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Murin PJ, Khasiyev F, Profirovic J, Fedorova M, Kafaie J. Comparing FGFR-3 and TS-HDS Seropositive Small Fiber Neuropathy: Unique Patient Features, Symptoms, Laboratory, and Nerve Conduction Study Findings. J Clin Neuromuscul Dis 2024; 25:171-177. [PMID: 38771226 DOI: 10.1097/cnd.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Small fiber neuropathy presents a significant diagnostic and therapeutic challenge. To solve this challenge, efforts have been made to identify autoantibodies associated with this condition. Previous literature has often considered tri-sulfated heparin disaccharide (TS-HDS) and fibroblast growth factor receptor 3 (FGFR3) as a singular seropositive group and/or focused primarily on symptomatic associations. METHODS One hundred seventy-two small fiber neuropathy patients with a Washington University Sensory Neuropathy panel were selected for TS-HDS seropositivity, FGFR-3 seropositivity, and seronegative controls. Data were collected to on the demographic, symptomatic, and laboratory profiles of each subgroup. RESULTS Percent female (P = 0.0043), frequency of neuropathic pain symptoms (P = 0.0074), and erythrocyte sedimentation rate (P = 0.0293), vitamin D (P < 0.0001), and vitamin B12 (P = 0.0033) differed between the groups. Skin biopsy was more frequently normal within both the FGFR-3 and the TS-HDS cohort (P = 0.0253). CONCLUSIONS TS-HDS and FGFR-3 display a distinct phenotype from both controls and one another. Immunoglobulin M (IgM) against FGFR-3 and IgM against TS-HDS may be individually valuable markers for the development of distinct clinical phenotypes.
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Affiliation(s)
- Peyton J Murin
- Department of Neurology, Saint Louis University, Saint Louis, MO
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University, Saint Louis, MO
| | - Jasmina Profirovic
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy at UHSP, St. Louis, MO
| | | | - Jafar Kafaie
- Department of Neurology, Saint Louis University, Saint Louis, MO
- Department of Pharmacology and Physiology, Saint Louis University, Saint Louis, MO
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Okazaki A, Nakano H, Haginomori SI, Ayani Y, Inaka Y, Ozaki A, Kikuoka Y, Inui T, Nakazawa A, Wada SI, Kawata R. Prognostic value of electroneurography using the midline method for predicting the development of synkinesis after peripheral facial palsy. Auris Nasus Larynx 2024; 51:599-604. [PMID: 38552423 DOI: 10.1016/j.anl.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 02/14/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE The prognostic value of electroneurography (ENoG) for predicting the incidence of synkinesis is reportedly about 40 % using the formal standard method (ENoG-SM). However, the prognostic value of ENoG using the newly developed midline method (ENoG-MM) has not been determined. The aim of this study was to demonstrate the optimal prognostic value and advantages of ENoG-MM for predicting the incidence of synkinesis. METHODS Participants were 573 patients treated for peripheral facial palsy including Bell's palsy or Ramsay Hunt syndrome. We investigated the clinical presence of any oral-ocular or ocular-oral synkinesis from the medical records. ENoG-MM and ENoG-SM were performed 10-14 days after symptom onset. In ENoG-MM, compound muscle action potentials were recorded by placing the anode on the mental protuberance and the cathode on the philtrum. In ENoG-SM, electrodes were placed on the nasolabial fold. Synkinesis was clinically assessed at the end of follow-up or at >1 year after onset. The sensitivity and specificity of ENoG values for predicting the incidence of synkinesis were compared between ENoG-MM and ENoG-SM at every 5 % around 40 % (range, 30-50 %). RESULTS At every 5 % of ENoG values around 40 %, ENoG-MM provided higher sensitivity and lower specificity for predicting the incidence of synkinesis compared with ENoG-SM. In particular, when the cut-off value was set at 45 %, sensitivity was 100 % and 95.3 % with ENoG-MM and ENoG-SM, respectively. CONCLUSION In peripheral facial palsy, ENoG-MM offered higher sensitivity than ENoG-SM for predicting synkinesis. ENoG-MM is useful for screening patients at risk of developing synkinesis. In clinical practice, an ENoG-MM cut-off value of 45 % must be the optimal prognostic value because of the 100 % sensitivity.
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Affiliation(s)
- Aishi Okazaki
- Department of Central Clinical Laboratory, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan.
| | - Haruki Nakano
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shin-Ichi Haginomori
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yusuke Ayani
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuko Inaka
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Akiko Ozaki
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yusuke Kikuoka
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takaki Inui
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ayumi Nakazawa
- Department of Central Clinical Laboratory, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Shin-Ichi Wada
- Laboratory of Medical Technology III, Faculty of Nutrition, Kobe Gakuin University, Kobe, Japan
| | - Ryo Kawata
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Hodzelmans JJA, Janssen MLF, Reulen JPH, Blijham PJ, Koster A, Stehouwer CDA, Mess WH, Sutedja NA. Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population-based cohort: Associations with demographic and anthropometric characteristics-The Maastricht study. Muscle Nerve 2024; 69:588-596. [PMID: 38459960 DOI: 10.1002/mus.28076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION/AIMS Nerve conduction studies (NCSs) are widely used to support the clinical diagnosis of neuromuscular disorders. The aims of this study were to obtain reference values for peroneal, tibial, and sural NCSs and to examine the associations with demographic and anthropometric factors. METHODS In 5099 participants (aged 40-79 years) without type 2 diabetes of The Maastricht Study, NCSs of peroneal, tibial, and sural nerves were performed. Values for compound muscle action potential (CMAP) and sensory nerve action potential amplitude, nerve conduction velocity (NCV), and distal latency were acquired. The association of age, sex, body mass index (BMI), and height with NCS values was determined using uni- and multivariate linear regression analyses. RESULTS Detailed reference values are reported per decade for men and women. Significantly lower NCVs and longer distal latencies were observed in all nerves in older and taller individuals as well as in men. In these groups, amplitudes of the tibial and sural nerves were significantly lower, whereas a lower peroneal nerve CMAP was only significantly associated with age. BMI showed a multidirectional association. After correction for anthropometric factors in the multivariate analysis, the association between sex and NCS values was less straightforward. DISCUSSION These values from a population-based dataset could be used as a reference for generating normative values. Our findings show the association of NCS values with anthropometric factors. In clinical practice, these factors can be considered when interpreting NCS values.
