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Salvalaggio A, Cacciavillani M, Tierro B, Coraci D, Currò R, Ferrarini M, Pegoraro E, Bello L, Fabrizi GM, Filla A, Padua L, Manganelli F, Cortese A, Briani C. Nerve ultrasound in CANVAS-spectrum disease: Reduced nerve size distinguishes genetically confirmed CANVAS from other axonal polyneuropathies. J Peripher Nerv Syst 2024. [PMID: 39219417 DOI: 10.1111/jns.12655] [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: 04/25/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Ultrasound nerve cross-sectional area (CSA) of patients affected with axonal neuropathy usually shows normal value. Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) seems to represent an exception, showing smaller CSA, but previous reports did not test for biallelic RFC1 gene repeat expansions. METHODS We compared nerve CSA from CANVAS patients (tested positive for biallelic RFC1 gene repeat expansions) with the CSA from a group of patients with chronic idiopathic axonal polyneuropathy (CIAP) who tested negative for RFC1 gene repeat expansions, hereditary axonal neuropathy (Charcot-Marie-Tooth type 2, CMT2), and Friedreich ataxia (FRDA). RESULTS We enrolled 15 CANVAS patients (eight men, mean age 66.3 ± 11.5 years, mean disease duration 9.3 ± 4.1 years), affected with sensory axonal neuronopathy. Controls consisted of 13 CIAP (mean age 68.5 ± 12.8 years, seven men), seven CMT2 (mean age 47.9 ± 18.1 years, four men), 12 FRDA (mean age 33.7 ± 8.8, five men). Nerve ultrasound was performed at median, ulnar, sciatic, sural, and tibial nerves and brachial plexus, bilaterally. The nerve CSA from CANVAS patients was significantly smaller than the one from the other cohorts at several sites with significant and high accuracy at Receiver-operating characteristic (ROC) curve analyses. RFC1 AAGGG pentanucleotide expansion, disease duration, and disability did not correlate with CSA at any site, after Bonferroni correction. INTERPRETATION Decreased sonographic nerve sizes, in arms and legs, in patients with sensory neuropathy and normal motor conduction studies could point to CANVAS-spectrum disease and help guide appropriate genetic testing.
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Affiliation(s)
- Alessandro Salvalaggio
- Department of Neuroscience, University of Padova, Padova, Italy
- Neurology Unit, University-Hospital of Padova, Padova, Italy
| | | | - Benedetta Tierro
- Department of Neuroscience, University of Padova, Padova, Italy
- Neurology Unit, University-Hospital of Padova, Padova, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Riccardo Currò
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Moreno Ferrarini
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padova, Italy
- Neurology Unit, University-Hospital of Padova, Padova, Italy
| | - Luca Bello
- Department of Neuroscience, University of Padova, Padova, Italy
- Neurology Unit, University-Hospital of Padova, Padova, Italy
| | - Gian Maria Fabrizi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Filla
- Department of Neurosciences Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Fiore Manganelli
- Department of Neurosciences Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
- Neurology Unit, University-Hospital of Padova, Padova, Italy
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Di Pietro G, Cioffi E, Falco P, Galosi E, De Stefano G, Di Stefano G, Leone C, Martines V, Perotti S, Casali C, Truini A. Nerve ultrasound in Friedreich's Ataxia: enlarged nerves as a biomarker of disease severity. Clin Neurophysiol 2024; 159:75-80. [PMID: 38359552 DOI: 10.1016/j.clinph.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/28/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE In Friedreich's ataxia research, the focus is on discovering treatments and biomarkers to assess disease severity and treatment effects. Our study examines high-resolution nerve ultrasound in these patients, seeking correlations with established clinical markers of disease severity. METHOD Ten patients with Friedreich's Ataxia underwent a comprehensive clinical assessment with established scales (SARA, FARS, mFARS, INCAT, ADL 0-36, IADL). Additionally, they underwent nerve conduction studies and high-resolution nerve ultrasound. Quantitative evaluation of nerve cross-sectional area, conducted at 24 nerve sites using high-resolution nerve ultrasound, was compared with data obtained from 20 healthy volunteers. RESULTS All the patients had a severe sensory axonal neuropathy. High-resolution nerve ultrasound showed significant increase, in cross sectional area, of median and ulnar nerves at the axilla and arm. The cumulative count of affected nerve sites was directly associated with clinical disability, as determined by SARA, FARS, mFARS, ADL 0-36, and INCAT score, while displaying an inverse correlation with IADL. CONCLUSIONS Our study shows that high-resolution ultrasound reveals notable nerve abnormalities, primarily in the upper limbs of patients diagnosed with Friedreich's Ataxia. The observed correlation between these nerve abnormalities and clinical disability scales indicates the potential use of this technique as a biomarker for evaluating disease severity and treatment effects. SIGNIFICANCE Nerve Ultrasound is a potential biomarker of disease severity in Friedreich's Ataxia.
