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Estublier B, Colineaux H, Arnaud C, Cintas P, Baudou E, Chaix Y, Rivier F, Biotteau M, Meyer P, Cheuret E. Long-term outcomes of paediatric Guillain-Barré syndrome. Dev Med Child Neurol 2024; 66:176-186. [PMID: 37501281 DOI: 10.1111/dmcn.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023]
Abstract
AIM To study long-term sequelae in children with Guillain-Barré syndrome (GBS). METHOD This was a prospective observational study with children from two French tertiary centres. Data were from clinical and several standardized scales or questionnaires. RESULTS Fifty-one patients were included with a median follow-up of 6 years 4 months (range 3-20 years) after the acute phase. The sequelae rate was 67% (95% confidence interval [CI] 53-78) and did not vary with time. Most children had minor sequelae (Guillain-Barré Syndrome Disability Score [GBSDS] = 1); only one was unable to run (GBSDS = 2). The most frequent complaints were paraesthesia (43%), pain (35%), and fatigue (31%). The neurological examination was abnormal in 18% of children, autonomy was compromised in 14%, and symptoms of depression occurred in 34%. The factors associated with late-onset sequelae were correlated with severity during the initial phase (i.e. initial GBSDS >4, odds ratio 6.6, 95% CI 1.8-33; p = 0.009). The predictive factors of more severe late-onset conditions were initial severity (p = 0.002) and sex (female patients; p = 0.01). INTERPRETATION Two-thirds of children with GBS had late-onset sequelae following an episode, often minor, but sometimes with continuing effects on their everyday lives. Particularly affected were those who had severe GBS during the acute phase and who lost the ability to walk. WHAT THIS PAPER ADDS Two-thirds of children with Guillain-Barré syndrome (GBS) had persistent sequelae. Sequelae were often minor, but daily repercussions of them were sometimes serious. Sequelae were significantly associated with severe GBS during the acute phase.
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Affiliation(s)
- Bastien Estublier
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
| | - Hélène Colineaux
- Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
- CERPOP, Centre for Epidemiology and Research in POPulation Health, UMR 1295, INSERM, Toulouse III University, Toulouse, France
| | - Catherine Arnaud
- Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
- CERPOP, Centre for Epidemiology and Research in POPulation Health, UMR 1295, INSERM, Toulouse III University, Toulouse, France
| | - Pascal Cintas
- Neurophysiological Exploration Department, Toulouse-Purpan University Hospital, Toulouse, France
| | - Eloise Baudou
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Yves Chaix
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - François Rivier
- Department of Pediatric Neurology, CHU Montpellier, PhyMedExp, University of Montpellier, Inserm, CNRS, Montpellier, France
| | - Maelle Biotteau
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Pierre Meyer
- Department of Pediatric Neurology, CHU Montpellier, PhyMedExp, University of Montpellier, Inserm, CNRS, Montpellier, France
| | - Emmanuel Cheuret
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
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Basta I, Delic N, Gunjic I, Arsenijevic Zdraljevic M, Kacar A, Bozovic I, Peric S. Chronic inflammatory demyelinating polyradiculoneuropathy: Diagnostic problems in clinical practice in Serbia. J Peripher Nerv Syst 2023. [PMID: 36738239 DOI: 10.1111/jns.12537] [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: 07/21/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Making diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is challenging since it can mimic a multitude of disorders, and is misdiagnosed in at least 50% of cases. We sought to determine the frequency of CIDP misdiagnosis in clinical practice in Serbia, to uncover CIDP mimics, and to identify factors that may aid in CIDP diagnosis. Our longitudinal retrospective cohort study included 86 eligible adult patients referred to the Neurology Clinic, University Clinical Centre of Serbia, with a diagnosis of CIDP. We also included 15 patients referred to us with different diagnoses that ended up having CIDP as their final diagnosis. Exactly half of patients referred as CIDP failed to meet the established diagnostic criteria (non-CIDP) and were given an alternative diagnosis at the first hospitalization. At the 1-year follow-up, the diagnosis was further revised in four subjects. Confirmed CIDP patients usually had their initial diagnosis based on the nerve conduction studies (NCS), a typical presentation with symmetrical involvement of all four limbs, as well as higher frequencies of elevated protein levels and albuminocytologic dissociation in the cerebrospinal fluid (CSF). CIDP patients also responded better to immune therapy. We found that 52% of the patients initially referred to our Clinic as CIDP were given other diagnoses after a 1-year follow-up. Out of all CIDP cases, 27% had been unrecognized prior to referral to our Center. Utilization of clear and objective indicators - conclusive NCS, improvement on therapy, and elevated CSF proteins may provide greater certainty in diagnosing CIDP.