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Affiliation(s)
- Jurriaan J A Hodzelmans
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Jos P H Reulen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul J Blijham
- Department of Clinical Neurophysiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nadia A Sutedja
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Stępień J, Pastuszak Ż. Distal symmetrical polyneuropathy in diabetes mellitus patients: Proposition of a new scoring system based on electroneurography findings. ADV CLIN EXP MED 2024; 33:379-385. [PMID: 37486701 DOI: 10.17219/acem/168504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/05/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Neuropathy affects 25% of people with diabetes mellitus. The evaluation of disease severity is still a challenge for modern medicine. Many screening instruments are based primarily on clinical criteria. There is a lack of a simple, reliable and precise scoring system that could improve the classification of neuropathy and monitor disease progression using not only clinical criteria but also electroneurography. There is a need to find sensitive neurography parameters that reflect peripheral nerve impairments in this group of patients. OBJECTIVES This study aimed to create a scoring system for diabetic neuropathy, based on electroneurography criteria, that reflects the natural course of the disease. A new scoring system will improve the treatment of patients with diabetes mellitus. MATERIAL AND METHODS A total of 113 patients with distal symmetrical polyneuropathy (DSPN) were involved in the study. Median, ulnar, sural, tibial, and peroneal nerves were examined. Parameters such as amplitude, conduction velocity, distal latency, and F wave latency were analyzed. The results of nerve conduction studies in the investigated group were compared to those of the control group, which consisted of 61 healthy volunteers. RESULTS The most sensitive parameter of peripheral nerve impairment severity was a reduction of the sensory action potential amplitude in the peroneal nerve by 72.8% (p < 0.05). The observation of changes in sensory action potential amplitudes in the peroneal nerve is the most important element of our scoring system. CONCLUSIONS A new electroneurography scoring system of DSPN severity should be based on sensory and motor action potential amplitudes that reflect axonal loss in the examined nerves and the nature of the disease.
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Affiliation(s)
| | - Żanna Pastuszak
- Laboratory of Preclinical Research and Environmental Agents, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
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Lee HS, Suh BC, Kim JK, Kim BJ, Nam TS, Oh J, Bae JS, Shin KJ, Kim SW, Kim SM, Shin HY. Serial Nerve Conduction Studies in Guillain-Barré Syndrome: Its Usefulness and Precise Timing. J Clin Neurophysiol 2024; 41:278-284. [PMID: 38436391 DOI: 10.1097/wnp.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Nerve conduction study (NCS) is essential for subclassifying Guillain-Barré syndrome (GBS). It is well known that the GBS subclassification can change through serial NCSs. However, the usefulness of serial NCSs is debatable, especially in patients with early stage GBS. METHODS Follow-up NCS data within 3 weeks (early followed NCS, EFN) and within 3 to 10 weeks (late-followed NCS, LFN) were collected from 60 patients with GBS who underwent their first NCS (FN) within 10 days after symptom onset. Each NCS was classified into five subtypes (normal, demyelinating, axonal, inexcitable, and equivocal), according to Hadden's and Rajabally's criteria. We analyzed the frequency of significant changes in classification (SCCs) comprising electrodiagnostic aggravation and subtype shifts between demyelinating and axonal types according to follow-up timing. RESULTS Between FN and EFN, 33.3% of patients with Hadden's criteria and 18.3% with Rajabally's criteria showed SCCs. Between FN and LFN, 23.3% of patients with Hadden's criteria and 21.7% with Rajabally's criteria showed SCCs, of which 71.4% (Hadden's criteria) and 46.2% (Rajabally's criteria) already showed SCCs from the EFN. The conditions of delayed SCCs between EFN and LFN were very early FN, mild symptoms at the FN, or persistent electrophysiological deterioration 3 weeks after symptom onset. CONCLUSIONS A substantial proportion of patients with GBS showed significant changes in neurophysiological classification at the early stage. Serial NCS may be helpful for precise neurophysiological classification. This study suggests that follow-up NCSs should be performed within 3 weeks of symptom onset in patients with GBS in whom FN was performed within 10 days of symptom onset.
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Affiliation(s)
- Hyung-Soo Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bum Chun Suh
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University College of Medicine, Seoul, Korea
| | - Jong Seok Bae
- Department of Neurology, Hallym University College of Medicine, Seoul, Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and
| | - Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Karakiliç GD, Arslan G. Carpal tunnel syndrome and nerve conduction studies in fibromyalgia patients. Rom J Intern Med 2024; 62:61-66. [PMID: 37991445 DOI: 10.2478/rjim-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate ENMG results of female patients with Fibromyalgia Syndrome (FMS) with a preliminary diagnosis of carpal tunnel syndrome (CTS) and to examine whether there are differences in ENMG results compared to control group. MATERIAL AND METHODS Ethical approval was obtained for this study on 30.12.2022 with number E. Kurul-2022-20/32 and recorded retrospectively between January 2021 and January 2023. 201 female patients who were diagnosed with FMS in Physical Therapy and Rehabilitation polyclinic and who were requested to have ENMG testing with a preliminary diagnosis of CTS were included in study as patient group. 201 patients were ıncluded as control group. RESULTS While the number of patients with right CTS was 39 (25.49%) in the FMS group, the number of patients with right CTS was 38 (24.20%) in control group. While the number of patients with left CTS was 34 (25%) in the FMS group, number of patients with left CTS in the control group was 36 (24.65%). When we analyzed a total of 592 ENMG results in our study, we found a high normal ENMG rate of 75%. CONCLUSION We found that there was no difference between the FMS and the control group in terms of compatibility between the pre-diagnosis and electroneurophysiological diagnosis in the ENMG results requested with the pre-diagnosis of CTS in our study. The ENMG examination should be requested for right patient in right indication, by first evaluating the patient well.
