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Misra K, Ślęczkowska M, Santoro S, Gerrits MM, Mascia E, Marchi M, Salvi E, Smeets HJM, Hoeijmakers JGJ, Martinelli Boneschi FG, Filippi M, Lauria Pinter G, Faber CG, Esposito F. Broadening the Genetic Spectrum of Painful Small-Fiber Neuropathy through Whole-Exome Study in Early-Onset Cases. Int J Mol Sci 2024; 25:7248. [PMID: 39000354 PMCID: PMC11242789 DOI: 10.3390/ijms25137248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Small-Fiber Neuropathy (SFN) is a disorder of the peripheral nervous system, characterised by neuropathic pain; approximately 11% of cases are linked to variants in Voltage-Gated Sodium Channels (VGSCs). This study aims to broaden the genetic knowledge on painful SFN by applying Whole-Exome Sequencing (WES) in Early-Onset (EO) cases. A total of 88 patients from Italy (n = 52) and the Netherlands (n = 36), with a disease onset at age ≤ 45 years old and a Pain Numerical Rating Score ≥ 4, were recruited. After variant filtering and classification, WES analysis identified 142 potentially causative variants in 93 genes; 8 are Pathogenic, 15 are Likely Pathogenic, and 119 are Variants of Uncertain Significance. Notably, an enrichment of variants in transient receptor potential genes was observed, suggesting their role in pain modulation alongside VGSCs. A pathway analysis performed by comparing EO cases with 40 Italian healthy controls found enriched mutated genes in the "Nicotinic acetylcholine receptor signaling pathway". Targeting this pathway with non-opioid drugs could offer novel therapeutic avenues for painful SFN. Additionally, with this study we demonstrated that employing a gene panel of reported mutated genes could serve as an initial screening tool for SFN in genetic studies, enhancing clinical diagnostics.
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Affiliation(s)
- Kaalindi Misra
- Laboratory of Human Genetics of Neurological Disorders, IRCCS San Raffaele Scientific Institute, Institute of Experimental Neurology, 20132 Milan, Italy
| | - Milena Ślęczkowska
- Department of Toxicogenomics, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Neurology, Mental Health and Neuroscience Research Intsitute, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Silvia Santoro
- Laboratory of Human Genetics of Neurological Disorders, IRCCS San Raffaele Scientific Institute, Institute of Experimental Neurology, 20132 Milan, Italy
| | - Monique M. Gerrits
- Department of Clinical Genetics, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
| | - Elisabetta Mascia
- Laboratory of Human Genetics of Neurological Disorders, IRCCS San Raffaele Scientific Institute, Institute of Experimental Neurology, 20132 Milan, Italy
| | - Margherita Marchi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Erika Salvi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Hubert J. M. Smeets
- Department of Toxicogenomics, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Janneke G. J. Hoeijmakers
- Department of Neurology, Mental Health and Neuroscience Research Intsitute, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Filippo Giovanni Martinelli Boneschi
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Neurology Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo and Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Massimo Filippi
- Neurology and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giuseppe Lauria Pinter
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20157 Milan, Italy
| | - Catharina G. Faber
- Department of Neurology, Mental Health and Neuroscience Research Intsitute, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Federica Esposito
- Laboratory of Human Genetics of Neurological Disorders, IRCCS San Raffaele Scientific Institute, Institute of Experimental Neurology, 20132 Milan, Italy
- Neurology and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Ammendola E, Quitadamo SG, Ladisa E, Tancredi G, Silvestri A, Lombardi R, Lauria G, de Tommaso M. YAP Ultralate Laser-Evoked Responses in Fibromyalgia: A Pilot Study in Patients with Small Fiber Pathology. J Clin Med 2024; 13:3078. [PMID: 38892789 PMCID: PMC11173050 DOI: 10.3390/jcm13113078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The investigation of C-fiber-evoked ultralow-level responses (ULEPs) at somatic sites is difficult in clinical practice but may be useful in patients with small fiber neuropathy. Aim: The aim of the study was to investigate changes in LEPs and ULEPs in patients with fibromyalgia affected or not by abnormal intraepidermal innervation. Methods: We recorded LEPs and ULEPs of the hand, thigh and foot in 13 FM patients with a normal skin biopsy (NFM), 13 patients with a reduced intraepidermal nerve fiber density (IENFD) (AFM) and 13 age-matched controls. We used a YAP laser, changing the energy and spot size at the pain threshold for LEPs and at the heat threshold for ULEPs. Results: ULEPs occurred at a small number of sites in both the NFM and AFM groups compared to control subjects. The absence of ULEPs during foot stimulation was characteristic of AFM patients. The amplitude of LEPs and ULEPs was reduced in patients with AFM at the three stimulation sites, and a slight reduction was also observed in the NFM group. Conclusions: The present preliminary results confirmed the reliability of LEPs in detecting small fiber impairments. The complete absence of ULEPs in the upper and lower limbs, including the distal areas, could confirm the results of LEPs in patients with small fiber impairments. Further prospective studies in larger case series could confirm the present findings on the sensitivity of LEP amplitude and ULEP imaging in detecting small fiber impairments and the development of IENFD in FM patients.
