Ioanna M Athanasopoulou1, Maria Rasenack1, Christine Grimm2, Hubertus Axer3, Michael Sinnreich1, Bernhard F Décard1, Alexander Grimm4. 1. Department of Neurology, Basel University Hospital, Basel, Switzerland. 2. Department of Internal Medicine, County Hospital Reutlingen, Germany. 3. Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany. 4. Department of Neurology, Tübingen University Hospital, Tübingen, Germany. Electronic address: alexander.grimm@usb.ch.
Abstract
OBJECTIVE: To investigate the use of peripheral nerve ultrasound (PNUS) in addition to nerve conduction studies (NCS) in the diagnosis of paraproteinemic neuropathies (PN). METHODS: PNUS/NCS of predefined peripheral nerves and the 5th/6th cervical roots were performed in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) (+/-paraprotein), patients with anti-MAG neuropathy, and patients with neuropathy and multiple myeloma or monoclonal gammopathy of uncertain significance (MGUS) - summarized as M-protein associated neuropathies (MPAN) and compared to controls (+/-paraprotein). RESULTS: 39 patients and 27 age-matched controls were included. Nerve enlargement was most marked in patients with CIDP, while in anti-MAG neuropathies enlargement was significant in the legs. In MPAN, no nerve enlargement is found regularly. However, in two cases, the diagnostic steps were influenced by the finding of multiple enlarged nerves and finally immunotherapy response was successfully initiated. By the use of the ultrasound pattern sum score (UPSS), differentiation of PN can be simplified. DISCUSSION: Due to the heterogeneous findings in NCS, correct diagnosis of PN, and straightforward therapeutic decisions often may be controversial. Particularly in cases of M-protein related neuropathy, the finding of multiple nerve enlargements facilitates the decision for therapeutic approaches or nerve biopsy. The UPSS enables the distinction of different PN from each other. CONCLUSION: The use of an ultrasound quantification tool in addition to NCS facilitates a differentiation of PN.
OBJECTIVE: To investigate the use of peripheral nerve ultrasound (PNUS) in addition to nerve conduction studies (NCS) in the diagnosis of paraproteinemic neuropathies (PN). METHODS: PNUS/NCS of predefined peripheral nerves and the 5th/6th cervical roots were performed in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) (+/-paraprotein), patients with anti-MAG neuropathy, and patients with neuropathy and multiple myeloma or monoclonal gammopathy of uncertain significance (MGUS) - summarized as M-protein associated neuropathies (MPAN) and compared to controls (+/-paraprotein). RESULTS: 39 patients and 27 age-matched controls were included. Nerve enlargement was most marked in patients with CIDP, while in anti-MAG neuropathies enlargement was significant in the legs. In MPAN, no nerve enlargement is found regularly. However, in two cases, the diagnostic steps were influenced by the finding of multiple enlarged nerves and finally immunotherapy response was successfully initiated. By the use of the ultrasound pattern sum score (UPSS), differentiation of PN can be simplified. DISCUSSION: Due to the heterogeneous findings in NCS, correct diagnosis of PN, and straightforward therapeutic decisions often may be controversial. Particularly in cases of M-protein related neuropathy, the finding of multiple nerve enlargements facilitates the decision for therapeutic approaches or nerve biopsy. The UPSS enables the distinction of different PN from each other. CONCLUSION: The use of an ultrasound quantification tool in addition to NCS facilitates a differentiation of PN.
Authors: H Stephan Goedee; Nicolette C Notermans; Leo H Visser; Jan-Thies H van Asseldonk; Hessel Franssen; Alexander F J E Vrancken; Stavros Nikolakopoulos; Leonard H van den Berg; W Ludo van der Pol Journal: Muscle Nerve Date: 2019-07-24 Impact factor: 3.217
Authors: Marc Dörner; Mihai Ceanga; Frank Schreiber; Jan-Hendrik Stahl; Cornelius Kronlage; Julia Wittlinger; Magdalena Kramer; Sophia Willikens; Stefanie Schreiber; Alexander Grimm; Natalie Winter Journal: Diagnostics (Basel) Date: 2021-02-09