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Affiliation(s)
| | - Güven Arslan
- Department of Neurology, Acibadem Kayseri Hospital affiliated to Acibadem University and Acibadem Healthcare Institutions, Kayseri, Turkey
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Di Pietro G, Falco P, D'Elia C, Cavalcanti L, De Stefano G, Di Stefano G, Fabiano E, Galosi E, Leone C, Vicenzini E, Truini A, Mancini P. Predicting value for incomplete recovery in Bell's palsy of facial nerve ultrasound versus nerve conduction study. Clin Neurophysiol 2024; 158:35-42. [PMID: 38150916 DOI: 10.1016/j.clinph.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE This longitudinal study aims at assessing the predictive value of facial nerve high-resolution ultrasound (HRUS) for incomplete clinical recovery in patients with Bell's palsy, the most common facial nerve disease. METHODS We prospectively enrolled 34 consecutive patients with Bell's palsy. All patients underwent neurophysiological testing (including facial nerve conduction study) and HRUS evaluations 10-15 days (T1), one month (T2), and three months (T3) after the onset of Bell's palsy. Patients who did not experience complete recovery within three months were also evaluated after six months (T4). We have then compared the accuracy of HRUS with that of the facial nerve conduction study in predicting incomplete clinical recovery at three and six months. RESULTS At T1, the facial nerve diameter, as assessed with HRUS, was larger on the affected side than on the normal side, particularly in patients with incomplete recovery at T2, T3 and T4. ROC curve analysis, however, showed that the facial nerve diameter at T1 had a lower predictive value than the facial nerve conduction study for an incomplete clinical recovery at three (T3) and six (T4) months. Still, the facial nerve diameter asymmetry, as assessed with HRUS, had a relatively high negative predictive value (thus indicating a strong association between normal HRUS examination and a good prognosis). CONCLUSIONS Although HRUS shows abnormally increased facial nerve diameter in patients in the acute phase of Bell's palsy, the predictive value of this technique for incomplete clinical recovery at three and six months is lower than that of the nerve conduction study. SIGNIFICANCE Nerve ultrasound has a low predictive value for incomplete clinical recovery in patients with Bell's Palsy.
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Affiliation(s)
- G Di Pietro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - P Falco
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - C D'Elia
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - L Cavalcanti
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - G De Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - E Fabiano
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - E Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - C Leone
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - E Vicenzini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - A Truini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
| | - P Mancini
- Department of Sense Organs, Sapienza University, Rome, Italy
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Ekman L, Dahlin LB, Andersson GS, Lindholm E. Diagnostic contribution of multi-frequency vibrometry to detection of peripheral neuropathy in type 1 diabetes mellitus compared with nerve conduction studies. PLoS One 2024; 19:e0296661. [PMID: 38198463 PMCID: PMC10781086 DOI: 10.1371/journal.pone.0296661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
AIM The aim was to assess the use of multi-frequency vibrometry (MFV) in detecting diabetic peripheral neuropathy (DPN) in type 1 diabetes in comparison to nerve conduction studies (NCS) and neurothesiometer (NT). Our objectives were to examine how VPTs correlated with NCS parameters, evaluate the efficacy of MFV in distinguishing DPN as well as to investigate whether MFV procedure could be based on fewer frequencies. METHODS Adults with type 1 diabetes with previous MFV examinations were recruited at Skåne University Hospital in Malmö, Sweden, between 2018 and 2020. Participants were examined regarding nerve function in the lower limbs through MFV, NT and NCS. RESULTS A total of 66 participants (28 women and 38 men) with a median age of 50 (39 to 64) years were included in the study. Through NCS assessment, 33 participants (50%) were diagnosed with DPN. We found negative correlations between VPTs and all NCS parameters, where the strongest correlation was found between sural nerve amplitude and the 125 Hz frequency of MFV. A combination of four frequencies, two low (4 and 8 Hz) and two high (125 and 250 Hz), showed the highest classification efficacy (AUC 0.83, 95% CI 0.73-0.93). CONCLUSION We conclude that a strong correlation exists between the sural nerve amplitude and the VPTs at 125 Hz and that VPT testing with MFV can be focused on only four frequencies instead of seven, thus shortening test time, to distinguish DPN in the lower limb.