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Affiliation(s)
- Elena Ammendola
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, 70124 Bari, Italy; (E.A.); (S.G.Q.); (E.L.); (G.T.); (A.S.)
| | - Silvia Giovanna Quitadamo
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, 70124 Bari, Italy; (E.A.); (S.G.Q.); (E.L.); (G.T.); (A.S.)
| | - Emmanuella Ladisa
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, 70124 Bari, Italy; (E.A.); (S.G.Q.); (E.L.); (G.T.); (A.S.)
| | - Giusy Tancredi
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, 70124 Bari, Italy; (E.A.); (S.G.Q.); (E.L.); (G.T.); (A.S.)
| | - Adelchi Silvestri
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, 70124 Bari, Italy; (E.A.); (S.G.Q.); (E.L.); (G.T.); (A.S.)
| | - Raffaella Lombardi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (R.L.); (G.L.)
| | - Giuseppe Lauria
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (R.L.); (G.L.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20133 Milan, Italy
| | - Marina de Tommaso
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, 70124 Bari, Italy; (E.A.); (S.G.Q.); (E.L.); (G.T.); (A.S.)
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Kersebaum D, Sendel M, Lassen J, Fabig SC, Forstenpointner J, Reimer M, Canaan-Kühl S, Gaedeke J, Rehm S, Gierthmühlen J, Baron R, Hüllemann P. Cold-evoked potentials in Fabry disease and polyneuropathy. FRONTIERS IN PAIN RESEARCH 2024; 5:1352711. [PMID: 38812855 PMCID: PMC11133603 DOI: 10.3389/fpain.2024.1352711] [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: 12/08/2023] [Accepted: 04/02/2024] [Indexed: 05/31/2024] Open
Abstract
Background Fabry disease (FD) causes cold-evoked pain and impaired cold perception through small fiber damage, which also occurs in polyneuropathies (PNP) of other origins. The integrity of thinly myelinated fibers and the spinothalamic tract is assessable by cold-evoked potentials (CEPs). In this study, we aimed to assess the clinical value of CEP by investigating its associations with pain, autonomic measures, sensory loss, and neuropathic signs. Methods CEPs were examined at the hand and foot dorsum of patients with FD (n = 16) and PNP (n = 21) and healthy controls (n = 23). Sensory phenotyping was performed using quantitative sensory testing (QST). The painDETECT questionnaire (PDQ), FabryScan, and measures for the autonomic nervous system were applied. Group comparisons and correlation analyses were performed. Results CEPs of 87.5% of the FD and 85.7% of the PNP patients were eligible for statistical analysis. In all patients combined, CEP data correlated significantly with cold detection loss, PDQ items, pain, and autonomic measures. Abnormal CEP latency in FD patients was associated with an abnormal heart frequency variability item (r = -0.684; adjusted p = 0.04). In PNP patients, CEP latency correlated significantly with PDQ items, and CEP amplitude correlated with autonomic measures (r = 0.688, adjusted p = 0.008; r = 0.619, adjusted p = 0.024). Furthermore, mechanical pain thresholds differed significantly between FD (gain range) and PNP patients (loss range) (p = 0.01). Conclusions Abnormal CEPs were associated with current pain, neuropathic signs and symptoms, and an abnormal function of the autonomic nervous system. The latter has not been mirrored by QST parameters. Therefore, CEPs appear to deliver a wider spectrum of information on the sensory nervous system than QST alone.
