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Nerve ultrasound as follow‐up tool in treated multifocal motor neuropathy
Author(s) -
Rattay T. W.,
Winter N.,
Décard B. F.,
Dammeier N. M.,
Härtig F.,
Ceanga M.,
Axer H.,
Grimm A.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13344
Subject(s) - medicine , mismatch negativity , multifocal motor neuropathy , ultrasound , nerve conduction study , peripheral , peripheral neuropathy , nerve conduction , radiology , surgery , electroencephalography , psychiatry , diabetes mellitus , endocrinology
Background and purpose High‐resolution ultrasound is a valuable tool in supporting the diagnosis of multifocal motor neuropathy ( MMN ) but longitudinal data under therapy are lacking. Methods The change in peripheral nerve ultrasound pattern in patients with MMN was assessed over time. Patients with MMN received a thorough initial examination and follow‐up over a period of 6–12 months using high‐resolution ultrasound of the cervical roots and the nerves of the arms and legs, nerve conduction studies, Medical Research Council Sum Score ( MRCSS ) and Rotterdam Inflammatory Neuropathy Cause and Treatment Group (INCAT ) score to evaluate changes under treatment. The Ultrasound Pattern Sum Score ( UPSS ) was used as standardized peripheral nerve ultrasound protocol. Results Seventeen patients with MMN received initial examinations of whom 12 were successfully followed up. All patients with MMN showed at least localized but often multifocal peripheral nerve enlargement. An enlarged overall cross‐sectional area as well as enlarged single fascicles (>3 mm²) in clinically and electrophysiologically affected (>90%) and unaffected (>70%) nerves were found. The UPSS did not correlate with clinical disability at both visits. However, the change in clinical disability (evaluated as difference in MRCSS ) and the change in UPSS correlated significantly inversely ( P = 0.004). Conclusions High‐resolution sonography of peripheral nerves revealed multifocal nerve enlargement in MMN . Distinct enlargement patterns may support the diagnosis. Ultrasound findings did not correlate well with clinical severity or electrophysiological findings at initial presentation. As changes in UPSS correlated significantly with the clinical course in terms of muscle strength ( MRCSS ), sonographic assessment may represent a useful tool for therapeutic monitoring.