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Affiliation(s)
- Linnéa Ekman
- Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gert S. Andersson
- Department of Clinical Sciences, Clinical Neurophysiology, Lund University, Malmö, Sweden
| | - Eero Lindholm
- Department of Clinical Sciences, Endocrinology, Lund University, Malmö, Sweden
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Tian Y, Hou X, Cao W, Zhou L, Jiao B, Zhang S, Xiao Q, Xue J, Wang Y, Weng L, Fang L, Yang H, Zhou Y, Yi F, Chen X, Du J, Xu Q, Feng L, Liu Z, Zeng S, Sun Q, Xie N, Luo M, Wang M, Zhang M, Zeng Q, Huang S, Yao L, Hu Y, Long H, Xie Y, Chen S, Huang Q, Wang J, Xie B, Zhou L, Long L, Guo J, Wang J, Yan X, Jiang H, Xu H, Duan R, Tang B, Zhang R, Shen L. Diagnostic value of nerve conduction study in NOTCH2NLC-related neuronal intranuclear inclusion disease. J Peripher Nerv Syst 2023; 28:629-641. [PMID: 37749855 DOI: 10.1111/jns.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND AND AIMS Neuronal intranuclear inclusion disease (NIID) is a rare progressive neurodegenerative disorder mainly caused by abnormally expanded GGC repeats within the NOTCH2NLC gene. Most patients with NIID show polyneuropathy. Here, we aim to investigate diagnostic electrophysiological markers of NIID. METHODS In this retrospective dual-center study, we reviewed 96 patients with NOTCH2NLC-related NIID, 94 patients with genetically confirmed Charcot-Marie-Tooth (CMT) disease, and 62 control participants without history of peripheral neuropathy, who underwent nerve conduction studies between 2018 and 2022. RESULTS Peripheral nerve symptoms were presented by 53.1% of patients with NIID, whereas 97.9% of them showed peripheral neuropathy according to electrophysiological examinations. Patients with NIID were characterized by slight demyelinating sensorimotor polyneuropathy; some patients also showed mild axonal lesions. Motor nerve conduction velocity (MCV) of the median nerve usually exceeded 35 m/s, and were found to be negatively correlated with the GGC repeat sizes. Regarding the electrophysiological differences between muscle weakness type (n = 27) and non-muscle weakness type (n = 69) of NIID, nerve conduction abnormalities were more severe in the muscle weakness type involving both demyelination and axonal impairment. Notably, specific DWI subcortical lace sign was presented in only 33.3% of muscle weakness type, thus it was difficult to differentiate them from CMT. Combining age of onset, distal motor latency, and compound muscle action potential of the median nerve showed the optimal diagnostic performance to distinguish NIID from major CMT (AUC = 0.989, sensitivity = 92.6%, specificity = 97.4%). INTERPRETATION Peripheral polyneuropathy is common in NIID. Our study suggest that nerve conduction study is useful to discriminate NIID.
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Affiliation(s)
- Yun Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Hou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wanqian Cao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Jiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Sizhe Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiao Xiao
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Jin Xue
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Ying Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Weng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Honglan Yang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yafang Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yi
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyu Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Sen Zeng
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiying Sun
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Nina Xie
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mengchuan Luo
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mengli Wang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Shunxiang Huang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lingyan Yao
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yacen Hu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyuan Xie
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Si Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Junpu Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Lin Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Hongwei Xu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Ruxu Zhang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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Murciano Casas MDLP, Rodríguez-Piñero M, Jiménez Sarmiento AS, Álvarez López M, Jiménez Jurado G. Evaluation of ultrasound as diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: Study protocol for a diagnostic testing study. PLoS One 2023; 18:e0281221. [PMID: 37948425 PMCID: PMC10637656 DOI: 10.1371/journal.pone.0281221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy, accounting for 90% of all neuropathies. Its prevalence ranges from 3.8%-7.8% in the population. The gold standard for its diagnosis is the neurophysiological study (85% sensitivity and 95% specificity), with the disadvantage of being invasive, complex and expensive, which means an increase in cost and time for the diagnosis of the disease. The main objective of this diagnostic test evaluation study is to investigate the value of ultrasound in the diagnosis of CTS, and among the secondary objectives, to establish the ultrasound parameters that are predictors of CTS in comparison with neurophysiological studies, attempting to standardize a protocol and reference values that determine the presence or absence of CTS. METHODS Prospective, cross-sectional study. The reference test with which we compared the ultrasound is the neurophysiological test (NPT). Patients will come consecutively from the Neurophysiology Department of the Virgen Macarena Hospital, with clinical suspicion of CTS and fulfilling the inclusion/exclusion criteria. To calculate the sample size (EPIDAT program) we proposed a sensitivity of 78% and specificity of 87% with a confidence level of 95%, requiring 438 patients (264 NPT positive, 174 NPT negative). We followed an ultrasound study protocol that included the ultrasound variables: cross-sectional area at the entrance and exit of the tunnel, range of nerve thinning, wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and the existence of adjacent wrists or masses. We propose a timeline for the study to be performed between 2020 and 2023. Finally, we propose a cost-effectiveness analysis. DISCUSSION Ultrasound not only allows to objectify the alterations of the median nerve but also the underlying pathological mechanisms in CTS. A multitude of ultrasound parameters have been described that should be regarded in syndrome's study, among which we included the cross-sectional area, the range of nerve thinning, the wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and assessment of anatomical alterations. The use of ultrasound as a diagnostic tool in CTS has many advantages for both doctors and the patients, as it is a non-invasive, convenient, and fast tool increasingly accessible to professionals. TRIAL REGISTRATION Trials registry number: NCT05556278.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Bland JDP. Use of nerve conduction studies in carpal tunnel syndrome. J Hand Surg Eur Vol 2023; 48:976-985. [PMID: 37812524 DOI: 10.1177/17531934231191685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
This review article examines the use of nerve conduction studies in the management of carpal tunnel syndrome. These studies should be understood not as a test that determines the diagnosis but as a measure of impaired nerve function. They are sensitive indicators of local demyelination and axonal loss that can detect and quantify these changes before the appearance of clinical signs, providing information that cannot be obtained with the unaided senses of the physician, nor by any other investigation. They are the best available indicator of overall disease severity, correlating with symptoms and anatomical change in the median nerve. They have some prognostic value for surgical outcome and are sufficiently sensitive to change for the evaluation of treatment response. When surgery does not yield the expected improvement in symptoms, they can help to establish whether decompression has been achieved provided preoperative results are available for comparison.
