-valent human papillomavirus vaccine (9vHPV) was approved for females and males aged 9 to 26 years in 2014. We analyzed postlicensure surveillance reports to the Vaccine Adverse Event Reporting System (VAERS). METHODS We searched VAERS data for US reports of adverse events (AEs) after 9vHPV from December 2014 through December 2017. We calculated reporting rates and conducted empirical Bayesian data mining to identify disproportional reporting. Physicians reviewed reports for selected prespecified conditions. RESULTS VAERS received 7244 reports after 9vHPV: 31.2% among females, 21.6% among males, and for 47.2%, sex was not reported. Overall, 97.4% of reports were nonserious. Dizziness, syncope, headache, and injection site reactions were most commonly reported; the most commonly reported AEs were similar between females and males. Two reports of death after 9vHPV were verified; no information in autopsy reports or death certificates suggested a causal relationship with vaccination. Approximately 28 million 9vHPV doses were distributed during the study period; crude AE reporting rates were 259 reports per million 9vHPV doses distributed for all reports and 7 per million doses distributed for serious reports. Syncope (a known AE associated with human papillomavirus vaccination) and several types of vaccine administration errors (eg, administered at wrong age) exceeded the statistical threshold for empirical Bayesian data mining findings. CONCLUSIONS No new or unexpected safety concerns or reporting patterns of 9vHPV with clinically important AEs were detected. The safety profile of 9vHPV is consistent with data from prelicensure trials and from postmarketing safety data of its predecessor, the quadrivalent human papillomavirus vaccine.
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Affiliation(s)
- Tom T Shimabukuro
- Division of Healthcare Quality Promotion, Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - John R Su
- Division of Healthcare Quality Promotion, Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Paige L Marquez
- Division of Healthcare Quality Promotion, Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Adamma Mba-Jonas
- Division of Epidemiology, Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Jorge E Arana
- Division of Healthcare Quality Promotion, Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Maria V Cano
- Division of Healthcare Quality Promotion, Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
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Broers MC, Bunschoten C, Nieboer D, Lingsma HF, Jacobs BC. Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis. Neuroepidemiology 2019; 52:161-172. [PMID: 30669140 DOI: 10.1159/000494291] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/02/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prevalence and incidence rates of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are required to determine the impact of CIDP on society. We aimed to estimate the prevalence and incidence of CIDP worldwide and to determine the effect of diagnostic criteria on prevalence and incidence. METHOD A systematic review was conducted for all published incidence and prevalence studies on CIDP until May 18, 2017. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. We performed a random effect meta-analysis to estimate pooled prevalence and incidence rates. RESULTS Of the 907 studies, 11 were included in the systematic review, 5 in the meta-analysis of incidence (818 cases; 220,513,514 person-years) and 9 in the meta-analysis of prevalence (3,160 cases; 160,765,325 population). These studies had a moderate quality. The pooled crude incidence rate was 0.33 per 100,000 person-years (95% CI 0.21-0.53; I2 = 95.7%) and the pooled prevalence rate was 2.81 per 100,000 (95% CI 1.58-4.39; I2 = 99.1%). Substantial heterogeneity in incidence and prevalence across studies seems to be partly explained by using different diagnostic criteria. CONCLUSION These findings provide a starting point to estimate the social burden of CIDP and demonstrate the need to reach consensus on diagnostic criteria for CIDP.
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Affiliation(s)
- Merel C Broers
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,
| | - Carina Bunschoten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Levine TD, Katz JS, Barohn R, Vaughan LJ, Dimachkie MM, Saperstein DS, Mozaffar T, Wolfe GI, Mayo MS, Badger GJ, Katzin L, Ritt E, Greer M, DiStefano J, Schmidt PM. Review process for IVIg treatment: Lessons learned from INSIGHTS neuropathy study. Neurol Clin Pract 2018; 8:429-436. [PMID: 30564497 PMCID: PMC6276327 DOI: 10.1212/cpj.0000000000000520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background This project is an effort to understand how orders for IV immunoglobulin (IVIg) are documented and prescribed by physicians, and subsequently, how they are reviewed by insurance companies for the treatment of immune neuropathies. Methods A panel of neuromuscular specialists reviewed case records from 248 IVIg-naive patients whose in-home IVIg infusion treatment was submitted to insurance for authorization. After reviewing a case record, 1 panelist was asked to make a diagnosis and to answer several questions about the treatment. A second panelist reviewed the original record and follow-up records that were obtained for reauthorization of additional treatments and was asked to determine whether the patient had responded to the treatment. Results Our specialists believed that only 32.2% of 248 patients had an immune neuropathy and were appropriate candidates for IVIg therapy, whereas 46.4% had neuropathies that were not immune mediated. Only 15.3% of cases met electrodiagnostic criteria for a demyelinating neuropathy. Our specialists believed that 36.7% of 128 cases with follow-up records had responded to therapy. In cases in which the initial reviewer had predicted that there would be a response to IVIg, the second reviewer found that 54% had responded. This is compared with a 27% response rate when the first reviewer predicted that there would be no response (p = 0.019). Conclusions Our expert review finds that the diagnosis of immune neuropathies made by providers, and subsequently approved for IVIg therapy by payers, is incorrect in a large percentage of cases. If payers include an expert in their review process, it would improve patient selection, appropriate use, and continuation of treatment with this expensive therapeutic agent.
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Affiliation(s)
- Todd D Levine
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Jonathan S Katz
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Richard Barohn
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Leslie J Vaughan
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Mazen M Dimachkie
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - David S Saperstein
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Tahseen Mozaffar
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Gil I Wolfe
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Matthew S Mayo
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Gary J Badger
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Lara Katzin
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Elissa Ritt
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Michelle Greer
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Joseph DiStefano
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
| | - Patrick M Schmidt
- Phoenix Neurological Associates, AZ (TDL, DSS); California Pacific Medical Center (JSK), San Francisco; The University of Kansas School of Medicine (RB, MMD, MSM); NuFACTOR, Inc. (LJV, GJB, ER, MG, JD, PMS), Temecula, CA; University of California Irvine (TM); State University of New York at Buffalo (GIW); and Grand Rounds LLC (LK), San Francisco, CA
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Chandra SR, Karru VR, Mukheem Mudabbir MA, Ramakrishnan S, Mahadevan A. Immune-mediated Neuropathies Our Experience over 3 Years. J Neurosci Rural Pract 2018; 9:30-35. [PMID: 29456342 PMCID: PMC5812156 DOI: 10.4103/jnrp.jnrp_376_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Immune-mediated peripheral neuropathy is the term applied to a spectrum of peripheral nerve disorders where immune dysregulation plays a role. Therefore, they are treatable. We analyzed the cases seen in the past 3 years by us and evaluated the clinical, laboratory, and outcome parameters in these patients. Patients and Methods Consecutive patients seen by the authors and diagnosed as immune-mediated neuropathy were analyzed for etiology, pathology, and outcome assessed. Results A total of sixty patients, 31 acute and 29 chronic neuropathies, were identified. Their subtypes treatment and outcome assessed. Males were significantly more in both acute and chronic cases. Miller Fisher 4, AMAN 1, paraplegic type 1, motor dominant type 19, Sensory-motor 1, MADSAM 3, Bifacial 2. Nonsystemic vasculitis was seen in 16 out of 29 chronic neuropathy and HIV, POEMS, and diabetes mellitus one each. Discussion There is a spectrum of immune-mediated neuropathy which varies in clinical course, response to treatment, etc., Small percentage of uncommon cases are seen. In this group, mortality was nil and morbidity was minimal. Conclusion Immune-mediated neuropathies are treatable and hence should be diagnosed early for good quality outcome.