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Affiliation(s)
- Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Schön Clinic Rendsburg, Department of Psychiatry, Psychotherapy and Psychosomatics, Rendsburg, Germany
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Josephine Lassen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie-Charlotte Fabig
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Maren Reimer
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sima Canaan-Kühl
- Division of Nephrology, Department of Medicine, Charité, Berlin, Germany
| | - Jens Gaedeke
- Division of Nephrology, Department of Medicine, Charité, Berlin, Germany
| | - Stefanie Rehm
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Janne Gierthmühlen
- Interdisciplinary Pain and Palliative Care Division, Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Philipp Hüllemann
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Allmendinger F, Scheuren PS, De Schoenmacker I, Brunner F, Rosner J, Curt A, Hubli M. Contact-Heat Evoked Potentials: Insights into Pain Processing in CRPS Type I. J Pain Res 2024; 17:989-1003. [PMID: 38505501 PMCID: PMC10949273 DOI: 10.2147/jpr.s436645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose The pathophysiological mechanisms underlying the development of chronic pain in complex regional pain syndrome (CRPS) are diverse and involve both peripheral and central changes in pain processing, such as sensitization of the nociceptive system. The aim of this study was to objectively distinguish the specific changes occurring at both peripheral and central levels in nociceptive processing in individuals with chronic CRPS type I. Patients and Methods Nineteen individuals with chronic CRPS type I and 16 age- and sex-matched healthy controls (HC) were recruited. All individuals underwent a clinical examination and pain assessment in the most painful limb, the contralateral limb, and a pain-free control area to distinguish between peripheral and central mechanisms. Contact-heat evoked potentials (CHEPs) were recorded after heat stimulation of the three different areas and amplitudes and latencies were analyzed. Additionally, quantitative sensory testing (QST) was performed in all three areas. Results Compared to HC, CHEP amplitudes in CRPS were only increased after stimulation of the painful area (p=0.025), while no increases were observed for the pain-free control area (p=0.14). None of the CHEP latencies were different between the two cohorts (all p>0.23). Furthermore, individuals with CRPS showed higher pain ratings after stimulation of the painful limb compared to their contralateral limb (p=0.013). Lastly, compared to HC, mechanical (p=0.012) and thermal (p=0.046) sensitivity was higher in the painful area of the CRPS cohort. Conclusion This study provides neurophysiological evidence supporting an intact thermo-nociceptive pathway with signs of peripheral sensitization, such as hyperexcitable primary afferent nociceptors, in individuals with CRPS type I. This is further supported by the observation of mechanical and thermal gain of sensation only in the painful limb. Additionally, the increased CHEP amplitudes might be related to fear-induced alterations of nociceptive processing.
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Affiliation(s)
- Florin Allmendinger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paulina Simonne Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Gad H, Kalra S, Pinzon R, Garcia RAN, Yotsombut K, Coetzee A, Nafach J, Lim LL, Fletcher PE, Lim V, Malik RA. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst 2024; 29:28-37. [PMID: 38268316 DOI: 10.1111/jns.12613] [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: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.
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Affiliation(s)
- Hoda Gad
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Rizaldy Pinzon
- Neurology Department of the Bethesda, General Hospital Yogyakarta, Yogyakarta, Indonesia
| | - Rey-An Nino Garcia
- College of Medicine, De LA Salle, Health Medical and Science Institute College of Medicine, Manila, Philippines
| | - Kitiyot Yotsombut
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ankia Coetzee
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Academic Health Corporation, Dubai, UAE
| | - Lee-Ling Lim
- Department of Medicine, Diabetes Care Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Pablo E Fletcher
- Endocrinology Department, Medical School, University of Panama, Panama, Panama
| | - Vivien Lim
- Endocrinology Department, Gleneagles Hospital, Singapore, Singapore
| | - Rayaz A Malik
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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Mancuso M, Cruciani A, Sveva V, Casula EP, Brown K, Rothwell JC, Di Lazzaro V, Koch G, Rocchi L. Somatosensory input in the context of transcranial magnetic stimulation coupled with electroencephalography: An evidence-based overview. Neurosci Biobehav Rev 2023; 155:105434. [PMID: 37890602 DOI: 10.1016/j.neubiorev.2023.105434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
The transcranial evoked potential (TEP) is a powerful technique to investigate brain dynamics, but some methodological issues limit its interpretation. A possible contamination of the TEP by electroencephalographic (EEG) responses evoked by the somatosensory input generated by transcranial magnetic stimulation (TMS) has been postulated; nonetheless, a characterization of these responses is lacking. The aim of this work was to review current evidence about possible somatosensory evoked potentials (SEP) induced by sources of somatosensory input in the craniofacial region. Among these, only contraction of craniofacial muscle and stimulation of free cutaneous nerve endings may be able to induce EEG responses, but direct evidence is lacking due to experimental difficulties in isolating these inputs. Notably, EEG evoked activity in this context is represented by a N100/P200 complex, reflecting a saliency-related multimodal response, rather than specific activation of the primary somatosensory cortex. Strategies to minimize or remove these responses by EEG processing still yield uncertain results; therefore, data inspection is of paramount importance to judge a possible contamination of the TEP by multimodal potentials caused by somatosensory input.