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Affiliation(s)
- Jeremy D P Bland
- Department of Clinical Neurophysiology, East Kent Hospitals University Foundation NHS Trust, Canterbury, Kent, UK
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Pang C, Yu H, Cai Y, Song M, Feng F, Gao L, Li K, Chen Y, Xie J, Cheng Y, Lin E, Pan X, Zhang W, Deng B. Vitamin D and diabetic peripheral neuropathy: A multi-centre nerve conduction study among Chinese patients with type 2 diabetes. Diabetes Metab Res Rev 2023; 39:e3679. [PMID: 37337761 DOI: 10.1002/dmrr.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
AIMS Increasing numbers of reports link vitamin D deficiency to diabetic peripheral neuropathy (DPN), yet evidence regarding neurological deficits and electromyogram is scarce. The present multi-centre study sought to investigate these associations based on objective quantifications. MATERIALS AND METHODS Information on DPN-related symptoms, signs, all diabetic microvascular complications, and nerve conduction abilities (quantified by nerve conduction amplitude and velocity, F-wave minimum latency (FML) of peripheral nerves) were collected from a derivation cohort of 1192 patients with type 2 diabetes (T2D). Correlation, regression analysis, and restricted cubic splines (RCS) were used to explore linear and non-linear relationships between vitamin D and DPN, which were validated in an external cohort of 223 patients. RESULTS Patients with DPN showed lower levels of vitamin D than those without DPN; patients with vitamin D deficiency (<30 nmol/L) tended to suffer more DPN-related neurological deficits (paraesthesia, prickling, abnormal temperature, ankle hyporeflexia, and distal pall hypoesthesia correlating with MNSI-exam score (Y = -0.005306X + 2.105, P = 0.048). Worse nerve conduction abilities (decreased motor nerve amplitude, sensory nerve amplitude, motor nerve velocity, and increased FML) were also observed in these patients. Vitamin D had a significant threshold association with DPN (adjusted OR = 4.136, P = 0.003; RCS P for non-linearity = 0.003) and correlates with other microvascular complications (diabetic retinopathy and diabetic nephropathy). CONCLUSIONS Vitamin D is associated with the conduction ability of peripheral nerves and may have a nerve- and threshold-selective relationship with the prevalence and severity of DPN among patients with T2D.
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Affiliation(s)
- Chunyang Pang
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huan Yu
- Department of Pediatrics, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunlei Cai
- Department of Neurology, Anyang District Hospital, Henan Province, China
| | - Mengwan Song
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, Ruian People's Hospital, Wenzhou, China
| | - Fei Feng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, Shaoxing People's Hospital, Shaoxing, China
| | - Lingfei Gao
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kezheng Li
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Yinuo Chen
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Jiali Xie
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yifan Cheng
- Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Er Lin
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Xinnan Pan
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wanli Zhang
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Binbin Deng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Chowdhury RA, Rahman MM, Islam MN, Roy S, Rahman MH, Hasan MH, Rahman MW, Alam I. Utility of Median-to-Ulnar Sensory Comparative Nerve Conduction Study to Increase Diagnostic Accuracy in Mild Carpal Tunnel Syndrome. Mymensingh Med J 2023; 32:1156-1162. [PMID: 37777915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Electro-physiological diagnosis of mild Carpal Tunnel Syndrome (CTS) based on traditional median motor and sensory studies are often inconclusive. Therefore, we wanted to investigate the utility of Median-to-Ulnar Sensory Conduction studies in diagnosis of mild CTS. Data from Nerve conduction study (NCS) of 82 cases with symptoms suggestive of CTS from September 2017 to October 2020 attending electrophysiology department of Mount Adora Hospital, Sylhet, Bangladesh was selected for study. About 54(66.0%) out of 82 symptomatic patients were diagnosed as CTS by the conventional method, and 28(34.0%) patients required further investigation as their test report were found to be inconclusive. combining methods showed 70(85.37%) were found to be positive and 12(14.63%) were negative in comparison study. Thus, it can be concluded that those patients found to be negative in conventional methods; comparison method is an option for diagnostic confirmation.
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Affiliation(s)
- R A Chowdhury
- Dr Rahat Amin Chowdhury, Associate Professor of Neurology, Sylhet Women's Medical College, Sylhet, Bangladesh; E-mail:
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Baertsch H, Cvancara DJ, Paniello RC, Hillel AD, Bhatt NK. Recurrent laryngeal motor nerve conduction studies in a rat model: Establishing an objective measure for investigating laryngeal innervation. Muscle Nerve 2023; 68:471-475. [PMID: 37575043 DOI: 10.1002/mus.27932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION/AIMS Disease or injury can cause neuromuscular changes to the larynx that can affect voice, breathing, and swallowing. Motor nerve conduction studies have had limited use in the study of laryngeal neurophysiology, despite their importance in other anatomic sites. The aim of this study was to explore the feasibility of performing recurrent laryngeal motor nerve conduction studies (rlMNCS) in a rat model. METHODS rlMNCS were performed in 15 rats under anesthesia. A bipolar stimulating electrode was placed on the recurrent laryngeal nerve (RLN) 5 mm below the cricoid cartilage. Via direct laryngoscopy, a recording electrode was placed transorally into the thyroarytenoid muscle. The RLN was maximally stimulated to determine the compound muscle action potential (CMAP). Three consecutive trials were averaged. RESULTS The mean stimulating threshold to the RLN to achieve a CMAP from the thyroarytenoid was 1.7 ± 0.6 mA. RLN stimulation caused a visible adductor twitch of the vocal fold in all animals. The mean negative amplitude was 2.0 ± 0.8 mV, and the total area was 1.0 ± 0.4 mV ms. The CMAP latency and negative duration were 1.0 ± 0.1 ms and 0.9 ± 0.2 ms, respectively. DISCUSSION rlMNCS are feasible and may be useful in understanding laryngeal neurophysiology with disease or injury. This work could provide a tractable animal model for studying and monitoring treatment of neuromuscular conditions affecting voice, breathing, and swallowing.