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Affiliation(s)
| | - Venkata Raviteja Karru
- Department of Neurocentre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M A Mukheem Mudabbir
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subashree Ramakrishnan
- Department of Neurocentre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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9
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da Silva IRF, Frontera JA, Bispo de Filippis AM, Nascimento OJMD. Neurologic Complications Associated With the Zika Virus in Brazilian Adults. JAMA Neurol 2017; 74:1190-1198. [PMID: 28806453 DOI: 10.1001/jamaneurol.2017.1703] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance There are no prospective cohort studies assessing the incidence and spectrum of neurologic manifestations secondary to Zika virus (ZIKV) infection in adults. Objective To evaluate the rates of acute ZIKV infection among patients hospitalized with Guillain-Barré syndrome (GBS), meningoencephalitis, or transverse myelitis. Design, Setting, and Participants A prospective, observational cohort study was conducted at a tertiary referral center for neurological diseases in Rio de Janeiro, Brazil, between December 5, 2015, and May 10, 2016, among consecutive hospitalized adults (>18 years of age) with new-onset acute parainfectious or neuroinflammatory disease. All participants were tested for a series of arbovirosis. Three-month functional outcome was assessed. Interventions Samples of serum and cerebrospinal fluid were tested for ZIKV using real-time reverse-transcriptase-polymerase chain reaction and an IgM antibody-capture enzyme-linked immunosorbent assay. Clinical, radiographic (magnetic resonance imaging), electrophysiological, and 3-month functional outcome data were collected. Main Outcomes and Measures The detection of neurologic complications secondary to ZIKV infection. Results Forty patients (15 women and 25 men; median age, 44 years [range, 22-72 years]) were enrolled, including 29 patients (73%) with GBS (90% Brighton level 1 certainty), 7 (18%) with encephalitis, 3 (8%) with transverse myelitis, and 1 (3%) with newly diagnosed chronic inflammatory demyelinating polyneuropathy. Of these, 35 patients (88%) had molecular and/or serologic evidence of recent ZIKV infection in the serum and/or cerebrospinal fluid. Of the patients positive for ZIKV infection, 27 had GBS (18 demyelinating, 8 axonal, and 1 Miller Fisher syndrome), 5 had encephalitis (3 with concomitant acute neuromuscular disease), 2 had transverse myelitis, and 1 had chronic inflammatory demyelinating polyneuropathy. Admission to the intensive care unit was required for 9 patients positive for ZIKV infection (26%), and 5 (14%) required mechanical ventilation. Compared with admission during the period from December 5, 2013, to May 10, 2014 (before the Brazilian outbreak of ZIKV), admissions for GBS increased from a mean of 1.0 per month to 5.6 per month, admissions for encephalitis increased from 0.4 per month to 1.4 per month, and admissions for transverse myelitis remained constant at 0.6 per month. At 3 months, 2 patients positive for ZIKV infection (6%) died (1 with GBS and 1 with encephalitis), 18 (51%) had chronic pain, and the median modified Rankin score among survivors was 2 (range, 0-5). Conclusions and Relevance In this single-center Brazilian cohort, ZIKV infection was associated with an increase in the incidence of a diverse spectrum of serious neurologic syndromes. The data also suggest that serologic and molecular testing using blood and cerebrospinal fluid samples can serve as a less expensive, alternative diagnostic strategy in developing countries, where plaque reduction neutralization testing is impractical.
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Affiliation(s)
- Ivan Rocha Ferreira da Silva
- Neurology Department, Universidade Federal Fluminense, Niteroi, Brazil.,Neurocritical Care Department, Americas Medical City, Rio de Janeiro, Brazil
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Clerici AM, Nobile-Orazio E, Mauri M, Squellati FS, Bono GG. Utility of somatosensory evoked potentials in the assessment of response to IVIG in a long-lasting case of chronic immune sensory polyradiculopathy. BMC Neurol 2017; 17:127. [PMID: 28668085 PMCID: PMC5494125 DOI: 10.1186/s12883-017-0906-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic immune sensory polyradiculopathy (CISP) identifies a progressive acquired peripheral dysimmune neuropathy recognized as a chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) variant. We describe a young woman with a thirteen-year history of CISP with a belated variable response to intravenous immunoglobulin (IVIG) and an almost erratic anticipation of symptoms between IVIG cycles. The association of IVIG and corticosteroids, immunosuppressants, plasmapheresis, did not lead to clinical improvement and was characterized by significant side effects. We evaluated a combined clinical and somatosensory evoked potentials (SSEPs) approach aimed to identify possible predictive parameters concerning the effect and duration of each IVIG administration. Neurologic disability was evaluated using INCAT - Overall Disability Sum Score (INCAT-ODSS). CASE PRESENTATION A 30-year-old woman presented on 2004 for the subacute onset of asymmetric paresthesias in the lower limbs over the previous six months. The symptoms had been relapsing-remitting during the first four months, followed by a slow progression, resulting in limbs ataxia and a progressive gait disturbance requiring Canadian crutches. Motor and sensory nerve conduction studies and electromyographic evaluation were into normal limits. Median SSEPs were normal, while tibial SSEPs were characterised by the bilateral absence of both lumbar and cortical responses. Cerebrospinal fluid detected an increased protein concentration, while spinal MRI showed a pronounced thickening of the sacral nerve roots, together with a tube-shaped enlargement. These findings led to the diagnosis of CISP and the patient was treated with IVIG reaching a stable remission over the following 9 years. In early 2014, the patient began to show a variable response to treatment with erratic anticipation of sensory disturbances, and a more pronounced walking disability: corticosteroids, plasmapheresis, mycophenolate mofetil and cyclophosphamide were uneffective and burdened by relevant side effects. To better assess the response to IVIG in terms of time-effect, consistency and duration, we have combined a scheduled clinical and SSEPs evaluation during and after each IVIG cycle. CONCLUSIONS The correlation between the neurophysiological data and the INCAT-ODSS scores has allowed the modulation of IVIG cycles with a significant reduction of the clinical fluctuations and disability. SSEPs may therefore represent an useful and recommended additional aid for the treatment schedule of this rare clinical form.