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Affiliation(s)
- Ivana Basta
- University Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Neda Delic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ilija Gunjic
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - Aleksandra Kacar
- University Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- University Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia
| | - Stojan Peric
- University Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia
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Parisi M, Dogliotti I, Clerico M, Bertuzzo D, Benevolo G, Orsucci L, Schiavetti I, Cavallo R, Cavallo F, Ragaini S, Di Liberto A, Ferrante M, Bondielli G, Artusi CA, Drandi D, Lopiano L, Ferrero B, Ferrero S. Efficacy of rituximab in anti-myelin-associated glycoprotein demyelinating polyneuropathy: Clinical, hematological and neurophysiological correlations during 2 years of follow-up. Eur J Neurol 2022; 29:3611-3622. [PMID: 36083713 PMCID: PMC9825860 DOI: 10.1111/ene.15553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE We evaluated the clinical and neurophysiological efficacy of rituximab (RTX) in a neurophysiologically homogeneous group of patients with monoclonal gammopathy and immunoglobulin M (IgM) anti-myelin-associated glycoprotein antibody (anti-MAG) demyelinating polyneuropathy. METHODS Twenty three anti-MAG-positive polyneuropathic patients were prospectively evaluated before and for 2 years after treatment with RTX 375 mg/m2 . The Inflammatory Neuropathy Cause and Treatment (INCAT) disability scale (INCAT-ds), modified INCAT sensory score (mISS), Medical Research Council sum score, Patients' Global Impression of Change scale were used, IgM levels were assessed and extensive electrophysiological examinations were performed before (T0) and 1 year (T1) and 2 years (T2) after RTX treatment. RESULTS At T1 and T2 there was a significant reduction from T0 both in mISS and in INCAT-ds, with a p value < 0.001 in the inferential Friedman's test overall analysis. Ulnar nerve Terminal Latency Index and distal motor latency significantly changed from T0 to T1 and in the overall analysis (p = 0.001 and p = 0.002), and ulnar nerve sensory nerve action potential (SNAP) amplitude was significantly increased at T2 from T1, with a p value < 0.001 in the overall analysis. Analysis of the receiver-operating characteristic curves showed that a 41.8% increase in SNAP amplitude in the ulnar nerve at T2 from T0 was a fair predictor of a mISS reduction of ≥2 points (area under the curve 0.85; p = 0.005; sensitivity: 90.9%, specificity: 83.3%). CONCLUSIONS This study suggests that RTX is effective in patients with clinically active demyelinating anti-MAG neuropathy over 2 years of follow-up, and that some neurophysiological variables might be useful for monitoring this efficacy.
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Affiliation(s)
- Mattia Parisi
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Irene Dogliotti
- Stem Cell Transplant UnitUniversity Hospital A.O.U. “Città della Salute e della Scienza di Torino”TurinItaly
| | - Michele Clerico
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | | | - Giulia Benevolo
- SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Lorella Orsucci
- Division of Hematology 2A.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Irene Schiavetti
- Section of Biostatistics, Department of Health SciencesUniversity of GenoaGenoaItaly
| | - Roberto Cavallo
- Department of NeurologyOspedale San Giovanni BoscoTurinItaly
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Simone Ragaini
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | | | - Martina Ferrante
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | - Giulia Bondielli
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | | | - Daniela Drandi
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | | | - Bruno Ferrero
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
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Nivet T, Baptiste A, Belin L, Ghillani-Dalbin P, Algrin C, Choquet S, Lamy T, Morel V, Musset L, Roos-Weil D, Viala K, Leblond V, Baron M. Immunochemotherapy versus rituximab in anti-myelin-associated glycoprotein neuropathy: A report of 64 patients. Br J Haematol 2022; 198:298-306. [PMID: 35420717 DOI: 10.1111/bjh.18202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023]
Abstract
Monoclonal immunoglobulin M (IgM) anti-myelin-associated glycoprotein (MAG) neuropathy is a rare disabling condition, most commonly treated with rituximab monotherapy (R), which leads to neurological improvement in only 30%-50% of patients. The combination of rituximab plus chemotherapy has been proven to improve the level of responses. We studied the outcomes of anti-MAG neuropathy patients treated either by R, or by immunochemotherapy (ICT) in our centre, focusing on the incidence of the first neurological response evaluated by the modified Rankin scale (mRS). From 2011 to 2018, 64 patients were studied: 34 were treated with R and 30 with ICT. According to our treatment decision-making process, the median mRS was higher in the ICT group (mRS 2) than in the R group (mRS 1). At one year, improvements of the mRS rates were 46% and 18% in the ICT and R groups of patients respectively, with median times to response of eight and 13 months (p = 0.023). Adverse effects were higher in the ICT group: 62% vs 15% (p ˂ 0.01), all grades included. One secondary acute leukaemia occurred five years after treatment with ICT. In conclusion, ICT may be used as a valid option for patients with rapidly progressive and/or severe anti-MAG neuropathy symptoms.