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Affiliation(s)
- M Mancuso
- Department of Human Neurosciences, University of Rome "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - A Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - V Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, University of Rome "Sapienza", Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - E P Casula
- Department of System Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - K Brown
- Department of Kinesiology, University of Waterloo, 200 University Ave W, N2L 3G5 Waterloo, ON, Canada
| | - J C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, WC1N 3BG London, United Kingdom
| | - V Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - G Koch
- Non-Invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina, 306/354, 00179 Rome, Italy
| | - L Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato Blocco I S.S, 554 bivio per Sestu 09042, Monserrato, Cagliari, Italy.
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Dunker Ø, Uglem M, Bu Kvaløy M, Løseth S, Hjelland IE, Allen SM, Dehli Vigeland M, Kleggetveit IP, Sand T, Nilsen KB. Diagnostic accuracy of the 5.07 monofilament test for diabetes polyneuropathy: influence of age, sex, neuropathic pain and neuropathy severity. BMJ Open Diabetes Res Care 2023; 11:e003545. [PMID: 37989346 PMCID: PMC10660161 DOI: 10.1136/bmjdrc-2023-003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION There is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred to polyneuropathy assessments, as well as to examine how disease severity, age, sex and neuropathic pain (NP) impact diagnostic accuracy. RESEARCH DESIGN AND METHODS Five Norwegian university hospitals recruited patients with diabetes aged 18-70 referred to neurological outpatient clinics for polyneuropathy assessments. The 5.07/10 g Semmes-Weinstein monofilament examination (SWME) was validated against the Toronto consensus for diagnosing diabetic neuropathies; the results were stratified by age, sex and NP. Disease severity was graded by a combined nerve conduction study (NCS) Z-score, and logistic regression was applied to assess whether disease severity was a predictor of diagnostic accuracy. RESULTS In total, 506 patients were included in the study. Global sensitivity was 0.60 (95% CI 0.55, 0.66), specificity 0.82 (95% CI 0.75, 0.87), positive and negative predictive values were 0.86 (95% CI 0.81, 0.90) and 0.52 (95% CI 0.46, 0.58), respectively, positive and negative likelihood ratios were 3.28 (95% CI 2.37, 4.53) and 0.49 (95% CI 0.42, 0.57), respectively. The SWME was less sensitive in females (0.43), had lower specificity in patients with NP (0.56), and performed worse in patients ≥50 years. NCS-based disease severity did not affect diagnostic accuracy (OR 1.15, 95% CI 0.95, 1.40). CONCLUSIONS This multicenter study demonstrates poor diagnostic performance for the 5.07/10 g SWME in patients with diabetes referred to polyneuropathy assessments; it is particularly unsuited for female patients and those with NP. The diagnostic accuracy of the SWME was not influenced by NCS-based disease severity, demonstrating that it does not perform better in patients with later stages of DPN. We do not recommend the use of the 5.07/10 g monofilament in the evaluation of patients with diabetes referred to polyneuropathy assessments.