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Affiliation(s)
- Angelo Maurizio Clerici
- Neurology Unit, Circolo & Macchi Foundation Hospital - Insubria University - DBSV, Viale L. Borri 57, 21100, Varese, Italy.
| | - Eduardo Nobile-Orazio
- 2nd Neurology, Humanitas Clinical and Research Institute, Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Milan University, Rozzano, Milan, Italy
| | - Marco Mauri
- Neurology Unit, Circolo & Macchi Foundation Hospital - Insubria University - DBSV, Viale L. Borri 57, 21100, Varese, Italy
| | - Federico Sergio Squellati
- Neurology Unit, Circolo & Macchi Foundation Hospital - Insubria University - DBSV, Viale L. Borri 57, 21100, Varese, Italy
| | - Giorgio Giovanni Bono
- Neurology Unit, Circolo & Macchi Foundation Hospital - Insubria University - DBSV, Viale L. Borri 57, 21100, Varese, Italy
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11
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Ikenoshita S, Yamashita S, Sakamoto T, Misumi Y, Ando Y. Hemiatrophy of the Tongue with Contralateral Hemiparesis in a Patient with Multifocal Acquired Demyelinating Sensory and Motor Neuropathy. J Clin Neurol 2017; 13:422-423. [PMID: 28831789 PMCID: PMC5653631 DOI: 10.3988/jcn.2017.13.4.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Susumu Ikenoshita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tetsuro Sakamoto
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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12
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Ellrichmann G, Gold R, Ayzenberg I, Yoon MS, Schneider-Gold C. Two years' long-term follow up in chronic inflammatory demyelinating polyradiculoneuropathy: efficacy of intravenous immunoglobulin treatment. Ther Adv Neurol Disord 2016; 10:91-101. [PMID: 28382108 DOI: 10.1177/1756285616679369] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Administration of intravenous immunoglobulins (IVIgs) is established for long-term treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Prevention of secondary axonal loss going along with permanent clinical disability and muscular atrophy is a major aim in CIDP therapy. To assess long-term clinical efficacy of IVIg treatment despite heterogenous disease course and variable complaints reported by the patients, long-term electrophysiological monitoring was performed for systematic evaluation of therapeutic efficacy of IVIg. METHODS A total of 21 patients with CIDP treated with IVIg 1 g/kg bodyweight every 3-6 weeks were examined electrophysiologically every 12 months over a period of 2 years. RESULTS Assessment of clinical symptoms, using the Inflammatory Neuropathy Cause and Treatment (INCAT) and Hughes functional grading score (F-score) revealed improvement of motor and sensory symptoms over a period of 2 years. As electrophysiological results remained stable, IVIg treatment seems to be suitable to prevent axonal loss in CIDP. CONCLUSIONS This study confirms efficacy of IVIg as firstline therapy in CIDP. Doses and frequency of IVIg application should be adapted based on clinical evaluation and analysis of long-term electrophysiological findings.
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Affiliation(s)
- Gisa Ellrichmann
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
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13
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Scheibe F, Alexander T, Prüss H, Wengert O, Harms L, Angstwurm K, Hiepe F, Arnold R, Meisel A. Devastating humoral CIDP variant remitted by autologous stem cell transplantation. Eur J Neurol 2016; 23:e12-4. [PMID: 26918747 DOI: 10.1111/ene.12896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- F Scheibe
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - T Alexander
- Department of Rheumatology and Clinical Immunology, Charité Berlin, Berlin, Germany
| | - H Prüss
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - O Wengert
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - L Harms
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - K Angstwurm
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - F Hiepe
- Department of Rheumatology and Clinical Immunology, Charité Berlin, Berlin, Germany
| | - R Arnold
- Department of Hematology and Oncology, Charité Berlin, Berlin, Germany
| | - A Meisel
- Department of Neurology, Charité Berlin, Berlin, Germany
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14
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Lotan I, Hellman MA, Steiner I. Diagnostic criteria of chronic inflammatory demyelinating polyneuropathy in diabetes mellitus. Acta Neurol Scand 2015; 132:278-83. [PMID: 25819084 DOI: 10.1111/ane.12394] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The possibility of co-association between diabetes mellitus (DM) and chronic inflammatory demyelinating polyneuropathy (CIDP) has long been a focus of interest as well as of clinical significance. As CIDP is a potentially treatable condition, it is diagnosis in the context of DM is of great importance. However, diagnostic criteria to identify CIDP in patients with diabetes are not available. We propose a diagnostic tool that should help clinicians to decide what is the probability that a patient with diabetes might have CIDP. METHODS We list several clinical, electrophysiological, and laboratory parameters that, when combined, have the power of discriminating an immune-mediated neuropathy in patients with DM. By summing the points assigned to each of these parameters, we define four levels of probability for a patient with diabetes to have CIDP. To analyze the validity of the diagnostic toll, we applied it in three different patient populations: (i) Patients with diabetes with peripheral neuropathy, (ii) Patients with CIDP without DM, and (iii) Patients with diabetes with CIDP. RESULTS The scores of patients with diabetes without CIDP ranged from -7 to 2, while those of patients with DM-CIDP ranged from 2 to 20. The scores of non-diabetic patients with CIDP were similar to those of patients with DM-CIDP and ranged from 6 to 16. The mean score of patients with DM-CIDP was 9.083, while the score of patients with CIDP was 11.16 and that of patients with diabetic polyneuropathy was -3.59. CONCLUSIONS These results show that this diagnostic tool is able to identify patients with diabetes with overlapping CIDP.
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Affiliation(s)
- I. Lotan
- Department of Neurology; Rabin Medical Center; Beilinson Campus; PetachTikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - M. A. Hellman
- Department of Neurology; Rabin Medical Center; Beilinson Campus; PetachTikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - I. Steiner
- Department of Neurology; Rabin Medical Center; Beilinson Campus; PetachTikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Khadilkar SV, Yadav RS, Soni G. A practical approach to enlargement of nerves, plexuses and roots. Pract Neurol 2015; 15:105-15. [DOI: 10.1136/practneurol-2014-001004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Scheidl E, Böhm J, Simó M, Bereznai B, Bereczki D, Arányi Z. Different patterns of nerve enlargement in polyneuropathy subtypes as detected by ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1138-1145. [PMID: 24613217 DOI: 10.1016/j.ultrasmedbio.2013.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
The purpose of our study was to examine how the pathologic type of polyneuropathy affects nerve size as assessed by high-resolution ultrasonography with a 15 MHz transducer. Cross-sectional area (CSA) of the C5-C7 nerve roots and several upper and lower limb nerves at multiple sites was measured in 38 patients with acquired diffuse sensorimotor demyelinating or axonal polyneuropathy and in 34 healthy control subjects. Significant differences were found among the groups for all nerve and root segments: Both types of polyneuropathy are characterized by nerve enlargement in comparison to controls, but in different patterns. In demyelinating polyneuropathies, an additional degree of nerve thickening appears in proximal upper limb nerves and cervical nerve roots compared with axonal polyneuropathies. With respect to the other nerves, a similar degree of nerve enlargement was observed in both patient groups. These results highlight that ultrasonography may be a complementary tool in differentiating polyneuropathies.
