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Changes of clinical, neurophysiological and nerve ultrasound characteristics in CIDP over time: a 3-year follow-up

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Abstract

Objectives

To evaluate, in a prospective study, high-resolution ultrasound (HRUS) changes of nerve segments in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and their relationships with clinical and electrodiagnostic (EDX) characteristics.

Methods

Twenty-three consecutive patients with CIDP were included in a 3-year follow-up (FU) study. Each patient underwent neurologic examination, EDX and HRUS study. HRUS was performed on median, ulnar and peroneal nerves, yielding a total of 319 scanned nerve segments. INCAT and MRC-sum scores, motor nerve conduction velocity (NCV), compound muscle action potential (cMAP) amplitude, and nerve cross-sectional area (NCSA) were collected at baseline and at FU end, and were used for statistical analysis. Twenty-two healthy individuals, matched to patients for age and BMI, served as controls.

Results

NCSA was higher in patients than in controls (p < 0.0001) and showed significant direct correlation with disease severity, and inverse correlation with NCV and cMAP amplitude, both at baseline and at FU end. Disease duration, clinical scores and EDX were predictors of NCSA enlargement at both time points. During FU, NCSA increased in 51% of nerve segments (p = 0.006), in correlation with INCAT increase and with NCV and cMAP reduction. Considering EDX changes in subgroups that reflect the different types of nerve damage, NCSA significantly increased in those nerve segments that from normal EDX switched to prevalent myelinopathic EDX characteristics.

Conclusions

Peripheral nerve size tends to increase over time in patients with CIDP, in correlation with clinical and EDX changes, in particular in those nerve segments that undergo a predominantly demyelinating damage.

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Data availability

Anonymized data and related documents that support the findings of this study are available and will be shared on request from any qualified investigator.

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Funding

This study did not receive any found.

Author information

Authors and Affiliations

  1. Neuromuscular and Rare Disease Center, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy

    Laura Fionda, Stefania Morino, Luca Leonardi, Fiammetta Vanoli, Simona Loreti, Matteo Garibaldi, Antonio Lauletta, Girolamo Alfieri, Elisabetta Bucci, Marco Salvetti & Giovanni Antonini

  2. Department of Neurology, E. Agnelli Hospital, Pinerolo, Turin, Italy

    Antonella Di Pasquale

Authors
  1. Laura Fionda
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  2. Antonella Di Pasquale
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  3. Stefania Morino
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  4. Luca Leonardi
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  5. Fiammetta Vanoli
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  6. Simona Loreti
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  7. Matteo Garibaldi
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  8. Antonio Lauletta
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  9. Girolamo Alfieri
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  10. Elisabetta Bucci
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  11. Marco Salvetti
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  12. Giovanni Antonini
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Contributions

LF: analysis and interpretation of ultrasound data and manuscript drafting for intellectual content. ADP: study concept, design and supervision. SM: analysis and interpretation of electrodiagnostic data; LL: analysis and interpretation of clinical assessment; FV, SL, MG: blind measurement of ultrasound recordings and interpretation of the data; AL, GA, EB: patient and control data collection, file preparation. MS: check of the protocol; GA: study concept, critical revision of manuscript for intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laura Fionda.

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Conflicts of interest

On behalf of all authors, Laura Fionda states that there is no conflict of interest.

Ethical standards

The study obtained the Sant’Andrea Hospital institutional review board/ethical approval and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent to participate in this study.

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Fionda, L., Di Pasquale, A., Morino, S. et al. Changes of clinical, neurophysiological and nerve ultrasound characteristics in CIDP over time: a 3-year follow-up. J Neurol 268, 3011–3019 (2021). https://doi.org/10.1007/s00415-021-10485-x

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  • DOI: https://doi.org/10.1007/s00415-021-10485-x

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