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Affiliation(s)
- Thomas Nivet
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France.,Department of Hematology, CHU de Rennes, Rennes, France
| | - Amandine Baptiste
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Lisa Belin
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascale Ghillani-Dalbin
- Department of Immunochemistry, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Caroline Algrin
- Department of Hematology, Groupe Hospitalier mutualiste de Grenoble, Grenoble, France
| | - Sylvain Choquet
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Thierry Lamy
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Véronique Morel
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Lucile Musset
- Department of Immunochemistry, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Damien Roos-Weil
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Karine Viala
- Department of Neurophysiology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Véronique Leblond
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Marine Baron
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
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Chaudhary UJ, Rajabally YA. Underdiagnosis and diagnostic delay in chronic inflammatory demyelinating polyneuropathy. J Neurol 2020; 268:1366-1373. [PMID: 33170339 PMCID: PMC7990867 DOI: 10.1007/s00415-020-10287-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 10/26/2022]
Abstract
BACKGROUND The frequency and causes of underdiagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) are uncertain. We aimed to assess the frequency and electroclinical features of pre-referral CIDP underdiagnosis and the duration of delay prior to diagnosis and treatment initiation in a tertiary specialist clinic. METHODS We retrospectively investigated 60 consecutive patients attending our Inflammatory Neuropathy Service, between 2015 and 2019, with a final diagnosis of treatment-responsive definite/probable CIDP. We reviewed the clinical and electrophysiological data in light of European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) guidelines and determined the frequency, causes and delay in diagnosis of CIDP. RESULTS An initial alternative diagnosis to that of CIDP had been made in 68.3% (41/60) of patients. The commonest alternative diagnosis was of Guillain-Barré syndrome (GBS) in 23.3% (14/60) patients. Non-GBS underdiagnoses (27/60; 45%) mainly consisted of genetic neuropathy (8/27; 29.6%), diabetic neuropathy (5/27; 18.5%) and chronic idiopathic axonal polyneuropathy (4/27; 14.8%). Non-GBS underdiagnoses were predominantly due to non-recognition of proximal weakness (70.4%), multifocal deficits (18.5%) or proprioceptive loss (7.4%). Electrophysiological misinterpretation was contributory to pre-referral non-GBS underdiagnoses of CIDP in 85% of patients. Mean diagnostic delay in patients with non-GBS underdiagnoses of CIDP was of 21.3 months (range 2-132 months). CONCLUSION Underdiagnosis of CIDP is frequent and may lead to significant diagnostic and treatment delay. We suggest that lack of comprehensive and precise attention to typical electroclinical features of CIDP and its diagnostic criteria at the time of initial evaluation are equally contributory to underdiagnoses.
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Affiliation(s)
- Umair J Chaudhary
- Inflammatory Neuropathy Clinic, Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK. .,Aston Medical School, Aston University, Birmingham, UK.
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6
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Sadjadi R, Peric S, Gwathmey K, Bozovic I, Aleksa P, Bjelica B, Burns T, Basta I. Psychometric longitudinal evaluation of the Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) in patients with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2020; 63:84-88. [PMID: 33043466 DOI: 10.1002/mus.27089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND We studied the performance of a 15-item, health-related quality-of-life polyneuropathy scale in a longitudinal study of patients with chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS Sixty-one patients with CIDP completed the Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) scale and Patient Impression of Change (PIC) at baseline and follow-up visits. Clinicians completed Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores at baseline and follow-up visits. Conventional and modern psychometric analyses were performed on the completed forms. RESULTS CAPPRI was psychometrically stable between visits without significant difference in response pattern between visits 1 and 2 (paired t-test P = .72). There was strong correlation between changes in INCAT and changes in CAPPRI scores between two visits (rho = 0.6, P < .001). In addition, we showed robust CAPPRI effect sizes between PIC categories. CONCLUSIONS We demonstrated psychometric stability and construct longitudinal validity of CAPPRI.
