TY - JOUR
T1 - Prognostic value of nerve ultrasonography: A prospective multicenter study on the natural history of chronic inflammatory neuropathies
AU - Telleman, Johan A.
AU - Herraets, Ingrid J. T.
AU - Goedee, Hendrik Stephan
AU - van Eijk, Ruben P. A.
AU - Verhamme, Camiel
AU - Eftimov, Filip
AU - Lieba-Samal, Doris
AU - Asseldonk, Jan Thies van
AU - van den Berg, Leonard H.
AU - van der Pol, Willem Ludo
AU - Visser, Leo H.
N1 - Funding Information: Funding was received from ZonMw, Xperiment Topzorg (project number 842003002). The funding source had no involvement in study design, data collection, analysis, interpretation of data, writing of the report or the decision to submit the article for publication. Funding Information: J. A. Telleman, I. J. T. Herraets, R. P. A. van Eijk, D. Lieba‐Samal, J. T. van Asseldonk – disclosures: none. H. S. Goedee receives research support from the Prinses Beatrix Spierfonds, and has received a travel grant and speakerfee from Takeda. C. Verhamme serves on clinical advisory board for Inflectis. F. Eftimov reports grants from Prinses Beatrix Spierfonds, Netherlands Organization for Health Research and Development, and a consulting fee from CSL Behring, UCB Pharma and Aserta Pharma that was paid to his institution, outside the submitted work. As coordinating investigator of INCbase, an international CIDP registry, he has received funding for INCbase from CSL Behring, Takeda Pharmaceutical Company, Kedrion and Terumo BCT. L. H. van den Berg has served on scientific advisory boards for Orion, Orphazyme, Calico and Cytokinetics, received an educational grant from Takeda, serves on the editorial boards of Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration and the Journal of Neurology, Neurosurgery, and Psychiatry, and receives research support from the Prinses Beatrix Spierfonds, Netherlands ALS Foundation, and the Netherlands Organization for Health Research and Development (Vici Scheme, JPND [SOPHIA, STRENGTH, ALSCare]). W. L. van der Pol serves on the scientific advisory board for SAB SMA Europe, is a member of the Branaplam data monitoring committee (DMC) for Novartis, provides ad hoc consultancy for Biogen and Avexis, and receives research support from the Prinses Beatrix Spierfonds, Vriendenloterij and Stichting Spieren voor Spieren. L. H. Visser receives research support from the Prinses Beatrix Spierfonds and the Netherlands Organization for Health Research and Development. Publisher Copyright: © 2021 European Academy of Neurology Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Background and objective: Nerve ultrasound is a promising new tool in chronic inflammatory neuropathies. The aim of this study was to determine its prognostic value in a prospective multicenter cohort study including incident and prevalent patients with CIDP and MMN. Methods: We enrolled 126 patients with CIDP, and 72 with MMN; 71 were treatment-naive. Patients with chronic idiopathic axonal polyneuropathy (CIAP; n = 35) were considered as disease controls. Standardized neurological examination, questionnaires, and nerve ultrasonography were obtained at time of inclusion and 1-year follow-up. Nerve size development over time and correlation between nerve size and clinical outcome measures were determined using linear mixed effects models. Results: Nerve size development over time was heterogeneous. Only in MMN was there a correlation between C5 nerve root size and deterioration of grip strength (−1.3 kPa/mm2 (95% confidence interval [CI] −2.3 to −0.2). No other significant correlations between nerve size and clinical outcome measures were found. In MMN, presence of nerve enlargement at inclusion predicted deterioration of grip strength, and MMN patients with enlargement confined to the brachial plexus seemed to have more favorable outcomes. No other predictive effects of sonographic nerve size were found. Conclusions: The present study indicates that the natural course of nerve size development in CIDP and MMN is heterogeneous, and that the prognostic value of sonographic nerve enlargement is limited. It had some predictive effect in patients with MMN. Further research in specific subgroups of chronic inflammatory neuropathy is necessary to determine the usefulness of nerve ultrasonography after the diagnostic phase.
AB - Background and objective: Nerve ultrasound is a promising new tool in chronic inflammatory neuropathies. The aim of this study was to determine its prognostic value in a prospective multicenter cohort study including incident and prevalent patients with CIDP and MMN. Methods: We enrolled 126 patients with CIDP, and 72 with MMN; 71 were treatment-naive. Patients with chronic idiopathic axonal polyneuropathy (CIAP; n = 35) were considered as disease controls. Standardized neurological examination, questionnaires, and nerve ultrasonography were obtained at time of inclusion and 1-year follow-up. Nerve size development over time and correlation between nerve size and clinical outcome measures were determined using linear mixed effects models. Results: Nerve size development over time was heterogeneous. Only in MMN was there a correlation between C5 nerve root size and deterioration of grip strength (−1.3 kPa/mm2 (95% confidence interval [CI] −2.3 to −0.2). No other significant correlations between nerve size and clinical outcome measures were found. In MMN, presence of nerve enlargement at inclusion predicted deterioration of grip strength, and MMN patients with enlargement confined to the brachial plexus seemed to have more favorable outcomes. No other predictive effects of sonographic nerve size were found. Conclusions: The present study indicates that the natural course of nerve size development in CIDP and MMN is heterogeneous, and that the prognostic value of sonographic nerve enlargement is limited. It had some predictive effect in patients with MMN. Further research in specific subgroups of chronic inflammatory neuropathy is necessary to determine the usefulness of nerve ultrasonography after the diagnostic phase.
KW - chronic inflammatory demyelinating polyneuropathy
KW - multifocal motor neuropathy
KW - nerve ultrasonography
KW - prognostic value
UR - http://www.scopus.com/inward/record.url?scp=85105732609&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ene.14885
DO - https://doi.org/10.1111/ene.14885
M3 - Article
C2 - 33909329
SN - 1351-5101
VL - 28
SP - 2327
EP - 2338
JO - European journal of neurology
JF - European journal of neurology
IS - 7
ER -