Functional and morphometric assessment of small-fibre damage in late-onset hereditary transthyretin amyloidosis with polyneuropathy: the controversial relation between small-fibre-related symptoms and diagnostic test findings

INTRODUCTION

We aimed at investigating whether functional and morphometric tests assessing small-fibre damage, ie quantitative sensory testing, Sudoscan and skin biopsy, reliably reflect neuropathic pain and autonomic symptoms in patients with late-onset hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN).

METHODS

In 30 patients with late-onset ATTRv-PN, we collected quantitative sensory testing, Sudoscan and skin biopsy with assessment of intraepidermal, piloerector muscle and sweat gland nerve fibre density. We then correlated these functional and morphometric parameters with neuropathic pain and autonomic symptoms as assessed with the Neuropathic Pain Symptom Inventory (NPSI) and Composite Autonomic Symptom Score-31 (COMPASS-31).

RESULTS

50% of patients showed small-fibre damage in the form of a pure small-fibre neuropathy, 47% in the context of a mixed fibre neuropathy with small and large fibre involvement. All patients complained of at least one autonomic symptom and 60% had neuropathic pain. Whereas quantitative sensory testing and Sudoscan parameters correlated with neuropathic pain and autonomic symptoms as assessed by NPSI and COMPASS-31, intraepidermal, piloerector muscle and sweat gland nerve fibre density quantification did not.

CONCLUSIONS

Our findings indicate that functional test parameters reliably reflect neuropathic pain and autonomic symptoms related to small-fibre damage. These findings might help to identify clinically useful biomarkers to assess patient follow-up.

Neuropathic Pain Symptom Inventory (NPSI) Questionnaire-Persian Version Can Differentiate Neuropathic from Non-Neuropathic Pain

BACKGROUND

Neuropathic pain (NP) is a common condition that impacts life negatively. This type of pain responds poorly to treatment. Neuropathic Pain Symptom Inventory (NPSI) is a common instrument used for the assessment of NP response to the treatment.

AIM

The current study aims to validate the Persian version of NPSI (PV-NPSI).

METHODS

The current study has been conducted on 162 patients experiencing pain from neuropathic ornon-neuropathic origin. The Persian version of NPSI was proposed through standard protocol and responded to by patients twice: at baseline within an interval of 3 hours and then again within 1 month. Its correlation with the patient global impression of change (PGIC) and the clinical global impression of change (CGIC) was assessed. In addition, the validity and reliability of the PV-NPSI was evaluated.

RESULTS

The reliability Cronbach's alpha of PV-NPSI was 0.834 and test-retest intraclass-coefficient was calculated as 0.983 (95% confidence interval [CI]: 0.977-0.988; p < .001). In addition, the measured coefficient sensitivity to change based on PGIC and CGIC was 0.859 for both. Receiver operating characteristic (ROC) curve for the diagnosis of NP revealed area under curve (AUC) of 0.936 (p < .001; 95%CI: 0.894-0.978).

CONCLUSIONS

Based on the current study's findings, the PV-NPSI is a reliable and valid means for the differentiation of NP from the other types of pain in patients with several musculoskeletal pain complaints, but we cannot determine a cutoff point for it. Also, this questionnaire can be efficiently used for the assessment of response to NP treatment.

6th Annual Conference of the Neuropathology Society of India (NPSICON) - Meeting Abstracts: February 23-25, 2023

The 6^th Annual conference of the Neuropathology Society of India, (NPSICON 2023) was held in a virtual mode, from 23^rd to 25^th February 2023, hosted by the Division of Neuropathology, Department of Pathology, Christian Medical College Vellore. Dr Geeta Chacko was the organizing Chairperson. The pre-conference workshop was on Fluorescence in situ hybridization with nearly 90 registrants. The workshop was conducted by NIMHANS Bangalore with Dr Shilpa Rao, Dr Vaishali Suri, Dr Vani Santosh and Dr Geeta Chacko as resource persons. There were 253 National registrants and 7 International registrations. The conference had participation from reputed national (34) and international (8) faculty and covered a wide range of topics in both neoplastic and non-neoplastic Neuropathology including sessions on perinatal pathology, epilepsy, neuromuscular pathology and several sessions in Neurooncology. There were five symposiums with several sessions of cases-based discussion. The first Prof Ashru K Banerjee oration was delivered by Dr Kenneth Aldape, from NIH Bethesda on: "Practical Aspects of Methylation-Based Diagnostics in Central Nervous System Tumors". The first Prof SK Shankar oration was delivered by Dr Avindra Nath, NIH Bethesda on "Neuropathology of two pandemics: AIDS and COVID". The Presidential oration was delivered by Dr Chitra Sarkar. The key note speakers included Dr Monika Hofer, Dr David Capper, Dr Takashi Komori and Dr Maysa Husseini. There were 28 papers for oral presentation and 38 posters. A highlight of the conference was a lively Quiz competition, which was held as the penultimate session. Despite being a virtual conference, there was active participation from all the delegates and the conference was very well received.