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Affiliation(s)
- Hans Baertsch
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David J Cvancara
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Randal C Paniello
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Allen D Hillel
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Neel K Bhatt
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Patel S, Hutchinson D, Arango SD, Miller AJ, McBeath R. Role of Preoperative Nerve Conduction Studies for Penetrating Hand Injuries Involving the Median Palmar Cutaneous Nerve. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00011. [PMID: 37856918 PMCID: PMC10586824 DOI: 10.5435/jaaosglobal-d-23-00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/21/2023]
Abstract
Penetrating lacerations to the hand are a common cause of nerve injury and can lead to debilitating pain and numbness in the distribution of the nerve affected. Owing to an overlap in the cutaneous innervation from different sensory nerves, clinically identifying the injured nerve can be difficult. We present a novel case of isolated injury to the palmar cutaneous nerve from a penetrating knife injury which was detected using 'comparison waveform' nerve conduction studies. Using this technique, we can isolate injuries to the palmar cutaneous branch of the median nerve (PCBmdn) from the median nerve, dorsal radial sensory nerve, and lateral antebrachial cutaneous nerve. In addition, sensory nerve testing identified conduction block as the mechanism of injury, which resolved after surgery at 8 weeks postoperatively. Preoperative nerve conduction study can discern the level of nerve injury to PCBmdn only, thus eliminating the need for median and radial nerve exploration at the forearm, unnecessary incisions, pain, and scarring. The objective of this case report is to illustrate the value of preoperative comparison waveform nerve conduction study, particularly the PCBmdn, in patients presenting with neurologic deficits who have sustained penetrating lacerations to the hand.
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Affiliation(s)
- Saral Patel
- From the Philadelphia Hand to Shoulder Center, Philadelphia, PA (Patel, Hutchinson, Dr. Miller and Dr. McBeath); the University of Miami Miller School of Medicine, Miami, FL (Arango); and Thomas Jefferson University, Philadelphia, PA (Dr. Miller and Dr. McBeath)
| | - David Hutchinson
- From the Philadelphia Hand to Shoulder Center, Philadelphia, PA (Patel, Hutchinson, Dr. Miller and Dr. McBeath); the University of Miami Miller School of Medicine, Miami, FL (Arango); and Thomas Jefferson University, Philadelphia, PA (Dr. Miller and Dr. McBeath)
| | - Sebastian D. Arango
- From the Philadelphia Hand to Shoulder Center, Philadelphia, PA (Patel, Hutchinson, Dr. Miller and Dr. McBeath); the University of Miami Miller School of Medicine, Miami, FL (Arango); and Thomas Jefferson University, Philadelphia, PA (Dr. Miller and Dr. McBeath)
| | - Andrew J. Miller
- From the Philadelphia Hand to Shoulder Center, Philadelphia, PA (Patel, Hutchinson, Dr. Miller and Dr. McBeath); the University of Miami Miller School of Medicine, Miami, FL (Arango); and Thomas Jefferson University, Philadelphia, PA (Dr. Miller and Dr. McBeath)
| | - Rowena McBeath
- From the Philadelphia Hand to Shoulder Center, Philadelphia, PA (Patel, Hutchinson, Dr. Miller and Dr. McBeath); the University of Miami Miller School of Medicine, Miami, FL (Arango); and Thomas Jefferson University, Philadelphia, PA (Dr. Miller and Dr. McBeath)
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Sharma K N S, Kumar H A. Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy. J Foot Ankle Res 2023; 16:65. [PMID: 37770911 PMCID: PMC10537102 DOI: 10.1186/s13047-023-00667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
AIMS Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .
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Affiliation(s)
- Srihari Sharma K N
- College of Physiotherapy, Dayananda Sagar University, Shavige Malleshwara Hills, 1st Stage, Kumaraswamy Layout, Bangalore, Karnataka, India, 560111.
| | - Anil Kumar H
- Department of Medicine, Dr Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER), Kanakapura, Karnataka, India
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Fargaly SN, Bland JDP. Do nerve conduction studies or ultrasound imaging correlate more closely with subjective symptom severity in carpal tunnel syndrome? Muscle Nerve 2023; 68:264-268. [PMID: 37392186 DOI: 10.1002/mus.27924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION/AIMS Previous studies have reported weak correlations between neurophysiological measurements and subjective severity of symptoms in carpal tunnel syndrome, with Pearson r ≤ 0.26. We hypothesize that this resulted in part from patient-to-patient variability in the assessment of subjective severity using tools such as the Boston Carpal Tunnel Questionnaire. To compensate for this, we aimed to assess within-patient differences in symptom and test result severity. METHODS In our study we used retrospective data from 13 005 patients with bilateral electrophysiological results and 790 patients with bilateral ultrasound imaging drawn from the Canterbury CTS database. Measures of neurophysiological (nerve conduction studies [NCS] grade) and anatomical (cross-sectional area on ultrasound) severity within individual patients were compared between the right and left hands, eliminating individual variation in the way in which patients interpret the questionnaire. RESULTS There was a correlation found between right-hand NCS grade and symptom severity score (Pearson r = -0.302, P < .001, n = 13,005), but not between right-hand cross-sectional area and symptom severity (Pearson r = 0.058, P = .10, n = 790). In the within-subject analyses, there were significant correlations between symptoms and NCS grade (Pearson r = 0.6, P < .001, n = 6521) and between symptoms and cross-sectional area (Pearson r = 0.3. P < .001, n = 433). DISCUSSION The simple correlation between symptomatic and electrophysiological severity was comparable with previous studies, but within-patient analysis revealed that the relationship was stronger than previously reported and strong enough to be clinically useful. The relationship between symptoms and cross-sectional area measurement on ultrasound imaging was weaker.
