1
|
Ginanneschi F, Cioncoloni D, Capoccitti G, Volpi N, Ferretti F, Giannini F, Rossi A. Study of total duration of distal compound muscle action potential in demyelinating and axonal Guillain-Barre' syndrome. Neurol Res 2023; 45:381-389. [PMID: 36403142 DOI: 10.1080/01616412.2022.2148517] [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]
Abstract
OBJECTIVES Electrophysiology plays a crucial role in Guillain-Barré syndrome (GBS) diagnosis and subtype classification. The aim of our study was to assess the potential role of distal compound muscle action potential (dCMAP) for early differentiation between acute inflammatory demyelinating polyneuropathy (AIDP) and axonal GBS. METHODS We retrospectively reviewed the medical records of 24 subjects with AIDP and 18 subjects with axonal GBS. We built up receiver operating characteristic curves for total dCMAP duration and negative phase of dCMAP duration, in order to derive cut-off values able to differentiate between AIDP and axonal GBS. RESULTS The total duration of dCMAP was significantly prolonged in AIDP compared to axonal GBS. AUCs, odds ratio and positive predictive values were higher for total duration than for negative peak duration. Nerve conduction parameters in the lower limbs were more sensitive than those in the upper limbs in distinguishing AIDP from axonal GBS. DISCUSSION Total duration of dCMAP dispersion may capture an adjunctive component of distal demyelination, not measured by the more traditional parameters and may thus represent a useful tool for early differentiation between AIDP and axonal GBS.
Collapse
Affiliation(s)
- Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - David Cioncoloni
- U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giorgio Capoccitti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Nila Volpi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Ferretti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Giannini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| |
Collapse
|
2
|
Stojkovic T, Masingue M, Turmel H, Hezode-Arzel M, Béhin A, Leonard-Louis S, Bassez G, Bauché S, Blondy P, Richard P, Sternberg D, Eymard B, Fournier E, Villar-Quiles RN. Diagnostic yield of a practical electrodiagnostic protocol discriminating between different congenital myasthenic syndromes. Neuromuscul Disord 2022; 32:870-878. [PMID: 36522822 DOI: 10.1016/j.nmd.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
Congenital myasthenic syndromes (CMS) are a group of heterogeneous diseases of the neuromuscular junction. We report electrodiagnostic testing (EDX) and genetic findings in a series of 120 CMS patients tested with a simple non-invasive EDX workup with surface recording of CMAPs and 3Hz repetitive nerve stimulation of accessory, radial and deep fibular nerves. Five ENMG phenotypes were retrieved based on the presence or not of R-CMAPs and the distribution pattern of decremental CMAP responses which significantly correlated with genetic findings (p <0.00001). R-CMAPs were found in all COLQ-mutated patients (CMS1A) and Slow Channel CMS (SCCMS) (CMS1B). CMS1A exhibited greater decrements in accessory nerve RNS than CMS1B. Patients without R-CMAPs were classified into CMS2A (DOK7-, MUSK-, GFPT1-, GMPPB-, TOR1AIP-mutated) when exhibiting predominant accessory nerve RNS decrements, CMS2B (CHRNE, CHRND, RAPSN) with predominant radial nerve RNS decrements, or CMS2C (AGRN) if there were predominant fibular decrements. Our algorithm may have a major impact on diagnostic and therapeutic monitoring in CMS patients, as well as for validation of the pathogenicity of genetic variants. It should also be part of the evaluation of unexplained muscle weakness or complex neuromuscular phenotypes.
Collapse
Affiliation(s)
- Tanya Stojkovic
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche en Myologie, Sorbonne Université-Inserm UMRS974, Paris, France
| | - Marion Masingue
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Helène Turmel
- Department of Neurophysiology, APHP, Pitié Salpetrière hospital, Paris, France
| | | | - Anthony Béhin
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Sarah Leonard-Louis
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Bassez
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche en Myologie, Sorbonne Université-Inserm UMRS974, Paris, France
| | - Stéphanie Bauché
- Centre de Recherche en Myologie, Sorbonne Université-Inserm UMRS974, Paris, France
| | - Patricia Blondy
- National Reference Center for Muscle Channelopathies, APHP, Pitié Salpetrière hospital, Paris, France; Biochemistry Department, Center of Molecular and Cellular Genetics, APHP, Pitié Salpetrière hospital, Paris, France
| | - Pascale Richard
- Biochemistry Department, Center of Molecular and Cellular Genetics, APHP, Pitié Salpetrière hospital, Paris, France
| | - Damien Sternberg
- National Reference Center for Muscle Channelopathies, APHP, Pitié Salpetrière hospital, Paris, France; Biochemistry Department, Center of Molecular and Cellular Genetics, APHP, Pitié Salpetrière hospital, Paris, France
| | - Bruno Eymard
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Fournier
- Department of Neurophysiology, APHP, Pitié Salpetrière hospital, Paris, France; National Reference Center for Muscle Channelopathies, APHP, Pitié Salpetrière hospital, Paris, France; Department of Physiology, Sorbonne University, Faculté de médecine Pitié-Salpêtrière, Paris, France
| | - Rocío Nur Villar-Quiles
- Reference Center for Neuromuscular Disorders (Nord/Est/Ile de France), Institute of Myology, Pitié-Salpêtrière Hospital, APHP, Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche en Myologie, Sorbonne Université-Inserm UMRS974, Paris, France
| |
Collapse
|