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Sand T, Grøtting A, Uglem M, Augestad N, Johnsen G, Sandvik J. Neuropathy 10-15 years after Roux-en-Y gastric bypass for severe obesity: A community-controlled nerve conduction study. Clin Neurophysiol Pract 2024; 9:130-137. [PMID: 38618240 PMCID: PMC11015066 DOI: 10.1016/j.cnp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Objective We searched for long-term peripheral nerve complications 10-15 years after Roux-en-Y gastric bypass surgery (RYGB), using a comprehensive nerve conduction study (NCS) protocol. Methods Patients (n = 175, mean age 52.0, BMI 35.2) and 86 community-controls (mean age 56.8, BMI 27.2) had NCS of one upper and lower limb. New abnormality scores from 27 polyneuropathy-relevant (PNP27s) and four carpal tunnel syndrome-relevant NCS-measures (CTS4s) were compared between groups with non-parametric statistics. Estimated prevalences were compared by 95 % confidence limits. The clinical neurophysiologist's diagnosis was retrieved from hospital records (PNP-ncs, CTS-ncs, other). Results Abnormality score did not differ between RYGB and control groups (PNP27s: 1.9 vs 1.7, CTS4s: 0.7 vs 0.6, p > 0.29). BMI correlated weakly with CTS4s in patients (rho = 0.19, p = 0.01), and less with PNP27s (rho = 0.12, p = 0.12). Polyneuropathy (PNP-ncs) prevalence was 12 % in patients and 8 % in controls. CTS-ncs prevalence was 21 % in patients and 10 % in controls (p = 0.04). Conclusions NCS-based abnormality scores did not differ between patients 10-15 years after RYGB and community-recruited controls, neither for PNP nor CTS. Significance Long-term polyneuropathic complications from RYGB have probably been avoided by modern treatment guidelines. NCS-diagnosed CTS is common in overweight RYGB patients. RYGB-patients with significant neuropathic symptoms need clinical evaluation.
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Affiliation(s)
- Trond Sand
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnstein Grøtting
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Martin Uglem
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nils Augestad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gjermund Johnsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Jorunn Sandvik
- Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Centre for Obesity Research, Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Schulte-Mattler W, Bischoff C. EMG und Neurografie – ein Update. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1759-9988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Elektromyografie (EMG) und Elektroneurografie (ENG) gelten als bewährte
Methoden, deren Anfänge aber schon Jahrzehnte zurückliegen. In
dieser Arbeit werden jüngere Entwicklungen beschrieben und die Rolle von
EMG und ENG in wichtigen Situationen diskutiert, nämlich bei
traumatische Nervenläsionen, Nervenkompressionssyndromen,
Polyneuropathien, Motoneuronerkrankungen, Myopathien, neuromuskulären
Transmissionsstörungen und bei muskulärer
Überaktivität.
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Ducci RDP, Tessaro CL, Kay CSK, Fustes OJH, Werneck LC, Lorenzoni PJ, Scola RH. Peripheral polyneuropathy from electrodiagnostic tests: a 10-year etiology and neurophysiology overview. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 80:270-279. [PMID: 34816968 DOI: 10.1590/0004-282x-anp-2020-0561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Polyneuropathies are characterized by a symmetrical impairment of the peripheral nervous system, resulting in sensory, motor and/or autonomic deficits. Due to the heterogeneity of causes, an etiological diagnosis for polyneuropathy is challenging. OBJECTIVE The aim of this study was to determine the main causes of polyneuropathy confirmed by electrodiagnostic (EDX) tests in a tertiary service and its neurophysiological aspects. METHODS This observational cross-sectional study from a neuromuscular disorders center included individuals whose electrodiagnostic tests performed between 2008 and 2017 confirmed a diagnosis of polyneuropathy. Through analysis of medical records, polyneuropathies were classified according to etiology and neurophysiological aspect. RESULTS Of the 380 included patients, 59.5% were male, with a median age of 43 years. The main etiologies were: inflammatory (23.7%), hereditary (18.9%), idiopathic (13.7%), multifactorial (11.1%), and diabetes (10.8%). The main electrophysiological patterns were axonal sensorimotor polyneuropathy (36.1%) and "demyelinating and axonal" sensorimotor polyneuropathy (27.9%). Axonal patterns showed greater etiological heterogeneity, with a predominance of idiopathic and multifactorial polyneuropathy, while demyelinating and "demyelinating and axonal" polyneuropathies had a significantly fewer etiologies, with a predominance of hereditary and inflammatory polyneuropathies. CONCLUSION The main causes of polyneuropathy confirmed by EDX test in this study were those that presented a severe, atypical and/or rapidly progressing pattern. Other causes were hereditary and those that defy clinical reasoning, such as multiple risk factors; some polyneuropathies did not have a specific etiology. EDX tests are useful for etiological diagnosis of rare polyneuropathies, because neurophysiological patterns are correlated with specific etiologies.