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Affiliation(s)
- Erika Scheidl
- Department of Neurology, Semmelweis University, Budapest, Hungary.
| | - Josef Böhm
- Department of Neurology, Freiberg County Hospital, Freiberg, Germany
| | - Magdolna Simó
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
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17
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Odaka M. Chronic inflammatory demyelinating polyneuropathy: a treatment protocol proposal. Expert Rev Neurother 2014; 6:365-79. [PMID: 16533141 DOI: 10.1586/14737175.6.3.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Guidelines for diagnostic criteria and treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) have been proposed by a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society, based on available evidence and expert consensus. These should prove practical for the clinical management of CIDP. Intravenous immunoglobulin followed by corticosteroids should be considered as the initial treatment, however no clear second drug of choice for patients who do not respond to the initial treatment is given. The author reports the long-term therapeutic efficacy of ciclosporin for patients with CIDP who did not show sustained improvement under steroid therapy. Ciclosporin should be tried for patients with intractable CIDP who require repeated intravenous immunoglobulin. An adequate initial dose of ciclosporin is 3 mg/kg/day, with plasma trough concentrations between 100 and 150 ng/ml. If patients respond to ciclosporin, remission can be maintained for 2 years, after which the dose can be slowly reduced over 1 year. Eventual withdrawal should be considered. This review proposes a treatment strategy that includes long-term maintenance therapy for CIDP based on published clinical trials and the author's clinical experience. Current concepts concerning the clinical spectrum of CIDP and diagnostic approaches are also considered.
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Affiliation(s)
- Masaaki Odaka
- Department of Neurology, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321-0293, Japan.
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18
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Dunnigan SK, Ebadi H, Breiner A, Katzberg HD, Lovblom LE, Perkins BA, Bril V. Conduction slowing in diabetic sensorimotor polyneuropathy. Diabetes Care 2013; 36:3684-90. [PMID: 24026550 PMCID: PMC3816879 DOI: 10.2337/dc13-0746] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Mild demyelination may contribute more to the pathophysiology of nerve fiber injury in diabetic sensorimotor polyneuropathy (DSP) than previously thought. We investigated the clinical and electrodiagnostic classifications of nerve injury in diabetic patients to detect evidence of conduction slowing in DSP. RESEARCH DESIGN AND METHODS Type 1 diabetic subjects (n = 62) and type 2 diabetic subjects (n = 111) with a broad spectrum of DSP underwent clinical examination and nerve conduction studies (NCS). Patients were classified as having axonal (group A), conduction slowing (group D), or combined (group C) DSP based on electrodiagnostic criteria. Patients with chronic immune-mediated neuropathies were not included. The groups were compared using ANOVA, contingency tables, and Kruskal-Wallis analyses. RESULTS Of the 173 type 1 and type 2 diabetic subjects with a mean age of 59.1 ± 13.6 years and hemoglobin A1c (HbA1c) of 8.0 ± 1.8% (64 ± 19.7 mmol/mol), 46% were in group A, 32% were in group D, and 22% were in group C. The severity of DSP increased across groups A, D, and C, respectively, based on clinical and NCS parameters. The mean HbA1c for group D subjects (8.9 ± 2.3% [74 ± 25.1 mmol/mol]) was higher than for group A and group C subjects (7.7 ± 1.4% [61 ± 15.3 mmol/mol] and 7.5 ± 1.3% [58 ± 14.2 mmol/mol]; P = 0.003), and this difference was observed in those with type 1 diabetes. CONCLUSIONS The presence of conduction slowing in patients with suboptimally controlled type 1 diabetes indicates the possibility that this stage of DSP may be amenable to intervention via improved glycemic control.
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19
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Tanaka K, Mori N, Yokota Y, Suenaga T. MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case-control study. BMJ Open 2013; 3:e003443. [PMID: 23996823 PMCID: PMC3758976 DOI: 10.1136/bmjopen-2013-003443] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To systematically evaluate the usefulness of assessing the cervical nerve roots by MRI for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). DESIGN Single-institution, retrospective case-control study. SETTING A regional referral hospital. PARTICIPANTS We retrospectively enrolled 15 consecutive patients with CIDP who satisfied the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) typical and definite criteria and underwent cervical MRI. 30 control patients who had also undergone cervical MRI were included, matched with regard to sex, age and MRI system. The diagnoses of the control patients included cervical spondylosis (n=19), cervical spine trauma (n=2), infection (n=1), malignancies (n=4), demyelinating disorders (n=2) and neurodegenerative disorders (n=2). MEASUREMENT A radiologist determined the C5-C8 root diameters on the coronal short tau inversion recovery (STIR) images. Signal intensities of these roots were quantified as nerve-to-muscle contrast-to-noise ratios (CNRs), which were calculated using mean signal intensities of the roots and sternocleidomastoid muscle as well as SD of background noise. Statistical analyses were performed to determine the diagnostic accuracy of the diameters and nerve-to-muscle CNRs. Another radiologist reviewed MRI for ensuring reproducibility. RESULTS The root diameters showed no significant differences between the patients with CIDP and control patients. The nerve-to-muscle CNRs were significantly higher in the patients with CIDP. We defined the sum of nerve-to-muscle CNRs of C5-C8 roots as the CNR score to serve as an index of overall signal intensity. The area under the receiver operating characteristic curve of CNR scores was 0.731. The reproducibility of the assessment procedure was satisfactory. CONCLUSIONS Our results suggest that assessment of the cervical nerve roots by MRI is useful for CIDP diagnosis when the signal intensities, rather than the diameters, are paid more attention on STIR images.
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Affiliation(s)
- Kanta Tanaka
- Department of Neurology, Tenri Hospital, Tenri, Japan
| | - Nobuyuki Mori
- Department of Radiology, Tenri Hospital, Tenri, Japan
| | - Yusuke Yokota
- Department of Radiology, Tenri Hospital, Tenri, Japan
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20
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A male with progressive lower extremity weakness and monoclonal gammopathy. J Clin Neuromuscul Dis 2013; 14:194-203. [PMID: 23703016 DOI: 10.1097/cnd.0b013e31829081cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EDUCATIONAL OBJECTIVES To discuss a case of progressive lower extremity paresis and paresthesias in a patient found to have monoclonal gammopathy. KEY QUESTIONS (1) What is the differential diagnosis of progressive lower extremity paresis and paresthesias? (2) How would one approach diagnostic testing for such a patient? (3) What is the differential diagnosis of neuropathy associated with gammopathy? and (4) What is the treatment for this patient?
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21
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Abstract
Electromyography (EMG) is an important diagnostic tool for the assessment of individuals with various neuromuscular diseases. It should be an extension of a thorough history and physical examination. Some prototypical characteristics and findings of EMG and nerve conduction studies are discussed; however, a more thorough discussion can be found in the textbooks and resources sited in the article. With an increase in molecular genetic diagnostics, EMG continues to play an important role in the diagnosis and management of patients with neuromuscular diseases and also provides a cost-effective diagnostic workup before ordering a battery of costly genetic tests.
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Affiliation(s)
- Bethany M Lipa
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA.
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22
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Affiliation(s)
- Kevin Mohee
- School of Medicine, University of Leeds, School of Medicine, Leeds, UK.