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Affiliation(s)
- Reza Sadjadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kelly Gwathmey
- Neuromuscular Division, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Palibrk Aleksa
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ted Burns
- Department of Neurology, The University of Virginia, Charlottesville, Virginia, USA
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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7
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Opalic M, Peric S, Palibrk A, Bozovic I, Bjelica B, Stevic Z, Basta I. Quality of life in patients with polyneuropathy associated with different types of monoclonal gammopathy of undetermined significance. Acta Neurol Belg 2020; 120:1133-1138. [PMID: 31201672 DOI: 10.1007/s13760-019-01155-x] [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: 01/05/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
Polyneuropathy associated with monoclonal gammopathy of undetermined significance (MGUS-PNP) has a chronic and slowly progressive course but can lead to significant disability and reduced quality of life (QoL). The aim of this study was to analyze QoL in MGUS-PNP patients and to determine its predictors. Our study included 51 patients diagnosed with MGUS-PNP (23.5% with IgM, 66.7% IgG or IgA, 7.8% undetermined paraprotein, 2.0% light chains). QoL was assessed using the SF-36 questionnaire. The Medical Research Council Sum Score (MRC-SS), INCAT disability and sensory scores, ataxia score, Krupp's Fatigue Severity Scale and Beck's Depression Inventory were also used. Total SF-36 score was 50.0 ± 21.4 and no difference was observed between IgM and IgG/IgA MGUS-PNP. Physical composite score was worse than mental (44.4 ± 21.4 vs. 54.5 ± 20.9). Following factors showed correlation with SF-36 total score in univariate analysis: INCAT disability score, MRC-SS, INCAT sensory score, level of ataxia, fatigue and depression (p < 0.01). Significant predictors of worse SF-36 total score in our MGUS-PNP patients were depression (β = - 0.46, p < 0.01), fatigue (β = - 0.32, p < 0.01) and INCAT disability score (β = - 0.27, p < 0.01). QoL in MGUS-PNP is equally affected in patients with different types of paraprotein. MGUS-PNP patients with more severe functional disability, fatigue and depression need special attention of clinicians since they could be at higher risk to have worse QoL. This should be taken into account when treating subjects with MGUS-PNP.
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Herraets IJT, Goedee HS, Telleman JA, van Eijk RPA, Verhamme C, Saris CGJ, Eftimov F, van Alfen N, van Asseldonk JT, Visser LH, van den Berg LH, van der Pol LW. Nerve ultrasound for diagnosing chronic inflammatory neuropathy: A multicenter validation study. Neurology 2020; 95:e1745-e1753. [PMID: 32675082 DOI: 10.1212/wnl.0000000000010369] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/06/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To validate the diagnostic accuracy of a previously described short sonographic protocol to identify chronic inflammatory neuropathy (CIN), including chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis Sumner syndrome, and multifocal motor neuropathy (MMN), and to determine the added value of nerve ultrasound to detect treatment-responsive patients compared to nerve conduction studies (NCS) in a prospective multicenter study. METHODS We included 100 consecutive patients clinically suspected of CIN in 3 centers. The study protocol consisted of neurologic examination, laboratory tests, NCS, and nerve ultrasound. We validated a short sonographic protocol (median nerve at forearm, upper arm, and C5 nerve root) and determined its diagnostic accuracy using the European Federation of Neurological Societies/Peripheral Nerve Society criteria of CIDP/MMN (reference standard). In addition, to determine the added value of nerve ultrasound in detecting treatment-responsive patients, we used previously published diagnostic criteria based on clinical, NCS, and sonographic findings and treatment response (alternative reference standard). RESULTS Sensitivity and specificity of the sonographic protocol for CIN according to the reference standard were 87.4% and 67.3%, respectively. Sensitivity and specificity of this protocol according to the alternative reference standard were 84.6% and 72.8%, respectively, and of NCS 76.1% and 93.4%. With addition of nerve ultrasound, 44 diagnoses of CIN were established compared to 33 diagnoses with NCS alone. CONCLUSIONS A short sonographic protocol shows high diagnostic accuracy for detecting CIN. Nerve ultrasound is able to detect up to 25% more patients who respond to treatment. CLASSIFICATION OF EVIDENCE This multicenter study provides Class IV evidence that nerve ultrasound improves diagnosis of CIN.