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Affiliation(s)
| | - Jeremy D P Bland
- East Kent Hospitals University Foundation NHS Trust, Canterbury, UK
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Colella M, Press DZ, Laher RM, McIlduff CE, Rutkove SB, Cassarà AM, Apollonio F, Pascual-Leone A, Liberti M, Bonmassar G. A study of flex miniaturized coils for focal nerve magnetic stimulation. Med Phys 2023; 50:1779-1792. [PMID: 36502488 PMCID: PMC10033376 DOI: 10.1002/mp.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/01/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Peripheral magnetic stimulation (PMS) is emerging as a complement to standard electrical stimulation (ES) of the peripheral nervous system (PNS). PMS may stimulate sensory and motor nerve fibers without the discomfort associated with the ES used for standard nerve conduction studies. The PMS coils are the same ones used in transcranial magnetic stimulation (TMS) and lack focality and selectiveness in the stimulation. PURPOSE This study presents a novel coil for PMS, developed using Flexible technologies, and characterized by reduced dimensions for a precise and controlled targeting of peripheral nerves. METHODS We performed hybrid electromagnetic (EM) and electrophysiological simulations to study the EM exposure induced by a novel miniaturized coil (or mcoil) in and around the radial nerve of the neuro-functionalized virtual human body model Yoon-Sun, and to estimate the current threshold to induce magnetic stimulation (MS) of the radial nerve. Eleven healthy subjects were studied with the mcoil, which consisted of two 15 mm diameter coils in a figure-of-eight configuration, each with a hundred turns of a 25 μm copper-clad four-layer foil. Sensory nerve action potentials (SNAPs) were measured in each subject using two electrodes and compared with those obtained from standard ES. The SNAPs conduction velocities were estimated as a performance metric. RESULTS The induced electric field was estimated numerically to peak at a maximum intensity of 39 V/m underneath the mcoil fed by 70 A currents. In such conditions, the electrophysiological simulations suggested that the mcoil elicits SNAPs originating at 7 mm from the center of the mcoil. Furthermore, the numerically estimated latencies and waveforms agreed with those obtained during the PMS experiments on healthy subjects, confirming the ability of the mcoil to stimulate the radial nerve sensory fibers. CONCLUSION Hybrid EM-electrophysiological simulations assisted the development of a miniaturized coil with a small diameter and a high number of turns using flexible electronics. The numerical dosimetric analysis predicted the threshold current amplitudes required for a suprathreshold peripheral nerve sensory stimulation, which was experimentally confirmed. The developed and now validated computational pipeline will be used to improve the performances (e.g., focality and minimal currents) of new generations of mcoil designs.
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Affiliation(s)
- Micol Colella
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Daniel Z. Press
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rebecca M. Laher
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Courtney E. McIlduff
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Seward B. Rutkove
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Antonino M. Cassarà
- IT'IS Foundation for Research on Information Technologies in Society, 8004 Zurich, Switzerland
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
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Ferrante MA. Neuromuscular electrodiagnosis. Handb Clin Neurol 2023; 195:251-270. [PMID: 37562871 DOI: 10.1016/b978-0-323-98818-6.00019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The electrodiagnostic (EDX) study is an extension of the clinical examination, which means that the clinical features dictate the initial nerve conduction studies (NCS) performed. However, once the EDX study is started, it continues in an independent manner, meaning that the initial NCS findings dictate the subsequent studies performed. Because competent EDX study performance requires considerable knowledge (and special training), it is not possible to convey all of the basic and advanced concepts in a single chapter. Nonetheless, the most important concepts are easily conveyed by a discussion limited to EDX-pertinent anatomical, physiological, pathological, pathophysiological, and basic electrical concepts. The focus of this chapter will be on the standard NCS and needle EMG measurements made during EDX studies and their significance with regard to lesion localization and characterization. Because the most challenging portion of EDX study is motor unit action potential analysis, this topic is more extensively reviewed. The utility of the sensory NCS for identifying focal axon loss, the utility of the motor NCS for screening long nerve segments for focal demyelination and for determining lesion severity, and the utility of the needle EMG for confirming the NCS findings, better defining lesion localization, and identifying the temporal features (e.g., chronicity) and rate of progression of the lesion are also reviewed.
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Affiliation(s)
- Mark A Ferrante
- Electromyography Laboratory, Department of Neurology, Veterans Administration Medical Center, University of Tennessee, Memphis, TN, United States.
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Stamatiou I, Papachristou S, Papanas N. Diabetes Mellitus and Bell's Palsy. Curr Diabetes Rev 2023; 19:46-49. [PMID: 35260056 DOI: 10.2174/1573399818666220308161023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
The aim of the present brief review was to discuss Bell's palsy (BP) in diabetes mellitus (DM). The risk of BP is increased in DM. DM subjects with BP are more prone to severe facial nerve degeneration. Further characteristics of BP in DM include a) infrequent taste impairment; b) more frequent and more marked facial nerve subclinical electrophysiological impairment; c) more frequent Blink reflex impairment; d) potentially concurrent distal symmetrical sensorimotor polyneuropathy; e) more frequent alternating BP with recurrent episodes affecting different sides of the face. Diagnosis of BP rests on clinical examination, along with facial nerve electromyographic and electroneurographic evaluation. Management of BP in DM includes physical therapy, corticosteroids, and antiviral agents. Finally, acupuncture, low-level laser therapy, lipoprostaglandin E1, and stellate ganglion block are new modalities with initially promising results.