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23
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Said G, Krarup C. Chronic inflammatory demyelinative polyneuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:403-13. [PMID: 23931792 DOI: 10.1016/b978-0-444-52902-2.00022-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic inflammatory demyelinative polyneuropathy (CIDP) is an acquired polyneuropathy presumably of immunological origin. It is characterized by a progressive or a relapsing course with predominant motor deficit. The diagnosis rests on the association of non-length-dependent predominantly motor deficit following a progressive or a relapsing course associated with increased CSF protein content. The demonstration of asymmetrical demyelinating features on nerve conduction studies is needed for diagnosis. The outcome depends on the amplitude of axon loss associated with demyelination. CIDP must be differentiated from acquired demyelinative neuropathies associated with monoclonal gammopathies. CIDP responds well to treatment with corticosteroids, intravenous immunoglobulins, and plasma exchanges, at least initially.
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Affiliation(s)
- Gérard Said
- Department of Neurology, Hôpital de la Salpêtrière, Paris, France.
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24
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Jani-Acsadi A, Lewis RA. Evaluation of a patient with suspected chronic demyelinating polyneuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:253-64. [PMID: 23931785 DOI: 10.1016/b978-0-444-52902-2.00015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Agnes Jani-Acsadi
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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25
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Peltier AC, Donofrio PD. Chronic inflammatory demyelinating polyradiculoneuropathy: from bench to bedside. Semin Neurol 2012; 32:187-95. [PMID: 23117943 DOI: 10.1055/s-0032-1329194] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common treatable chronic autoimmune neuropathy. Multiple diagnostic criteria have been established, with the primary goal of identifying neurophysiologic hallmarks of acquired demyelination. Treatment modalities have expanded to include numerous immunomodulatory therapies, although the best evidence continues to be for corticosteroids, plasma exchange, and intravenous immunoglobulin (IVIg). This review describes the pathology, epidemiology, pathogenesis, diagnosis, and treatment of CIDP.
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Affiliation(s)
- Amanda C Peltier
- Department of Neurology, Vanderbilt Medical Center, Medical Center North, Nashville, Tennessee 37232-2551, USA.
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26
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Abstract
Polyradiculopathies are uncommon peripheral nervous system syndromes that result from a variety of conditions. The clinical manifestations are variable but often include symmetric or asymmetric distal and proximal weakness with a variable degree of sensory loss and reduction or loss of reflexes. The most common cause of an acute polyradiculopathy is acute inflammatory demyelinating polyradiculopathy (also known as Guillain-Barré syndrome); however, other inflammatory, infectious, or neoplastic causes can present with similar features. Chronic polyradiculopathies include chronic inflammatory demyelinating polyradiculopathy as well as paraprotein-related syndromes and other inflammatory and infectious causes. Evaluation using a combination of serologic studies, electrodiagnostic testing, and CSF evaluation can help to identify the underlying etiology and implement the appropriate treatment. This article reviews the approach to patients with suspected polyradiculopathy and the features of the more common causes of acute and chronic polyradiculopathies.
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27
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Abstract
The electrodiagnostic studies of 13 consecutive patients with multifocal sensory and motor neuropathy of unknown etiology were reviewed to determine whether they exhibit features of demyelination or axonal degeneration. The type and frequency of demyelinating features, fulfillment of electrodiagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP), and response to immunotherapy were noted. Of 13 patients, 11 had at least one electrodiagnostic feature of demyelination at presentation and 2 had none. Seventeen percent to 77% of the patients fulfilled at least one of the published electrodiagnostic CIDP criteria, depending on the criteria used, but the number of demyelinating features per patient was less than reported for unselected patients with CIDP. Patients with multifocal sensory and motor neuropathy had a similar percentage of nerves with partial conduction block or F-wave prolongation as reported for unselected CIDP, but a smaller percentage of nerves exhibiting prolonged distal compound muscle action potential duration, distal latency prolongation or slowed conduction velocities. All treated patients, including 2 who did not meet any CIDP criteria, had at least a moderate response to immunotherapy. The results indicate that a large majority of, but not all, patients with idiopathic multifocal sensory and motor neuropathies exhibit electrodiagnostic features of demyelination, although fewer than seen in classic CIDP.
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Electrophysiological Characteristics of Polyneuropathy in POEMS Syndrome. J Clin Neurophysiol 2012; 29:345-8. [DOI: 10.1097/wnp.0b013e3182624462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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29
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Scheidl E, Böhm J, Simó M, Rózsa C, Bereznai B, Kovács T, Arányi Z. Ultrasonography of MADSAM neuropathy: focal nerve enlargements at sites of existing and resolved conduction blocks. Neuromuscul Disord 2012; 22:627-31. [PMID: 22513319 DOI: 10.1016/j.nmd.2012.03.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/25/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023]
Abstract
Using the emerging technique of peripheral nerve ultrasonography, multiple focal nerve swellings corresponding to sites of existing conduction blocks have been described in demyelinating polyneuropathies. We report two cases of multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). In the first, multiple focal nerve enlargements were detected by ultrasound at sites of previous conduction blocks, well after complete clinical and electrophysiological resolution. In the second case, existing proximal conduction blocks could be localized by ultrasound. Our cases highlight the importance of nerve ultrasound in identifying conduction blocks and demonstrate that ultrasonographic morphological changes may outlast functional recovery in demyelinating neuropathies.
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Affiliation(s)
- Erika Scheidl
- Dept. of Neurology, Semmelweis University, Budapest, Hungary.
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30
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Short and long-term effect of IVIg in demyelinating neuropathy associated with MGUS, experience of a monocentric study. Rev Neurol (Paris) 2011; 167:897-904. [PMID: 22023823 DOI: 10.1016/j.neurol.2011.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 04/12/2011] [Accepted: 04/26/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The optimal treatment for demyelinating neuropathy associated with MGUS and anti-MAG neuropathy is not known. METHODS We retrospectively studied the efficacy of IVIg in 14 patients with DN-MGUS (seven IgM and seven IgG/A) and seven with anti-MAG neuropathies, treated in our reference center between 2002 and 2007. Patients were clinically evaluated before the first infusion, after the first infusion, and after the last IVIg treatment. RESULTS Anti-MAG neuropathy: after a single infusion, one patient improved and six were stable. At last follow-up (mean: 15.6months [range: 3.5-31], mean number of IVIg courses: 8 [2-33]), one patient maintained her improvement from baseline. DN-MGUS: after a single infusion, nine patients improved (64%), four were stable and one deteriorated further. The factor predictive of short-term response to IVIg was relapsing neuropathy responding better in the walking score analysis (Fisher exact test: P=0.005). At last follow-up (mean: 22.6months [range 2-72], mean number of IVIg courses: seven [1-24]), neurological status improved in four patients, five patients remained stable, including three who are still under regular IVIg, and four had deteriorated. Improvement from baseline persisted for a prolonged period in two patients after IVIg were stopped. Patients who were responders on Norris after the first IVIg course were significantly better responders at long-term follow-up than the others (P=0.001). We report no serious adverse effect. CONCLUSION IVIg are not very efficient in the management of anti-MAG neuropathies. Nevertheless, they have a frequent short-term beneficial effect in DN-MGUS, which was maintained at long-term follow-up in one-third of our patients. When a DN-MGUS patient is regularly treated by IVIg courses, frequent periodic clinical evaluations must be performed to determine when to stop treatment and switch to another one.