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Affiliation(s)
- Ingrid J T Herraets
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan A Telleman
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruben P A van Eijk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Verhamme
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christiaan G J Saris
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Filip Eftimov
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nens van Alfen
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J Thies van Asseldonk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leo H Visser
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludo W van der Pol
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., L.W.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.P.A.v.E.), University Medical Center Utrecht; Amsterdam Neuroscience (C.V., F.E.), Amsterdam University Medical Center, University of Amsterdam; and Department of Neurology (C.G.J.S., N.v.A.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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9
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Herraets IJT, Goedee HS, Telleman JA, van Eijk RPA, van Asseldonk JT, Visser LH, van den Berg LH, van der Pol WL. Nerve ultrasound improves detection of treatment-responsive chronic inflammatory neuropathies. Neurology 2020; 94:e1470-e1479. [PMID: 31959710 DOI: 10.1212/wnl.0000000000008978] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/07/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To examine the diagnostic accuracy of nerve ultrasound in a prospective cohort of consecutive patients with a clinical suspicion of chronic inflammatory neuropathies, including chronic inflammatory demyelinating polyneuropathy, Lewis-Sumner syndrome, and multifocal motor neuropathy, and to determine the added value in the detection of treatment-responsive patients. METHODS Between February 2015 and July 2018, we included 100 consecutive incident patients with a clinical suspicion of chronic inflammatory neuropathy. All patients underwent nerve ultrasound, extensive standardized nerve conduction studies (NCS), and other relevant diagnostic investigations. We evaluated treatment response using predefined criteria. A diagnosis of chronic inflammatory neuropathy was established when NCS were abnormal (fulfilling criteria of demyelination of the European Federation of Neurological Societies/Peripheral Nerve Society) or when the degree of nerve enlargement detected by sonography was compatible with chronic inflammatory neuropathy and there was response to treatment. RESULTS A diagnosis of chronic inflammatory neuropathy was established in 38 patients. Sensitivity and specificity of nerve ultrasound and NCS were 97.4% and 69.4% and 78.9% and 93.5%, respectively. The added value of nerve ultrasound in detection of treatment-responsive chronic inflammatory neuropathy was 21.1% compared to NCS alone. CONCLUSIONS Nerve ultrasound and NCS are complementary techniques with superior sensitivity in the former and specificity in the latter. Addition of nerve ultrasound significantly improves the detection of chronic inflammatory neuropathies. Therefore, it deserves a prominent place in the diagnostic workup of chronic inflammatory neuropathies. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that nerve ultrasound is an accurate diagnostic tool to detect chronic inflammatory neuropathies.
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Affiliation(s)
- Ingrid J T Herraets
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Johan A Telleman
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Ruben P A van Eijk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - J Thies van Asseldonk
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Leo H Visser
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology and Neurosurgery (I.J.T.H., H.S.G., J.A.T., R.P.A.v.E., L.H.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Department of Neurology and Clinical Neurophysiology (I.J.T.H., J.A.T., J.T.v.A., L.H.V.), Elisabeth-Tweesteden Hospital Tilburg; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
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10
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Validation of the Serbian version of inflammatory Rasch‐built overall disability scale in patients with chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2019; 24:260-267. [DOI: 10.1111/jns.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
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11
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Rinkel WD, Aziz MH, Van Neck JW, Cabezas MC, van der Ark LA, Coert JH. Development of grading scales of pedal sensory loss using Mokken scale analysis on the Rotterdam Diabetic Foot Study Test Battery data. Muscle Nerve 2019; 60:520-527. [PMID: 31281987 PMCID: PMC6852564 DOI: 10.1002/mus.26628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Loss of sensation due to diabetes-related neuropathy often leads to diabetic foot ulceration. Several test instruments are used to assess sensation, such as static and moving 2-point discrimination (S2PD, M2PD), monofilaments, and tuning forks. METHODS Mokken scale analysis was applied to the Rotterdam Diabetic Foot Study data to select hierarchies of tests to construct measurement scales. RESULTS We developed 39-item and 31-item scales to measure loss of sensation for research purposes and a 13-item scale for clinical practice. All instruments were strongly scalable and reliable. The 39 items can be classified into 5 hierarchically ordered core clusters: S2PD, M2PD, vibration sense, monofilaments, and prior ulcer or amputation. DISCUSSION Guided by the presented scales, clinicians may better classify the grade of sensory loss in diabetic patients' feet. Thus, a more personalized approach concerning individual recommendations, intervention strategies, and patient information may be applied.