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Affiliation(s)
- G Di Pietro
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
| | - E Cioffi
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - P Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - E Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - G De Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - C Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - V Martines
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy; UOC Neuroradiologia, Policlinico Umberto I, Roma, Italy
| | - S Perotti
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy; UOC Neuroradiologia, Policlinico Umberto I, Roma, Italy
| | - C Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - A Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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Broser P, Lütschg J. Funktion und Struktur peripherer Nerven aus
neuropädiatrischer Sicht: Wie klinische, neurophysiologische und
Ultraschalluntersuchungen ergänzende diagnostische Informationen
liefern. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1506-8603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungIn der vorliegenden Übersicht wird dargestellt, wie sich klinisch
neurophysiologische Methoden (Nervenleitgeschwindigkeit und Elektromyografie)
und Ultraschalluntersuchungen (US) von peripheren Nerven bei der
Abklärung von hereditären senso-motorischen Neuropathien (HMSN),
der Friedreichschen Ataxie, erworbenen Neuropathien (am Beispiel von Diabetes
mellitus) und traumatischen Nervenläsionen bei Kindern
ergänzen können. Bei allen Formen der HMSN 1 kommt es zu einer
Verlangsamung der Nervenleitgeschwindigkeit. Die Ultraschalluntersuchung zeigt
nur bei HMSN1A eine deutlich vergrösserte
Nervenquerschnittsfläche. Beim M. Friedreich können meist
keine sensiblen Potentiale ausgelöst werden und die US-Resultate sind
variabel. Bei traumatischen Nervenläsionen kann vor allem mithilfe der
US-Untersuchung entschieden werden, ob eine operative Nervenrevision indiziert
ist. Die erworbenen Neuropathien werden am Beispiel der diabetischen Neuropathie
dargestellt. Die US- und die ENG Resultate sind oft abnorm, auch wenn klinisch
keine Neuropathie-Symptome nachweisbar sind.
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Mulroy E, Pelosi L, Leadbetter R, Joshi P, Rodrigues M, Mossman S, Kilfoyle D, Roxburgh R. Peripheral nerve ultrasound in Friedreich ataxia. Muscle Nerve 2017; 57:852-856. [PMID: 29130498 DOI: 10.1002/mus.26012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Sensory impairment in Friedreich ataxia (FRDA) is generally accepted as being due to a ganglionopathy. The degree of contribution from axonal pathology remains a matter of debate. Nerve ultrasound may be able to differentiate these processes. METHODS The ultrasound cross-sectional area of median, ulnar, tibial, and sural nerves of 8 patients with FRDA was compared with 8 age- and gender-matched healthy controls and with reference values in our population. RESULTS The nerves of the patients with FRDA were significantly larger than those of healthy controls at all upper limb sites (P < 0.05) but not significantly different in the lower limbs. DISCUSSION Our findings add additional weight to the theory that dorsal root ganglionopathy is not the sole cause of peripheral sensory loss in FRDA. Peripheral neuropathic processes are also likely to play a role. Muscle Nerve 57: 852-856, 2018.
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Affiliation(s)
- Eoin Mulroy
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
- Department of Clinical Neurophysiology, Auckland District Health Board, Auckland, New Zealand
| | - Luciana Pelosi
- Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Ruth Leadbetter
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Purwa Joshi
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Miriam Rodrigues
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
- Department of Clinical Neurophysiology, Auckland District Health Board, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Stuart Mossman
- Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Dean Kilfoyle
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
- Department of Clinical Neurophysiology, Auckland District Health Board, Auckland, New Zealand
| | - Richard Roxburgh
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
- Department of Clinical Neurophysiology, Auckland District Health Board, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
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