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Yoon MS, Chan A, Gold R. Standard and escalating treatment of chronic inflammatory demyelinating polyradiculoneuropathy. Ther Adv Neurol Disord 2011; 4:193-200. [PMID: 21694819 DOI: 10.1177/1756285611405564] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, immune-mediated polyradiculoneuritis that is progressive or relapsing over a period of at least 8 weeks. Although the exact pathogenesis is unclear, it is thought to be mediated by both cellular and humoral immune reactions directed against the peripheral nerve myelin or axon. CIDP also involves spinal nerve roots. Early medical treatment of CIDP is important to prevent axonal loss. Only three treatment regimens for CIDP have demonstrated benefit in randomized, controlled studies: corticosteroids, plasma exchange, and intravenous immunoglobulins (IVIg). Approximately 25% of patients respond inadequately to corticosteroids, plasma exchange or IVIg. Large placebo-controlled trials with alternative immunosuppressive compounds, e.g. mycophenolate mofetil, cyclosporine, cyclophosphamide, or monoclonal antibodies, are lacking.
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Affiliation(s)
- Min-Suk Yoon
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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Maccabee PJ, Eberle LP, Stein IA, Willer JA, Lipitz ME, Kula RW, Marx T, Muntean EV, Amassian VE. Upper leg conduction time distinguishes demyelinating neuropathies. Muscle Nerve 2011; 43:518-30. [DOI: 10.1002/mus.21909] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2010] [Indexed: 11/11/2022]
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Nam TS, Lee SH, Park MS, Choi KH, Kim JT, Choi SM, Kim BC, Kim MK, Cho KH. Mononeuropathy multiplex in a patient with chronic active hepatitis B. J Clin Neurol 2010; 6:156-8. [PMID: 20944818 PMCID: PMC2950922 DOI: 10.3988/jcn.2010.6.3.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 12/02/2022] Open
Abstract
Background Mononeuropathy multiplex is a rare complication during the course of chronic hepatitis B, despite various neuropathies following acute hepatitis B having been reported previously. Case Report A 30-year-old man presented with sensorimotor symptoms in multiple peripheral nerves. The serological tests for hepatitis were consistent with chronic active hepatitis B. After treatment with oral prednisone combined with an antiviral agent, the sensory and motor symptoms improved and hepatitis B virus replication was reduced. Conclusions We suggest that chronic immune-mediated neuropathy associated with hepatitis B virus infection should be considered in the differential diagnosis of patients with hepatitis B.
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Affiliation(s)
- Tai Seung Nam
- Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
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34
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Viala K, Maisonobe T, Stojkovic T, Koutlidis R, Ayrignac X, Musset L, Fournier E, Léger JM, Bouche P. A current view of the diagnosis, clinical variants, response to treatment and prognosis of chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2010; 15:50-6. [PMID: 20433605 DOI: 10.1111/j.1529-8027.2010.00251.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We retrospectively analyzed 146 patients fulfilling the European Federation of Neurological Societies and the Peripheral Nerve Society (EFNS/PNS) criteria for definite chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) to (1) evaluate the relevance of these criteria, (2) assess the frequency of CIDP variants, and (3) determine the response to treatment and the prognosis. We found that 75% of these patients fulfilled the main EFNS/PNS clinical and electrophysiological criteria (type I). The remaining patients were diagnosed using laboratory tools as supportive criteria. The common form of CIDP represented 51% of patients. We observed a high frequency of the sensory variant (35% of patients) and the rapid onset form (18%). A positive response to treatment was observed in 87% of patients, with a similar efficacy of prednisone and IVIg. However, in the long term, 40% of treated patients remained dependent on treatment. The IVIg dependency rate was higher than the prednisone or plasma exchange dependency rate (55%, 18%, and 23%, respectively; p = 0.0054). Severe handicap was observed in 24% of patients.
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Affiliation(s)
- Karine Viala
- Fédération de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France.
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35
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Sartucci F, Bocci T, Borghetti D, Orlandi G, Manfredonia F, Murri L, Giannini F, Rossi A. Further insight on A-wave in acute and chronic demyelinating neuropathies. Neurol Sci 2010; 31:609-16. [DOI: 10.1007/s10072-010-0354-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 06/03/2010] [Indexed: 11/27/2022]
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36
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De Sousa EA. Chronic inflammatory demyelinating polyneuropathy: diagnosis and management. Expert Rev Clin Immunol 2010; 6:373-80. [PMID: 20441424 DOI: 10.1586/eci.10.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the course of 8 weeks, a 50-year-old man developed progressive bilateral leg and arm weakness, with numbness and tingling of the feet and hands. His symptoms persisted for 6 months, with impaired manual dexterity, arm weakness when brushing his teeth, tripping when walking, inability to climb stairs and gait imbalance. On examination, there is mild proximal and distal weakness of the upper and lower extremity muscles, length-dependent sensory loss of vibratory perception and joint position sense, areflexia, positive Romberg test and steppage gait with bilateral foot drop. Motor nerve conduction studies of the arms and legs show partial conduction blocks in several nerves with nonuniform slowing, and sensory responses are absent in the hands, however, normal sural responses are noted. Lumbar puncture reveals acellular cerebrospinal fluid with elevated protein. After 2 months following treatment, his strength and gait improved significantly, and his sensory symptoms resolved.
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Affiliation(s)
- Eduardo A De Sousa
- Neuromuscular Medicine, Department of Neurology, Jefferson Medical College, Thomas Jefferson University, 900 Walnut Street, Ste 200, Philadelphia, PA 19107, USA.
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37
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Dionne A, Nicolle MW, Hahn AF. Clinical and electrophysiological parameters distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy. Muscle Nerve 2010; 41:202-7. [PMID: 19882646 DOI: 10.1002/mus.21480] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Up to 16% of chronic inflammatory demyelinating polyneuropathy (CIDP) patients may present acutely. We performed a retrospective chart review on 30 acute inflammatory demyelinating polyneuropathy (AIDP) and 15 acute-onset CIDP (A-CIDP) patients looking for any clinical or electrophysiological parameters that might differentiate AIDP from acutely presenting CIDP. A-CIDP patients were significantly more likely to have prominent sensory signs. They were significantly less likely to have autonomic nervous system involvement, facial weakness, a preceding infectious illness, or need for mechanical ventilation. With regard to electrophysiological features, neither sural-sparing pattern, sensory ratio >1, nor the presence of A-waves was different between the two groups. This study suggests that patients presenting acutely with a demyelinating polyneuropathy and the aforementioned clinical features should be closely monitored as they may be more likely to have CIDP at follow-up.
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Affiliation(s)
- Annie Dionne
- Department of Clinical Neurological Sciences, Université Laval, 1401 18 rue, Québec City, Québec G1J 1Z4, Canada.