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Affiliation(s)
- Øystein Dunker
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Martin Uglem
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marie Bu Kvaløy
- Department of Neurology, Section of Clinical Neurophysiology, Stavanger University Hospital, Stavanger, Norway
| | - Sissel Løseth
- Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
| | - Ina Elen Hjelland
- Department of Clinical Neurophysiology, Haukeland University Hospital, Bergen, Norway
| | - Sara Maria Allen
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | | | - Inge Petter Kleggetveit
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Bernhard Nilsen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
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Cluse F, Hermier M, Demarquay G, Rogemond V, Mallaret M, Svahn J, Pegat A, Honnorat J, Bernard E. Trigeminal Nerve Involvement in Bulbar-Onset Anti-IgLON5 Disease. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200153. [PMID: 37607754 PMCID: PMC10584367 DOI: 10.1212/nxi.0000000000200153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/13/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Anti-IgLON5 disease (IgLON5-D) may present with a bulbar-onset motor neuron disease-like phenotype, mimicking bulbar-onset amyotrophic lateral sclerosis. Recognition of their distinctive clinical and paraclinical features may help for differential diagnosis. We report 2 cases of atypical trigeminal neuropathy in bulbar-onset IgLON5-D. METHODS Trigeminal nerve involvement was assessed using comprehensive clinical, laboratory, electrophysiologic, and MRI workup. RESULTS Both patients were referred for progressive dysphagia, sialorrhea, and hoarseness. They were treated with bilevel positive airway pressure for nocturnal hypoventilation. Patient 1 complained of continuous facial burning pain with allodynia, exacerbated by mastication and prolonged speech. Patient 2 reported no facial pain. Anti-IgLON5 autoantibodies (IgLON5-Abs) were positive in serum for both patients and CSF for patient 1. Cerebral MRI revealed bilateral T2 fluid-attenuated inversion recovery (FLAIR) hyperintensity and enlargement of trigeminal nerves without gadolinium enhancement in both patients. Needle myography showed fasciculations in masseter muscles. Blink-reflex study confirmed bilateral trigeminal neuropathy only in patient 2. Cortical laser-evoked potentials showed a bilateral small-fiber dysfunction in the trigeminal nerve ophthalmic branch in patient 1. DISCUSSION In case of progressive atypical bulbar symptoms, the presence of a trigeminal neuropathy or trigeminal nerve abnormalities on MRI should encourage the testing of IgLON5-Abs in serum and CSF.
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Affiliation(s)
- Florent Cluse
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France.
| | - Marc Hermier
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Genevieve Demarquay
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Veronique Rogemond
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Martial Mallaret
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Juliette Svahn
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Antoine Pegat
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Jerome Honnorat
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
| | - Emilien Bernard
- From the ALS Resource and Competence Center (F.C., J.S., A.P., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Electroneuromyography and Neuromuscular Diseases Unit (F.C.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Department of Neuroradiology (M.H.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Neurophysiology & Epilepsy Unit (G.D.), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon; Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (V.R., J.H.), Hospices Civils de Lyon, Neurological Hospital, Bron; and Centre de Compétences des Maladies Neuro Musculaires (M.M.), CHU Grenoble Alpes, Grenoble, France
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9
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Small Fiber Neuropathy: A Clinical and Practical Approach. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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10
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Després O, Mamino E, Pebayle T, Lithfous S, Dufour A. An electronical stimulator for quantitative sensory testing and evoked potential analysis of tactile Aβ nerve fibers. Clin Neurophysiol 2023; 150:184-193. [PMID: 37075683 DOI: 10.1016/j.clinph.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/17/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE We aimed to determine the ability of an innovative device, the Cutaneous Mechanical Stimulator (CMS), to evaluate touch sensory pathways in Human. METHODS Two experiments were conducted in 23 healthy volunteers aged 20-30 years. In the first, mechanical detection thresholds (MDTs) were assessed using Semmes-Weinstein monofilaments and the CMS. In the second experiment, touch-evoked potentials (TEPs) elicited by tactile stimulation of the CMS on the left hand dorsum and left foot dorsum were recorded. Electroencephalographic (EEG) data were recorded at each cutaneous stimulation site in blocks of 20 tactile stimulations delivered by the CMS. The data were segmented into 1000-ms epochs. RESULTS MDTs measured by monofilaments and by the CMS were equivalent. Analyses of TEPs showed N2 and P2 components. The latencies of the N2 components on the hand dorsum and foot dorsum resulted in an estimated average conduction velocity of about 40 m.s-1, within the range of Aβ fibers. CONCLUSIONS These findings showed that the CMS could assess touch sensory pathways in young adults. SIGNIFICANCE The CMS can offer new research perspectives, as this device allows easy assessment of the MDT and enables estimation of fiber conduction velocities after tactile stimulation by the device synchronized with EEG recordings.