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Affiliation(s)
- Willem D Rinkel
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive, and Hand Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Hosein Aziz
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan W Van Neck
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - L Andries van der Ark
- Faculty of Social and Behavioural Sciences, Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - J Henk Coert
- Department of Plastic, Reconstructive, and Hand Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Bjelica B, Peric S, Gwathmey K, Sadjadi R, Bozovic I, Burns TM, Basta I. Chronic Acquired Polyneuropathy Patient Reported Index (CAPPRI) in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2019; 24:247-252. [DOI: 10.1111/jns.12329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Kelly Gwathmey
- Department of NeurologyVirginia Commonwealth University Richmond Virginia
| | - Reza Sadjadi
- Harvard Medical SchoolMassachusetts General Hospital Boston Massachusetts
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Ted M. Burns
- Department of NeurologyThe University of Virginia Charlottesville Virginia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
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13
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Bjelica B, Peric S, Bozovic I, Kacar A, Cobeljic M, Dejanovic I, Stevic Z, Basta I. One-year follow-up study of neuropathic pain in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2019; 24:180-186. [PMID: 30973184 DOI: 10.1111/jns.12318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/30/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Abstract
We sought to gather information about frequency and features of neuropathic pain (NeP) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients and to investigate course of NeP during 1-year follow-up. Study included 105 patients diagnosed with CIDP. Patients with diabetes (N = 26) were excluded. NeP was diagnosed by the official guidelines and painDETECT questionnaire (PD-Q). Medical Research Council Sum Score (MRC-SS), INCAT disability and sensory scores, and Beck Depression Inventory were also measured. PD-Q showed presence of NeP in 16 (20%) of 79 CIDP patients and their mean pain was moderate (5.1 ± 3.0 of 10). Diagnostic delay in CIDP patients with NeP was prolonged compared to CIDP patients without NeP (21 ± 28 vs 9 ± 12 months, P < .05). Slowly progressive course of the disease was more frequent in patients with NeP (81% vs 52%, P < .05). Patients with NeP had worse INCAT sensory score (P < .01), INCAT disability score (P < .05), MRC-SS, as well as worse disease outcome at time of testing (P < .05). Depression was more common in patients with NeP (69% vs 17%, P < .01). During 1-year follow-up, majority of our CIDP patients had good control of NeP with gabapentinoids or amitriptyline. NeP was common in our cohort of non-diabetic CIDP patients. It was associated with worse functional disability, worse sensory deficit, and depression. Special attention should be paid to CIDP patients with NeP because they request additional symptomatic therapy that appeared efficacious in our cohort.
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Affiliation(s)
- Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Kacar
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mina Cobeljic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Dejanovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorica Stevic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Merkies ISJ, Lawo JP, Edelman JM, De Bleecker JL, Sommer C, Robberecht W, Saarela M, Kamienowski J, Stelmasiak Z, Mielke O, Tackenberg B, Léger JM. Minimum clinically important difference analysis confirms the efficacy of IgPro10 in CIDP: the PRIMA trial. J Peripher Nerv Syst 2019; 22:149-152. [PMID: 28594116 PMCID: PMC6084359 DOI: 10.1111/jns.12204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Ingemar S J Merkies
- Spaarne Hospital, Hoofddorp, and Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Claudia Sommer
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Mika Saarela
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | | - Jean-Marc Léger
- Reference Center for Rare Neuromuscular Diseases, Hôpital Pitié-Salpêtrière, and University Paris VI, Paris, France
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15
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Rasch model-based testing of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy (QLQ-CIPN20) using Alliance for Clinical Trials in Oncology (Alliance) A151408 study data. Support Care Cancer 2018; 27:2599-2608. [PMID: 30460399 DOI: 10.1007/s00520-018-4553-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To test the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy (QLQ-CIPN20) using Rasch-based methods. METHODS A secondary data analysis was performed using pooled QLQ-CIPN20 data from patients (N = 1008) who had participated in any of four multi-site chemotherapy-induced peripheral neuropathy (CIPN) treatment and prevention trials. QLQ-CIPN20 responses were evaluated using a polytomous Rasch partial credit model. Data were assessed for person-item fit using the chi-square statistic, item scaling based on response proportions, threshold ordering using item characteristic curves and logit threshold locations, differential item response (DIF) (i.e., response bias) using likelihood ratio tests, and unidimensionality using cluster analysis. RESULTS A statistically significant chi-square test indicated poor fit of the observed to the expected responses. More than 70% of the respondents reported a complete absence of six symptoms, reflecting significant floor effects and poor item scaling. Disordered/non-ordinal or narrow response thresholds were found for 11 of the 20 items. Item responses were significantly different by gender (p < 0.0001) and chemotherapy type (p < 0.0001). Cluster analysis findings suggest that the QLQ-CIPN20 is a unidimensional scale due to the absence of item clusters. CONCLUSIONS Rasch model testing revealed psychometric weaknesses that could be addressed by revising the QLQ-CIPN20's problematic items and response options. Alternatively, perhaps the new gold standard CIPN measurement approach in future intervention trials should involve use of only the best items, which would also allow comparisons across previous trials that utilized the QLQ-CIPN20.