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Affiliation(s)
- Iliana Stamatiou
- Second Department of Internal Medicine, Diabetes Centre, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stella Papachristou
- Second Department of Internal Medicine, Diabetes Centre, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre, Democritus University of Thrace, Alexandroupolis, Greece
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Gu W, Li Z, Zhu X, Huang X, Zhang D, Jiang Y, Ye Z, Sun Y, Ao P, Zhang X, Cao Q, Wei L, Wang S. Correlation analysis between plasma fibrinogen and nerve electrophysiological changes in type 2 diabetic peripheral neuropathy. Folia Neuropathol 2023; 61:153-162. [PMID: 37587890 DOI: 10.5114/fn.2023.126609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION The aim of the study was to investigate the pathogenesis of diabetic peripheral neuropathy (DPN) and the value of fibrinogen (FIB) in the early diagnosis of DPN. MATERIAL AND METHODS A total of 121 patients with type 2 diabetes mellitus (T2DM) and DPN hospitalized in the Endocrinology Department of the 923 Hospital of the People's Liberation Army of China were randomly selected between May and October 2020 and divided into a T2DM asymptomatic (no peripheral neuropathy-related symptoms) group (66 cases) and a T2DM symptomatic group (55 cases) according to the presence or absence of clinical neurological symptoms and signs. Forty healthy volunteers were selected as a normal control group. In addition to plasma FIB and nerve electrophysiological tests, all included subjects were electrophysiologically tested for nerve conduction velocity (NCV), terminal motor latency (DML), sensory nerve action potential (SNAP) amplitude, and compound muscle action potential (CMAP) amplitude. RESULTS Compared with the control group, NCV was slowed down in T2DM patients, DML was prolonged, and the amplitude of CMAP and SNAP were decreased. Compared with asymptomatic T2DM patients, symptomatic patients had slower NCV, longer DML, lower CMAP amplitude of median nerve, ulnar nerve and tibial nerve, and significantly lower SNAP amplitude of median nerve and ulnar nerve. CMAP amplitudes were decreased, and median and ulnar nerve SNAP amplitudes were also significantly decreased ( p < 0.05). The plasma FIB concentration of asymptomatic patients with T2DM was higher than that of the control group, and the plasma FIB concentration of symptomatic patients with T2DM was higher than that of asymptomatic patients with T2DM ( p < 0.01). The NCV and DML of asymptomatic patients with T2DM slowed down and prolonged as the FIB level increased; the NCV of T2DM symptomatic patients also slowed down as FIB increased, and median and ulnar nerve DML increased as FIB increased. There was no correlation between NCV and DML and the plasma FIB level in the control group. SNAP amplitudes of symptomatic and asymptomatic patients with T2DM decreased as plasma FIB increased, while CMAP amplitudes of the tibial nerve and the T2DM symptomatic ulnar nerve decreased as FIB increased in the control group. CONCLUSIONS FIB may be a contributing factor for diabetic neuropathy and could be used as an indicator in the early screening and diagnosis of peripheral neuropathy in patients with T2DM.
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Affiliation(s)
- Weili Gu
- College of Basic Medicine, Guangxi Medical University, Nanning, China
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Zhenhong Li
- College of Basic Medicine, Guangxi Medical University, Nanning, China
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Xiaobei Zhu
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Xiaojuan Huang
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Dengfeng Zhang
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Yu Jiang
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Zhaotian Ye
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Ying Sun
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Pian Ao
- College of Basic Medicine, Guangxi Medical University, Nanning, China
| | - Xinyue Zhang
- College of Basic Medicine, Guangxi Medical University, Nanning, China
| | - Qimin Cao
- Department of Ultrasound Diagnosis, 923 Hospital of the People's Liberation Army, Nanning, China
| | - Li Wei
- College of Basic Medicine, Guangxi Medical University, Nanning, China
| | - Shaojun Wang
- Maternity and Child Health Care of Guang Xi Zhuang Autonomous Region, Nanning, China
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Shelly S, Ramon-Gonen R, Paul P, Klein CJ, Klang E, Rahman N, Nikitin V, Ben David M, Dori A. Nerve Conduction Differences in a Large Clinical Population: The Role of Age and Sex. J Neuromuscul Dis 2023; 10:925-935. [PMID: 37545257 PMCID: PMC10578272 DOI: 10.3233/jnd-230052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The normal limits of nerve conduction studies are commonly determined by testing healthy subjects. However, in comprehensive real-life nerve conduction electrodiagnostic (EDX) evaluations, multiple nerves are tested, including normal nerves, for purposes of comparison with abnormal ones. OBJECTIVE This study aims to evaluate the average values of normal nerve conduction studies in a large population and examined the influence of age and sex. METHODS EDX parameters were extracted from an electronic database of studies performed from May 2016 to February 2022. Established normal values were used to determine the classification of a nerve study as normal. RESULTS We identified 10,648 EDX reports with 5077 normally interpreted nerve conduction studies (47.6%) of which 57% (n = 2890) were for females. The median age of studies with no abnormalities was 45.1 years (range < 1 to 92) overall and 42.5 years (range: 0.16 -89.5 years) for males and 47.5 years (range:<1 -91.7) for females. Correlations between age and amplitude, latency, and velocity (p < 0.001) were observed in most nerves. Amplitude correlated negatively with age in adults in all nerves with a mean of -0.44 (range: -0.24 to -0.62). However, in the pediatric population (age < 18 years), amplitude as well as velocity increased significantly with age. In the adult cohort, sex differences were noted, where females had higher mean sensory nerve action potentials in ulnar, median, and radial evaluations (p < 0.001). In older patients (aged > 70 years) with normally interpreted EDX studies (845 records of 528 patients), sural responses were present in 97%. CONCLUSIONS This real-life study confirms that advanced aging is associated with decreased nerve conduction amplitudes, increased latency, and the slowing of conduction velocity. The findings also indicate higher sensory amplitudes and conduction velocities in females. Sural nerve responses were identified in most adults over age 70.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, Rambam Medical Center, Haifa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Roni Ramon-Gonen
- The Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan, Israel
| | - Pritikanta Paul
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Eyal Klang
- Department of diagnostic imaging, Sheba Medical Center, Sackler Faculty Institute, Tel Aviv, Israel
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Nisim Rahman
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Vera Nikitin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Merav Ben David
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Amir Dori
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
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