The Impact of Micro RNA-320a Serum Level on Severity of Symptoms and Cerebral Processing of Pain in Patients with Fibromyalgia

OBJECTIVES

The aim of this work was to explore the expression of miR-320a level in fibromyalgia patients in comparison to healthy controls, and to clarify its impact on the severity of symptoms and the cerebral processing of pain assessed by middle latency somatosensory evoked potentials (SSEPs).

DESIGN

Case-control study.

SETTING

Rheumatology and Neurology outpatient clinics.

SUBJECTS

Seventy-four fibromyalgia patients and seventy-four normal healthy controls.

METHODS

The included patients were subjected to detailed history taking, assessment of severity of fibromyalgia symptoms using the Fibromyalgia Impact Questionnaire Revised (FIQR), assessment of pain intensity using the Neuropathic Pain Symptom Inventory (NPSI), measurement of the serum level of miR-320a in addition to of measurement peak latencies and amplitudes of middle latency SSEPs.

RESULTS

Fibromyalgia patients had significantly higher micro-RNA-320a levels (0.907 ± 0.022) in comparison to controls (0.874 ± 0.015) (P-value < .001). The mean values of micro-RNA-320a levels were significantly higher in fibromyalgia patients with insomnia, chronic fatigue syndrome, persistent depressive disorder, and primary headache disorder than those without (P-value = .024, <.001, .006, .036 respectively). There were statistically significant positive correlations between micro-RNA-320a levels, and disease duration, FIQR, and NPSI total scores (P-value <0.001, 0.003, 0.002 respectively). There were no statistically significant correlations between micro-RNA-320a levels and middle latency SSEPs.

DISCUSSION

Micro-RNA-320a level is significantly upregulated in fibromyalgia patient. It has a crucial impact on the severity of symptoms but not related to the cerebral processing of pain.

5th Asian Oceanian Congress of Neuropathology along with the 5th Annual Conference of the Neuropathology Society of India (AOCN-NPSICON) - Meeting Abstracts

The 5^th Asian Oceanian Congress of Neuropathology along with the 5^th Annual Conference of the Neuropathology Society of India (AOCN-NPSICON) was held in virtual mode on September 24-26, 2021, at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India, hosted by the Department of Neuropathology. It had 361 attendees from 20 countries from Asia and Oceania including India. The event brought together pathologists, clinicians and neuroscientists from all over Asia and Oceania with invited speakers from the USA, Germany and Canada. The program was very comprehensive and covered advances in the fields of neurooncology with emphasis on the upcoming WHO 2021 classification of CNS tumors, neuromuscular disorders, epilepsy and neurodegenerative disorders through key note addresses and symposia that featured 78 distinguished international and national faculty sharing their expertise. In addition, there were case-based learning modules, opportunities for paper presentations and poster sessions for young faculty and postgraduates with several awards for young investigators, best papers and posters. A highlight of the conference was a unique debate on the hot topic of the decade: Methylation-based classification of CNS tumors and a panel discussion on COVID-19. The participants were highly appreciative of the academic content.

Is quantitative sensory testing helpful in the management of oxaliplatin neuropathy? a two-year clinical study

PURPOSE

To better understand how quantitative sensory testing could help the clinician in the management of oxaliplatin-induced peripheral neuropathy in terms of earlier and more reliable detection, we conducted a two-year prospective study.

METHODS

Thermal sensory assessment, tactile sensory assessment, neuropathic pain assessment and adverse events gradation (NCI-CTC) were performed during treatment and 6 months after treatment completion.

RESULTS

35 patients were enrolled and followed-up during one year. Cold and Warm Detection Thresholds were higher 6 months after treatment completion than at enrollment. Mechanical detection thresholds didn't change significantly. Neurotoxicity was mostly grade-1, only 18% grade-2 and no grade-3. Grade-2 patients received lower oxaliplatin cumulative dose than grade-1, which reveals effective dose adaptation and grade-2 patients were more likely to develop painful neuropathy.