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16
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Rinkel WD, Rizopoulos D, Aziz MH, Van Neck JW, Cabezas MC, Coert JH. Grading the loss of sensation in diabetic patients: A psychometric evaluation of the rotterdam diabetic foot study test battery. Muscle Nerve 2018; 58:559-565. [PMID: 30028522 PMCID: PMC6646912 DOI: 10.1002/mus.26192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 12/22/2022]
Abstract
Introduction: Static‐ and moving 2‐point discrimination (S2PD, M2PD), 10‐g monofilaments‐ and tuning fork are validated outcome measures of clinical manifestations of diabetes‐related neuropathy. No modern statistical techniques have been used to investigate how well these instruments combine to measure sensory loss. Methods: To grade sensory loss at the feet, we fitted parametric forms of Item Response Theory models to the data of these instruments. Results: The fit statistics indicate that the loss of sensation is gradable, with readily available instruments. S2PD and M2PD are lost first, followed by vibration sense, the 10‐g monofilament and the ability to feel a cold stimulus. Conclusions: This test battery appears to provide sound measurement properties in a group of diabetic patients with diverse amounts of sensory loss. This approach may be used in clinical practice to grade sensory loss reliably and quickly, with instruments that are easy to use. Muscle Nerve58: 559–565, 2018
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Affiliation(s)
- Willem D Rinkel
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - M Hosein Aziz
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands
| | - Johan W Van Neck
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - J Henk Coert
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
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17
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Bjelica B, Basta I, Bozovic I, Kacar A, Nikolic A, Dominovic‐Kovacevic A, Vukojevic Z, Martic V, Stojanov A, Djordjevic G, Petrovic M, Stojanovic M, Peric S. Employment status of patients with chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2018; 23:178-182. [DOI: 10.1111/jns.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Aleksandra Kacar
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Ana Nikolic
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
| | - Aleksandra Dominovic‐Kovacevic
- Clinic for Neurology, University Clinical Centre of Republic of Srpska, Faculty of MedicineUniversity of Banja Luka Banja Luka Republic of Srpska, Bosnia and Herzegovina
| | - Zoran Vukojevic
- Clinic for Neurology, University Clinical Centre of Republic of Srpska, Faculty of MedicineUniversity of Banja Luka Banja Luka Republic of Srpska, Bosnia and Herzegovina
| | - Vesna Martic
- Neurology ClinicMilitary Medical Academy Belgrade Serbia
| | | | | | | | | | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of MedicineUniversity of Belgrade Belgrade Serbia
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Kacar A, Bjelica B, Bozovic I, Peric S, Nikolic A, Cobeljic M, Petrovic M, Stojanov A, Djordjevic G, Vukojevic Z, Dominovic-Kovacevic A, Stojanovic M, Stevic Z, Rakocevic-Stojanovic V, Lavrnic D, Basta I. Neuromuscular disease-specific questionnaire to assess quality of life in patients with chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2018; 23:11-16. [PMID: 29360221 DOI: 10.1111/jns.12251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
Abstract
To date, generic questionnaires have been used to investigate quality of life (QoL) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. Although these measures are very useful, they are not usually precise enough to measure all specific characteristics of the disease. Our aim was to investigate QoL using the neuromuscular disease-specific questionnaire (individualized neuromuscular quality of life, INQoL) in a large cohort of patients with CIDP. Our study comprised 106 patients diagnosed with CIDP. INQoL questionnaire, Medical Research Council (MRC) sum score, Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, Visual Analogue Pain Scale, Beck Depression Inventory, and Krupp's Fatigue Severity Scale were used in our study. Physical domains of INQoL were more affected than mental, and the overall score was 57 ± 25. Significant predictors of higher INQoL score in our patients with CIDP were severe fatigue (β = 0.35, p < 0.01), higher INCAT disability score at time of testing (β = 0.29, p < 0.01), and being unemployed/retired (β = 0.22, p < 0.05). QoL was reduced in our cohort of CIDP patients, which was more pronounced in physical segments. Patients with fatigue, more severe disability, and unemployed/retired need special attention of neurologists because they could be at greater risk to have worse QoL.