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Affiliation(s)
- Renata Dal-Prá Ducci
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Neurologia, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | | | - Cláudia Suemi Kamoi Kay
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Neurologia, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Otto Jesus Hernandez Fustes
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Neurologia, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Lineu Cesar Werneck
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Neurologia, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Paulo José Lorenzoni
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Neurologia, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Rosana Herminia Scola
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Divisão de Neurologia, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
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Davalos L, London ZN, Stino AM, Gallagher GW, Callaghan BC, Wieland CM, Nowacek DG. Patients who meet electrodiagnostic criteria for CIDP rarely present with a sensory predominant DSP phenotype. Muscle Nerve 2021; 63:881-884. [PMID: 33745140 DOI: 10.1002/mus.27235] [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: 09/17/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION It is unknown how often patients with electrodiagnostic evidence of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), a potentially treatable condition, present with a distal symmetric polyneuropathy (DSP) phenotype. METHODS We reviewed the records of patients who presented to our electrodiagnostic laboratory between January 1, 2011, to December 31, 2019, and fulfilled electrodiagnostic criteria for CIDP to identify those who presented with a sensory predominant DSP phenotype. RESULTS One hundred sixty-two patients had a chronic acquired demyelinating neuropathy, of whom 138 met criteria for typical or atypical CIDP. Nine of these patients presented with a sensory predominant DSP phenotype, among whom six were eventually diagnosed with distal acquired demyelinating symmetric (DADS) neuropathy; one with Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, Skin changes (POEMS) syndrome; and two with idiopathic DSP. The prevalence of acquired chronic demyelinating neuropathies among all patients presenting with a DSP phenotype was estimated to be 0.34%. DISCUSSION Patients who meet electrodiagnostic criteria for CIDP rarely present with a sensory predominant DSP phenotype, and electrodiagnostic testing rarely identifies treatable demyelinating neuropathies in patients who present with a DSP phenotype.
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Affiliation(s)
- Long Davalos
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Zachary N London
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Amro M Stino
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Gary W Gallagher
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Brian C Callaghan
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Clare M Wieland
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Dustin G Nowacek
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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Tankisi H, Pugdahl K, Beniczky S, Andersen H, Fuglsang‐Frederiksen A. The role of electrodiagnostic testing in patients referred with the suspicion of polyneuropathy. Muscle Nerve 2020; 62:E66-E67. [DOI: 10.1002/mus.27032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Hatice Tankisi
- Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
| | - Kirsten Pugdahl
- Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
| | - Sandor Beniczky
- Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
| | - Henning Andersen
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Anders Fuglsang‐Frederiksen
- Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
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Geiger CD, Preston DC. The value of electrodiagnostic studies in patients with suspected polyneuropathy. Muscle Nerve 2020; 61:263-264. [DOI: 10.1002/mus.26805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Christopher D. Geiger
- Neurological Institute, University Hospitals Cleveland Medical CenterCase Western Reserve University Cleveland Ohio
| | - David C. Preston
- Neurological Institute, University Hospitals Cleveland Medical CenterCase Western Reserve University Cleveland Ohio
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