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Affiliation(s)
- Olivier Després
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS - Université de Strasbourg (UNISTRA), 12 rue Goethe, 67000 Strasbourg, France.
| | - Elisa Mamino
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS - Université de Strasbourg (UNISTRA), 12 rue Goethe, 67000 Strasbourg, France
| | - Thierry Pebayle
- Centre d'Investigations Neurocognitives et Neurophysiologiques (CI2N), UAR 3489 CNRS - Université de Strasbourg (UNISTRA), 21 rue Becquerel, 67087 Strasbourg Cedex, France
| | - Ségolène Lithfous
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS - Université de Strasbourg (UNISTRA), 12 rue Goethe, 67000 Strasbourg, France
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS - Université de Strasbourg (UNISTRA), 12 rue Goethe, 67000 Strasbourg, France; Centre d'Investigations Neurocognitives et Neurophysiologiques (CI2N), UAR 3489 CNRS - Université de Strasbourg (UNISTRA), 21 rue Becquerel, 67087 Strasbourg Cedex, France
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11
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Pia H, Nochi Z, Kristensen AG, Pelz B, Goetz M, Hoeink JN, Blockeel AJ, Mouraux A, Truini A, Finnerup NB, Phillips KG, Treede RD, Tankisi H. The test–retest reliability of large and small fiber nerve excitability testing with threshold tracking. Clin Neurophysiol Pract 2023; 8:71-78. [PMID: 37181417 PMCID: PMC10172996 DOI: 10.1016/j.cnp.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 04/09/2023] Open
Abstract
Objective Standard nerve excitability testing (NET) predominantly assesses Aα- and Aβ-fiber function, but a method examining small afferents would be of great interest in pain studies. Here, we examined the properties of a novel perception threshold tracking (PTT) method that preferentially activates Aδ-fibers using weak currents delivered by a novel multipin electrode and compared its reliability with NET. Methods Eighteen healthy subjects (mean age:34.06 ± 2.0) were examined three times with motor and sensory NET and PTT in morning and afternoon sessions on the same day (intra-day reliability) and after a week (inter-day reliability). NET was performed on the median nerve, while PTT stimuli were delivered through a multipin electrode located on the forearm. During PTT, subjects indicated stimulus perception via a button press and the intensity of the current was automatically increased or decreased accordingly by Qtrac software. This allowed changes in the perception threshold to be tracked during strength-duration time constant (SDTC) and threshold electrotonus protocols. Results The coefficient of variation (CoV) and interclass coefficient of variation (ICC) showed good-excellent reliability for most NET parameters. PTT showed poor reliability for both SDTC and threshold electrotonus parameters. There was a significant correlation between large (sensory NET) and small (PTT) fiber SDTC when all sessions were pooled (r = 0.29, p = 0.03). Conclusions Threshold tracking technique can be applied directly to small fibers via a psychophysical readout, but with the current technique, the reliability is poor. Significance Further studies are needed to examine whether Aβ-fiber SDTC may be a surrogate biomarker for peripheral nociceptive signalling.
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Røikjer J, Croosu SS, Sejergaard BF, Hansen TM, Frøkjær JB, Søndergaard CB, Petropoulos IN, Malik RA, Nielsen E, Mørch CD, Ejskjaer N. Diagnostic Accuracy of Perception Threshold Tracking in the Detection of Small Fiber Damage in Type 1 Diabetes. J Diabetes Sci Technol 2023:19322968231157431. [PMID: 36825610 DOI: 10.1177/19322968231157431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AIM An objective assessment of small nerve fibers is key to the early detection of diabetic peripheral neuropathy (DPN). This study investigates the diagnostic accuracy of a novel perception threshold tracking technique in detecting small nerve fiber damage. METHODS Participants with type 1 diabetes (T1DM) without DPN (n = 20), with DPN (n = 20), with painful DPN (n = 20) and 20 healthy controls (HCs) underwent perception threshold tracking on the foot and corneal confocal microscopy. Diagnostic accuracy of perception threshold tracking compared to corneal confocal microscopy was analyzed using logistic regression. RESULTS The rheobase, corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) (all P < .001) differed between groups. The diagnostic accuracy of perception threshold tracking (rheobase) was excellent for identifying small nerve fiber damage, especially for CNFL with a sensitivity of 94%, specificity 94%, positive predictive value 97%, and negative predictive value 89%. There was a significant correlation between rheobase with CNFD, CNBD, CNFL, and Michigan Neuropathy Screening Instrument (all P < .001). CONCLUSION Perception threshold tracking had a very high diagnostic agreement with corneal confocal microscopy for detecting small nerve fiber loss and may have clinical utility for assessing small nerve fiber damage and hence early DPN. CLINICAL TRIALS NCT04078516.