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38
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Kimura A, Sakurai T, Koumura A, Yamada M, Hayashi Y, Tanaka Y, Hozumi I, Yoshino H, Yuasa T, Inuzuka T. Motor-dominant chronic inflammatory demyelinating polyneuropathy. J Neurol 2009; 257:621-9. [PMID: 20361294 DOI: 10.1007/s00415-009-5386-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 11/03/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
Abstract
We reviewed the clinical, electrophysiological an laboratory findings, plus the therapeutics and evolution of patients with motor-dominant Chronic inflammatory demyelinating polyneuropathy (CIDP) and compared them with those of other CIDP patients. Among 12 consecutive CIDP patients, we identified five patients with motor-dominant CIDP. The five patients with motor-dominant CIDP initially presented with weakness of the upper limbs. Cervical magnetic resonance imaging (MRI) examinations of the patients with motor-dominant CIDP showed that the most affected lesions are the cervical nerve roots and brachial plexus. The clinical course of these patients was relapsing-remitting, and they improved markedly after treatment by intravenous immunoglobulin (IVIg) infusion or plasmapheresis. However, they did not improve in response to corticosteroid therapy during the acute phase of relapses. The relapses frequently occurred within 2 years, but rarely occurred after that. The score in the modified Rankin disability scale (mRDS) at the last follow-up period was statistically lower for the patients with motor-dominant CIDP than for the other CIDP patients (P < 0.002). The characteristic clinical features, responsiveness to treatment, and prognosis suggest that motor-dominant CIDP is a distinct subtype of CIDP, with a specific immunological background. Repeated IVIg therapy is required to maintain the motor functions of patients with motor-dominant CIDP. We consider that treatment for recurrence prevention as an alternative to IVIg therapy is very important for patients with motor-dominant CIDP.
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Affiliation(s)
- Akio Kimura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, 1-1 Yanagido, Gifu, 501-1194, Japan.
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39
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Hergüner MO, Incecik F, Altunbaşak S. Cyclosporin treatment in three children with chronic inflammatory demyelinating neuropathy. Pediatr Neurol 2009; 41:223-5. [PMID: 19664543 DOI: 10.1016/j.pediatrneurol.2009.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 03/11/2009] [Accepted: 03/16/2009] [Indexed: 01/15/2023]
Abstract
Chronic inflammatory demyelinating neuropathy is an uncommon acquired polyneuropathy in children. Oral prednisolone, intravenous methyl prednisolone, and intravenous immunoglobulin are its main initial therapies. In patients resistant to these modalities, other immunosuppressants can be used. We demonstrate the efficacy of cyclosporin in three children with chronic inflammatory demyelinating neuropathy. Two of them were infants. None had adverse effects, except for hirsutism. We conclude that cyclosporin treatment can be effective and safe in chronic inflammatory demyelinating neuropathy, when standard treatments are ineffective. Cyclosporin can also be used safely in infants.
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Affiliation(s)
- M Ozlem Hergüner
- Department of Pediatric Neurology, Cukurova University, 01330 Balcali, Adana, Turkey.
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40
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Laughlin RS, Dyck PJ, Melton LJ, Leibson C, Ransom J, Dyck PJB. Incidence and prevalence of CIDP and the association of diabetes mellitus. Neurology 2009; 73:39-45. [PMID: 19564582 PMCID: PMC2707109 DOI: 10.1212/wnl.0b013e3181aaea47] [Citation(s) in RCA: 198] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The reported prevalence of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) varies greatly, from 1.9 to 7.7 per 100,000. CIDP is reported to occur more commonly in patients with diabetes mellitus (DM) but has not been rigorously tested. OBJECTIVES To determine the incidence (1982-2001) and prevalence (on January 1, 2000) of CIDP in Olmsted County, Minnesota, and whether DM is more frequent in CIDP. METHODS CIDP was diagnosed by clinical criteria followed by review of electrophysiology. Cases were coded as definite, probable, or possible. DM was ascertained by clinical diagnosis or current American Diabetes Association glycemia criteria. RESULTS One thousand five hundred eighty-one medical records were reviewed, and 23 patients (10 women and 13 men) were identified as having CIDP (19 definite and 4 probable). The median age was 58 years (range 4-83 years), with a median disease duration at diagnosis of 10 months (range 2-64 months). The incidence of CIDP was 1.6/100,000/year. The prevalence was 8.9/100,000 persons on January 1, 2000. Only 1 of the 23 CIDP patients (4%) also had DM, whereas 14 of 115 age- and sex-matched controls (12%) had DM. CONCLUSIONS 1) The incidence (1.6/100,000/year) and prevalence (8.9/100,000) of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are similar to or higher than previous estimates. 2) The incidence of CIDP is similar to that of acute inflammatory demyelinating polyradiculoneuropathy within the same population. 3) Diabetes mellitus (DM) is unlikely to be a major risk covariate for CIDP, but we cannot exclude a small effect. 4) The perceived association of DM with CIDP may be due to misclassification of other forms of diabetic neuropathies and excessive emphasis on electrophysiologic criteria.
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Affiliation(s)
- R S Laughlin
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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41
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Varela H, Rubin DI. Facial and trigeminal neuropathies as the initial manifestation of chronic inflammatory demyelinating polyradiculopathy. J Clin Neuromuscul Dis 2009; 10:194-198. [PMID: 19494731 DOI: 10.1097/cnd.0b013e31819f7cd5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To report the clinical and electrophysiological features of a patient who presented with facial weakness and numbness as the initial manifestation of Chronic inflammatory demyelinating polyradiculopathy (CIDP). CASE REPORT An 83-year-old woman presented with facial numbness and weakness. Examination demonstrated mild facial weakness with no other cranial abnormalities. Blink and jaw-jerk reflex latencies were prolonged bilaterally; myokymic discharges were seen in the right frontalis. Cerebrospinal fluid demonstrated an elevated protein. After 3 weeks of intravenous immunoglobulin treatment, the symptoms and electrophysiological findings improved but the symptoms recurred and became more generalized after cessation of intravenous immunoglobulin. CONCLUSIONS This case represents a patient with an unusual initial presentation of cranial nerve involvement in CIDP. Blink reflexes may be a useful electrophysiological technique to assess for peripheral nerve demyelination in patients with suspected CIDP.
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Affiliation(s)
- Heber Varela
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
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42
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Stangel M, Hartung HP, Gold R, Kieseier BC. [The significance of intravenous immunoglobulin in treatment of immune-mediated polyneuropathies]. DER NERVENARZT 2009; 80:678-687. [PMID: 19139838 DOI: 10.1007/s00115-008-2631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Long-term treatment of immune-mediated polyneuropathies remains difficult. For acute polyneuritis, or Guillain-Barré syndrome, the established standard therapy utilizes high doses of polyvalent intravenous immunoglobulins (IVIG). A recently published randomized placebo-controlled study of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) showed IVIG to be clinically effective also for this disorder in both short and long term. This survey presents data of this so-called ICE study ("Intravenous immune globulin for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy"). It also discusses the value of IVIG in the treatment of immune-mediated polyneuropathies.