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Affiliation(s)
- Aleksandra Kacar
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Nikolic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mina Cobeljic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milutin Petrovic
- Neurology Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | | | | | - Zoran Vukojevic
- Neurology Clinic, Clinical Center Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | | | | | - Zorica Stevic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Dragana Lavrnic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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Bozovic I, Kacar A, Peric S, Nikolic A, Bjelica B, Cobeljic M, Petrovic M, Stojanov A, Djuric V, Stojanovic M, Djordjevic G, Martic V, Dominovic A, Vukojevic Z, Basta I. Quality of life predictors in patients with chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol 2017; 264:2481-2486. [DOI: 10.1007/s00415-017-8658-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
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20
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Gazzola S, Delmont E, Franques J, Boucraut J, Salort-Campana E, Verschueren A, Sagui E, Hubert AM, Pouget J, Attarian S. Predictive factors of efficacy of rituximab in patients with anti-MAG neuropathy. J Neurol Sci 2017; 377:144-148. [DOI: 10.1016/j.jns.2017.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/21/2017] [Accepted: 04/10/2017] [Indexed: 01/01/2023]
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21
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Delmont E, Hiew FL, Cassereau J, Aubé-Nathier AC, Grapperon AM, Attarian S, Rajabally YA. Determinants of health-related quality of life in anti-MAG neuropathy: a cross-sectional multicentre European study. J Peripher Nerv Syst 2017; 22:27-33. [DOI: 10.1111/jns.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS; University Hospital La Timone; Marseille France
- Aix-Marseille University; CNR2M, CNRS UMR 7286, Medicine Faculty; Marseille France
| | - Fu Liong Hiew
- Regional Neuromuscular Clinic, Queen Elizabeth Hospital; University Hospitals of Birmingham; Birmingham UK
| | - Julien Cassereau
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
| | - Anne-Catherine Aubé-Nathier
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS; University Hospital La Timone; Marseille France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS; University Hospital La Timone; Marseille France
- Inserm UMR S 910 Medical Genetics and Functional Genomics; Aix Marseille University; Marseille France
| | - Yusuf A. Rajabally
- Regional Neuromuscular Clinic, Queen Elizabeth Hospital; University Hospitals of Birmingham; Birmingham UK
- School of Life and Health Sciences, Aston Brain Centre; Aston University; Birmingham UK
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22
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What is new in 2015 in dysimmune neuropathies? Rev Neurol (Paris) 2016; 172:779-784. [PMID: 27866728 DOI: 10.1016/j.neurol.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022]
Abstract
This review discusses and summarizes the concept of nodopathies, the diagnostic features, investigations, pathophysiology, and treatment options of chronic inflammatory demyelinating polyradiculoneuropathy, and gives updates on other inflammatory and dysimmune neuropathies such as Guillain-Barré syndrome, sensory neuronopathies, small-fiber-predominant ganglionitis, POEMS syndrome, neuropathies associated with IgM monoclonal gammopathy and multifocal motor neuropathy. This field of research has contributed to the antigenic characterization of the peripheral motor and sensory functional systems, as well as helping to define immune neuropathic syndromes with widely different clinical presentation, prognosis and response to therapy.
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23
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Hanewinckel R, Ikram MA, van Doorn PA. Assessment scales for the diagnosis of polyneuropathy. J Peripher Nerv Syst 2016; 21:61-73. [PMID: 26968746 DOI: 10.1111/jns.12170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
Epidemiological studies that investigate the occurrence and determinants of chronic length-dependent polyneuropathy are scarce. Population-based studies on polyneuropathy require a valid and reliable screening protocol with both good sensitivity and specificity. Several questionnaires and scoring scales have been developed for the detection of polyneuropathy, grading the severity of the disease, or evaluating the clinical course during follow-up. This review summarizes the aims and content of existing diagnostic polyneuropathy screening tools in order to help future studies decide which scale to use for screening in specific situations. We searched the PubMed database and identified 27 scales, 13 are based on symptoms alone, 8 on neurological signs alone, and 6 on a combination of symptoms and signs. Scales that combine questions concerning symptoms and a neurological examination with a focus on sensory alterations seem to have the best discriminatory power. However, all scoring scales were developed for and investigated in prespecified patient populations. Therefore, the generalizability of specific findings to the general population may be limited. We also discuss other limitations of existing scales. Future studies are required to determine which clinimetrically well-developed scales are preferred for use in population-based studies.
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Affiliation(s)
- Rens Hanewinckel
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hadden RDM, Collins MP, Živković SA, Hsieh ST, Bonetto C, Felicetti P, Marchione P, Santuccio C, Bonhoeffer J. Vasculitic peripheral neuropathy: Case definition and guidelines for collection, analysis, and presentation of immunisation safety data. Vaccine 2015; 35:1567-1578. [PMID: 26655629 DOI: 10.1016/j.vaccine.2015.11.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Saša A Živković
- Department of Neurology, University of Pittsburgh Medical Center, USA
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taiwan
| | | | | | | | | | - Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland
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25
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Van den Bergh PYK, Lunn MP. Future needs in peripheral neuropathy outcome measures. J Peripher Nerv Syst 2015; 20:341-6. [PMID: 26306616 DOI: 10.1111/jns.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
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