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Affiliation(s)
- Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Suganthiya Santhiapillai Croosu
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tine Maria Hansen
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | - Esben Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Dahl Mørch
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain, Center for Sensory-Motor Interaction, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Assessment of C Fibers Evoked Potentials in Healthy Subjects by Nd : YAP Laser. Pain Res Manag 2022; 2022:7737251. [PMID: 36601434 PMCID: PMC9807303 DOI: 10.1155/2022/7737251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/11/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022]
Abstract
Introduction Although laser stimuli activate both Ad- and C-fibres, the corresponding laser evoked potentials (LEPs) remain restricted to the Ad-fibers input, while the C-fibers related potential is hardly detectable. Aims To evaluate multichannel ultralate LEPs (U-LEPs) by using Nd : Yap laser pulses in healthy volunteers to stimulation of face and lower and upper limbs, in order to estimate the reliability of C-LEPs elicited from both trigeminal and somatic sites. Methods Twenty healthy volunteers participated in two stimulation sessions to record Aδ-LEPs and C-LEPs. We used a Nd : YAP Laser and 62 EEG recording electrodes. Stimuli parameters were set to activate either small myelinated (Aδ), eliciting purely warmth sensations, or unmyelinated (C) afferents, and eliciting pinprick sensations. Results At the trigeminal level, we obtained a negative-positive complex in a time interval compatible with the C fibers activation. In the somatic districts, the averaged responses consisted of an earlier negative-positive complex, followed by a later one. Single trials analysis of U-LEPs showed a maximal positive peak in a time interval in the range of C fibers. Topographical analysis of U-LEPs resembled that of LEPs. All subjects exhibited readable U-LEPs in at least 2 stimulated sites. Discussion. A purely warmth sensation seems to correspond to Aδ and C-fibers coactivation, at least in the somatic districts. While the related cortical waves seem hardly readable, their total absence could be a sign of systemic involvement of warm related C-fibers in specific clinical conditions.
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Metwally NAE, Hasan MM, Abd Elaziz AES, Elhadad AF, Ibraheem KS, Ali MAA, Elsalam HAA. Assessment of intraepidermal nerve fiber density and neurophysiological studies in patients with idiopathic polyneuropathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Idiopathic polyneuropathy is an asymmetrical, length-dependent neuropathy in which neurophysiology demonstrates axonal damage involving large fibers, along with insidious onset and slow progression over 6 months, with no identified etiology in spite of thorough investigations. This study aimed to evaluate the diagnostic role of clinical, electrophysiological, and histopathological studies in patients with idiopathic polyneuropathy.
Methods
Case–control study included 20 patients with clinical and neurophysiological evidence of sensory or sensory–motor neuropathy with no apparent etiology after laboratory investigation were recruited from 127 patients with sensory–motor neuropathy of unknown etiology (the patients group). Twenty apparently healthy individuals, age- and sex-matched, with no neuropathy symptoms (the control group), were recruited from the Neurology Clinic of Al-Azhar University, Assuit.
Results
Age of onset of patients with idiopathic polyneuropathy (44–70) years, duration of illness (1–6) years, 60% had painful neuropathy, diagnostic neuropathic pain questioner (DN4 score) (5–7), abnormal pin brick (80%), abnormal vibration (90%), abnormal fine touch (75%), distal weakness (70%), and lost ankle reflex (90%). In the control group, there were substantial differences with respect to prolonged latency, diminished sympathetic skin response amplitude, and significant intraepidermal nerve fiber density reduction in skin biopsy cases. In diagnosing idiopathic polyneuropathy, the specificity and sensitivity of sympathetic skin response were (80–86)% and (81–89.5)%, respectively, whereas those of diminished intraepidermal nerve fiber density were (92.5%) and (97.5%), respectively.
Conclusion
The assessment of intraepidermal nerve fiber density had an important good diagnostic role in cases presented with polyneuropathy.