CONCLUSION

Thermal thresholds impairment emerges too late to help the clinician in the prophylaxis of neuropathy. Management of OXA-treatment based on NCI-CTC, as currently recommended, remains the best way to detect neuropathy and ensure treatment adaptation.

Prevalence of Neuropathic Pain in Patients with Traumatic Brachial Plexus Injury: A Multicenter Prospective Hospital-Based Study

Objective

Prevalence and clinical characteristics of neuropathic pain due to traumatic brachial plexus injury.

Design

Observational epidemiological study.

Setting

Hospital-based multicenter study.

Subjects

One hundred seven prospectively enrolled patients with brachial plexus injury.

Methods

All the patients underwent clinical examination and neurophysiological testing for a definitive diagnosis of the brachial plexus lesion. The DN4 questionnaire was used to identify neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to evaluate the different symptoms of neuropathic pain. The SF36 questionnaire and the Beck Depression Inventory (BDI) were used to assess quality of life and mood disturbances in patients with neuropathic pain.

Results

Of the 107 enrolled patients, 74 had pain (69%); neuropathic pain, as assessed by means of the DN4, was identified in 60 (56%) of these patients. According to the NPSI, the most frequent and severe pain type was the spontaneous burning pain. Clinical and neurophysiological findings showed that pain is unrelated to age but is associated with the severity of peripheral nerve damage. The SF36 questionnaire and BDI showed that neuropathic pain impairs quality of life and causes depression.

Conclusions

Our study provides information on the prevalence, characteristics, and variables associated with neuropathic pain due to traumatic brachial plexus injuries that might provide a basis for improving the clinical management of this condition.

Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria

BACKGROUND

Pain is a common and heterogeneous complication of multiple sclerosis (MS). In this multicenter, cross sectional study, we aimed at investigating the prevalence of pain in MS using highly specific criteria for distinguishing the different types of pain.

MATERIALS AND METHODS

After a structured interview, in patients with pain, clinical examination and DN4 questionnaire were used for distinguishing neuropathic and nociceptive pain. In subjects with neuropathic pain, the Neuropathic Pain Symptom Inventory was used for differentiating neuropathic pain symptoms.

RESULTS

We enrolled 1249 participants (832 F, 417 M, mean age 33.9 years, mean disease duration 8 years, mean EDSS 3.2); based on clinical evaluation and DN4 score 429 patients (34.34%) were classified with pain (470 pain syndromes): 286 nociceptive pain syndromes and 184 neuropathic pain syndromes. Multivariate analysis showed that pain was associated with age, gender and disease severity and that neuropathic pain was distinctly associated with EDSS.

CONCLUSIONS

Our study, providing definite information on the prevalence, characteristics and variables associated with neuropathic pain due to MS, shows that a more severe disease course is associated with a higher risk of neuropathic pain. Our findings might, therefore, provide a basis for improving the clinical management of this common MS complication.

Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs

This manuscript aimed to characterize the clinical profile of various neuropathic pain (NeP) disorders and to identify whether patterns of sensory symptoms/signs exist, based on baseline responses on the Neuropathic Pain Symptom Inventory (NPSI) questionnaire and the quantitative sensory testing (QST). These post hoc analyses were based on data from 4 randomized, double-blind, placebo-controlled clinical studies of pregabalin (150-600mg/day) in patients with NeP syndromes: central poststroke pain, posttraumatic peripheral pain, painful HIV neuropathy, and painful diabetic peripheral neuropathy. The NPSI questionnaire includes 10 different pain symptom descriptors. QST was used to detect sensory thresholds of accurately calibrated sensory stimuli and to quantify the intensity of evoked sensation. To identify symptoms/signs clusters and select the number of clusters, a principal component analysis (PCA) and hierarchical clustering methods with clinical input were used. Analysis of the NPSI pain qualities and individual QST measures at baseline indicated no clear association between particular symptoms/signs profiles and etiologies. Based on NPSI symptoms, PCA identified 3 pain dimensions: provoked, deep, and pinpoint. A hierarchical cluster analysis identified 3 clusters with distinct pain characteristics profiles independent of NeP syndrome. Based on QST signs, PCA identified 2 pain dimensions: evoked by cold and evoked by touch. A hierarchical cluster analysis identified 4 clusters with distinct pain characteristics profiles. These "trans-etiological" profiles may reflect distinct pathophysiological mechanisms and therefore, potential differential responses to treatment.