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Affiliation(s)
- M Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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43
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Neuropathie motrice multifocale : existe-t-il une altération de la conduction sensitive au long cours ? Une étude rétrospective chez 21 patients. Rev Neurol (Paris) 2009; 165:243-8. [DOI: 10.1016/j.neurol.2008.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 09/03/2008] [Accepted: 10/08/2008] [Indexed: 11/21/2022]
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44
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Koski C, Baumgarten M, Magder L, Barohn R, Goldstein J, Graves M, Gorson K, Hahn A, Hughes R, Katz J, Lewis R, Parry G, van Doorn P, Cornblath D. Derivation and validation of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy. J Neurol Sci 2009; 277:1-8. [DOI: 10.1016/j.jns.2008.11.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 11/17/2008] [Accepted: 11/18/2008] [Indexed: 11/30/2022]
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45
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Bragg JA, Benatar MG. Sensory nerve conduction slowing is a specific marker for CIDP. Muscle Nerve 2008; 38:1599-603. [DOI: 10.1002/mus.21186] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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46
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Abstract
PURPOSE OF REVIEW The aim of this review is to describe the value of high-dose polyclonal intravenous immunoglobulins as a treatment option in autoimmune disorders affecting the peripheral nervous system. RECENT FINDINGS A randomized placebo-controlled trial in patients with chronic inflammatory demyelinating polyradiculoneuropathy revealed short-term and long-term efficacy and safety of intravenous immunoglobulins as a treatment option for the chronically inflamed peripheral nervous system. Case reports suggest that the subcutaneous administration of immunoglobulins may represent a convenient alternative. SUMMARY Intravenous immunoglobulin represents an effective and safe treatment option in patients with autoimmune-mediated diseases affecting the peripheral nerves.
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47
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Abstract
Tumor necrosis factor (TNF)-alpha plays an important role in many aspects of immune system development, immune-response regulation, and T-cell-mediated tissue injury. The evidence that TNF-alpha, released by autoreactive T cells and macrophages, may contribute to the pathogenesis of immune-mediated demyelinating neuropathies is reviewed. TNF-alpha antagonists (infliximab, etanercept, adalimumab) are indicated for the treatment of advanced inflammatory rheumatic and bowel disease, but these drugs can induce a range of autoimmune diseases that also attack the central and peripheral nervous systems. Case histories and series report on the association between anti-TNF-alpha treatment and various disorders of peripheral nerve such as Guillain-Barré syndrome, Miller Fisher syndrome, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy with conduction block, mononeuropathy multiplex, and axonal sensorimotor polyneuropathies. The proposed pathogeneses of TNF-alpha-associated neuropathies include both a T-cell and humoral immune attack against peripheral nerve myelin, vasculitis-induced nerve ischemia, and inhibition of signaling support for axons. Most neuropathies improve over a period of months by withdrawal of the TNF-alpha antagonist, with or without additional immune-modulating treatment. Preliminary observations suggest that TNF-alpha antagonists may be useful as an antigen-nonspecific treatment approach to immune-mediated neuropathies in patients with a poor response to, or intolerance of, standard therapies, but further studies are required.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology and Neuroscience, Cornell University Medical College, New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4897, USA.
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48
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Beydoun SR, Sykes SN, Ganguly G, Lee TS. Hereditary neuropathy with liability to pressure palsies: description of seven patients without known family history. Acta Neurol Scand 2008; 117:266-72. [PMID: 17922888 DOI: 10.1111/j.1600-0404.2007.00935.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Hereditary neuropathy with liability to pressure palsies (HNPP) is an inherited disorder resulting in a polyneuropathy with particular involvement at sites of entrapment, and is often underdiagnosed or misdiagnosed. We report findings on seven patients referred for evaluation of focal mononeuropathies or polyneuropathies of undetermined etiology, in whom we established a diagnosis of HNPP. MATERIALS AND METHODS We retrospectively reviewed clinical, electrophysiological and laboratory data for patients diagnosed with HNPP over a 4-year period at our institution. RESULTS All patients had transient or recurrent neurological symptoms, some with residual deficits. No patients had a family history of any neuropathy. Electrodiagnostic studies revealed abnormal conduction findings at symptomatic and asymptomatic sites. Testing for the Peripheral Myelin Protein (PMP22) deletion was positive in all patients. CONCLUSIONS A high index of clinical suspicion and thorough electrodiagnostic evaluation can lead to correct diagnosis of HNPP, despite the absence of a positive family history.
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Affiliation(s)
- S R Beydoun
- Department of Neurology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.
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49
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Riccioli LA, D'Agostino V, Marliani A, Leonardi M. Massive Peripheral Nerve Hypertrophy in a Patient with Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Neuroradiol J 2008; 21:107-9. [DOI: 10.1177/197140090802100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 07/20/2007] [Indexed: 11/17/2022] Open
Abstract
We describe a male patient with chronic inflammatory demyelinating polyradiculoneuropathy presenting extensive diffuse hypertrophy of the nerve roots of peripheral nerves. Since adolescence the patient has had a slow and progressive mainly distal loss of sensitivity and muscle weakness in all four limbs. He presented with diffuse muscle atrophy with enlarged palpable nerve trunks. Electromyography disclosed impaired sensory and motor responses in the bilateral median nerves and the right ulnar nerve. CSF examination showed elevated protein content, while MR scans depicted extensive hypertrophy of the spinal nerve roots. The patient benefitted from corticosteroid treatment.
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Affiliation(s)
| | - V. D'Agostino
- Chair in Neuroradiology, University of Naples; Naples, Italy
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50
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Tazawa KI, Matsuda M, Yoshida T, Shimojima Y, Gono T, Morita H, Kaneko T, Ueda H, Ikeda SI. Spinal nerve root hypertrophy on MRI: clinical significance in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Intern Med 2008; 47:2019-24. [PMID: 19043253 DOI: 10.2169/internalmedicine.47.1272] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate the clinical usefulness of measuring diameters of spinal nerve roots on magnetic resonance imaging (MRI) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with regard to the diagnosis and estimation of neurofunctional impairment. PATIENTS AND METHODS Fourteen patients with CIDP (mean age, 38.9+/-19.2 years) and 10 controls were enrolled in this study. Diameters of cervical and lumbosacral spinal nerve roots were determined on the short tau inversion recovery image of MRI. Correlations between these diameters and clinical indices, including the conduction velocity of median and tibial nerves, were examined. RESULTS Mean diameters of cervical and lumbosacral spinal nerve roots in CIDP patients were 6.0 to 6.8 mm and 7.3 to 10.4 mm, respectively. CIDP patients showed higher values of the diameter in C5 (p<0.05), C6 (p<0.05), C7 (p<0.005) and C8 (p<0.01) than controls. C7 and C8 showed significantly negative correlations between diameters of spinal nerve roots and the F-wave conduction velocity (FWCV) (p<0.05). In the lumbosacral region, L3, L4 and S1 showed significantly negative correlations between diameters of spinal nerve roots and FWCV (p<0.005, p<0.0005 and p<0.005, respectively). The latency-time difference between F- and M-waves increased with diameters of spinal nerve roots, and there were significantly positive correlations between them in L3 (p<0.05) and L4 (p<0.005). CONCLUSION Hypertrophy of spinal nerve roots shown on MRI may be useful as a clue to the diagnosis of CIDP and also as a clinical marker suggesting impairment of peripheral nerve conduction, particularly FWCV.
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Affiliation(s)
- Ko-ichi Tazawa
- Department of Internal Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
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