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De Stefano G, Leone C, Di Pietro G, Esposito N, Falco P, Galosi E, Litewczuk D, Mollica C, Truini A, Di Stefano G. Unravelling the role of unmyelinated nerve fibres in trigeminal neuralgia with concomitant continuous pain. Clin Neurophysiol 2022; 142:52-58. [DOI: 10.1016/j.clinph.2022.07.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
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Malik RA. Corneal confocal microscopy for the assessment of diabetic neuropathy and beyond in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:767-769. [PMID: 36252583 PMCID: PMC9703882 DOI: 10.1055/s-0042-1756169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rayaz A. Malik
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
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Small-Fiber-Neuropathien. DGNEUROLOGIE 2022; 5. [PMCID: PMC9559077 DOI: 10.1007/s42451-022-00488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die Small-Fiber-Neuropathie (SFN) ist eine Erkrankung des peripheren Nervensystems aufgrund einer isolierten oder vorwiegenden Schädigung dünn myelinisierter Aδ-Fasern und/oder unmyelinisierter C‑Fasern. Für die sichere Diagnose einer SFN ist neben der klinischen Symptomatik mit Schmerzen und Sensibilitätsstörungen, typischerweise mit distal betonter Ausbreitung, der apparative Nachweis einer Rarefizierung oder einer Funktionsstörung der dünn myelinisierten Aδ-Fasern und/oder der unmyelinisierten C‑Fasern gefordert. Im vorliegenden Beitrag wird eine Übersicht über die diagnostischen Verfahren zum Nachweis einer SFN sowie über mögliche Ursachen und Behandlungsoptionen gegeben.
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Eitner L, Maier C, Brinkmann F, Schlegtendal A, Knoke L, Enax-Krumova E, Lücke T. Somatosensory abnormalities after infection with SARS-CoV-2 - A prospective case-control study in children and adolescents. Front Pediatr 2022; 10:977827. [PMID: 36263148 PMCID: PMC9574195 DOI: 10.3389/fped.2022.977827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term neurological complaints after SARS-CoV-2 infection occur in 4-66% of children and adolescents. Controlled studies on the integrity of the peripheral nerve system are scarce. Therefore, we examined the somatosensory function in children and adolescents after SARS-CoV-2 infection in a case-control study compared with age-matched individuals. MATERIALS AND METHODS Eighty-one subjects after SARS-CoV-2 infection (n = 44 female, 11.4 ± 3.5 years, n = 75 SARS-CoV-2 seropositive, n = 6 PCR positive during infection and SARS-CoV-2 seronegative at the time point of study inclusion, n = 47 asymptomatic infection) were compared to 38 controls without SARS-CoV-2 infection (26 female, 10.3 ± 3.4 years, n = 15 with other infection within last 6 months). After standardised interviews and neurological examinations, large fibre (tactile and vibration detection thresholds) and small fibre (cold and warm detection thresholds, paradoxical heat sensation) functions were assessed on both feet following a validated protocol. After z-transformation of all values, all participants were compared to published reference values regarding the number of abnormal results. Additionally, the mean for all sensory parameters values of both study groups were compared to an ideal healthy population (with z-value 0 ± 1), as well as with each other, as previously described. Statistical analyses: t-test, Chi-squared test, and binominal test. FINDINGS None of the controls, but 27 of the 81 patients (33%, p < 0.001) reported persistent complaints 2.7 ± 1.9 (0.8-8.5) months after SARS-CoV-2 infection, most often reduced exercise capacity (16%), fatigue (13%), pain (9%), or paraesthesia (6%). Reflex deficits or paresis were missing, but somatosensory profiles showed significantly increased detection thresholds for thermal (especially warm) and vibration stimuli compared to controls. Approximately 36% of the patients after SARS-CoV-2, but none of the controls revealed an abnormal sensory loss in at least one parameter (p < 0.01). Sensory loss was characterised in 26% by large and 12% by small fibre dysfunction, the latter appearing more frequently in children with prior symptomatic SARS-CoV-2 infection. Myalgia/paraesthesia was indicative of somatosensory dysfunction. In all eight re-examined children, the nerve function recovered after 2-4 months. INTERPRETATION This study provides evidence that in a subgroup of children and adolescents previously infected with SARS-CoV-2, regardless of their complaints, the function of large or small nerve fibres is presumably reversibly impaired.
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Affiliation(s)
- Lynn Eitner
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.,University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Maier
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Folke Brinkmann
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anne Schlegtendal
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Leona Knoke
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Lücke
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.,University Children's Hospital, Ruhr University Bochum, Bochum, Germany
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