EPV 21. Ultrasonic homogeneity score and focal nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Grimm, A.; Schubert, V.; Vittore, D.; Decard, B.; Axer, H.
• Is Part Of: Clinical neurophysiology. Volume 127:Issue 9(2016:Sep.)
• Page Start: e229
• Page End: e230
• Publication Date: 2016-09
• Subjects: Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2016.05.053
• Languages: English
• ISSNs: 1388-2457

Abstract

Abstract : Objective: To investigate the use of nerve ultrasound (NUS) in addition to nerve conduction studies (NCS) in the differentiation between Charcot-Marie Tooth hereditary neuropathy (CMT1) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor neuropathies (MADSAM) . Methods: NUS/NCS of predefined nerves/cervical roots were performed in patients with CMT1a/b and in patients with immunoneuropathies and finally compared to controls. Ultrasound pattern sum score (UPSS, sum of the amount of 12 predefined measurement points), homogeneity score (HS) and focal nerve enlargement (NE) index in ulnar, median and tibial nerve (FNEI) were used for evaluation of morphology. Results: 13 CMT1, 27 CIDP, 10 MADSAM, 12 MMN and 23 controls were included. Significant NE was shown in all neuropathies compared to the controls, most prominent in CMT1 ( p < 0.001). The amount of NE was evaluated by the UPSS, which was highly significant in CMT compared to the others ( p < 0.001). Homogeneous NE was significantly more often seen in CMT (66.6%), the HS was significantly increased ( p < 0.001), while in CIDP the enlargement was heterogeneous (focal, homogeneous or inhomogeneous ∼30%). In MMN and MADSAM focal enlargement (48% vs. 40%) next to normal segments (∼20%) predominated. Discussion: Both, immunoneuropathies and CMT patients show NE. However, while NE in CMT is homogeneous and generalized, in CIDP the enlargement pattern is more often heterogeneous, while in MMN/MADSAM focal enlargement predominates. Thus, the UPSS and FNEI are quantitative tools to operationalize ultrasound examination and may help to differentiate between hereditary and acquired polyneuropathies.