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OBJECTIVES: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the body and impacts approximately 5% of the U.S. population costing nearly $5 billion/year. Electrodiagnostic (EDX) testing is considered the gold standard for CTS diagnosis. Classification systems exist that categorize CTS severity based on EDX findings. This investigation evaluated EDX findings across consecutive CTS severity categories within existing classification systems and consolidated classifications. METHODS: This retrospective study analyzed 665 hands from 468 patients undergoing EDX testing for suspected CTS. Complete classification systems and consolidated classifications were evaluated for discrimination capability across consecutive CTS severity categories based on EDX findings. Additional analysis evaluated the relationship of sex and age factors and CTS severity. RESULTS: Consolidated classifications demonstrated superior discrimination capability between consecutive CTS severity categories regardless of classification system used. Demographic factors significantly influenced EDX findings and categorization of CTS severity. CONCLUSIONS: This study underscores the value of consolidated classifications for enhancing discrimination between consecutive CTS severity categories based on EDX findings. Demographic factors should be considered when interpreting EDX findings for the purpose of categorizing CTS severity. Future research should refine existing classification systems and explore additional factors influencing CTS severity used to inform medical management.
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Síndrome del Túnel Carpiano , Electrodiagnóstico , Índice de Severidad de la Enfermedad , Humanos , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/clasificación , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Electrodiagnóstico/métodos , Electrodiagnóstico/normas , Adulto , AncianoRESUMEN
INTRODUCTION/AIMS: Using a set of process-of-care quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome (CTS), the research team previously documented large variations in electrodiagnostic testing practices and adherence to quality measures. This study sought to enhance the applicability and validity of the quality measures by integrating acceptable variations in testing practices. METHODS: We recruited 13 expert electrodiagnostic medicine specialists from five specialty societies. The experts iteratively refined five quality measures, and then rated the validity of the refined quality measures (1-9 scale). During this process, the experts reviewed data on adherence to existing quality measures and variations in electrodiagnostic testing practices, and considered recently published quality measures from the American Association of Neuromuscular and Electrodiagnostic Medicine. RESULTS: Three quality measures (electrodiagnostic testing before surgery for CTS, temperature assessment during electrodiagnostic testing, and electrodiagnostic criteria for severe median neuropathy) underwent few refinements and were rated valid (medians 8-9). Two measures (essential components of electrodiagnosis, criteria for interpreting electrodiagnostic tests as median neuropathy) were judged valid (medians 8) after revisions. For these measures, experts' ratings on the recommended components of sensory or mixed nerve conduction studies varied: agreement among the experts about the use of sensory peak latency was greater than for onset latency or sensory velocity. DISCUSSION: This study produced quality measures that provide minimum standards for electrodiagnostic testing for suspected CTS that are more comprehensive and nuanced than prior versions. Future work can assess the feasibility, reliability, and validity of these refined measures in diverse physician practices.
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Síndrome del Túnel Carpiano , Electrodiagnóstico , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/fisiopatología , Humanos , Electrodiagnóstico/normas , Electrodiagnóstico/métodos , Conducción Nerviosa/fisiologíaRESUMEN
Expert consensus was sought to guide clinicians on the use of electrodiagnostic tests (EDX) and neuromuscular ultrasound (NMUS) in the investigation of suspected carpal tunnel syndrome (CTS). Consensus was achieved using the Delphi method via three consecutive anonymised surveys of 15 experts and was defined as rating agreement ≥ 80%. The panel agreed that combining EDX and NMUS is more informative than using each modality alone. NMUS adds value in patients with clinically suspected CTS with non-localizing or normal EDX, atypical EDX, failed CTS surgery, polyneuropathy, and CTS suspected to be secondary to structural pathology. The median nerve cross-sectional area should be measured at the site of maximal nerve enlargement, and the nerve should be scanned from mid-forearm to the palm. The group also identified those situations where the wrist-to-forearm area ratio and longitudinal scans of the median nerve should also be obtained. EDX should always be performed to quantify CTS severity and in individuals over age 70. This document is an initial step to guide clinicians on the combined investigation of CTS using EDX and NMUS, to be updated regularly with the emergence of new research.
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Síndrome del Túnel Carpiano/diagnóstico , Electrodiagnóstico/métodos , Ultrasonografía/métodos , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/fisiopatología , Consenso , Electrodiagnóstico/normas , Humanos , Unión Neuromuscular/diagnóstico por imagen , Unión Neuromuscular/fisiología , Guías de Práctica Clínica como Asunto , Ultrasonografía/normasRESUMEN
OBJECTIVE: The diagnostic values of measuring median nerve (MN) stiffness and vascularity with shear wave elastography (SWE) and high-definition (HD) color were investigated in carpal tunnel syndrome (CTS). METHODS: Seventy patients (123 wrists) with CTS and thirty-five healthy volunteers (70 wrists) were enrolled. Based on nerve conduction studies (NCS), the patients were subdivided into NCS-negative, mild-to-moderate, and severe CTS groups. MN and abductor pollicis brevis (APB) SWE and MN HD color were performed on a longitudinal plane. RESULTS: The mild-to-moderate and severe CTS groups showed increased MN stiffness at the wrist and MN stiffness ratio (wrist-to forearm) compared with the control (p < 0.001). The NCS-negative CTS group showed increased MN stiffness at the wrist (p = 0.022) and MN stiffness ratio (p = 0.032) compared with the control. The severe CTS group showed increased MN stiffness at the wrist compared with the mild-to-moderate CTS group (p = 0.034). The cutoff-values in diagnosing NCS-confirmed CTS were 50.12 kPa for MN stiffness at the wrist, 1.91 for MN stiffness ratio, and grade 1 for HD color. CONCLUSIONS: SWE and HD color are good supportive tools in diagnosing and assessing severity in CTS. SIGNIFICANCE: SWE and HD color demonstrated that MN in CTS was associated with increased stiffness and hypervascularity.
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Síndrome del Túnel Carpiano/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Ultrasonografía Doppler en Color/métodos , Adulto , Anciano , Anciano de 80 o más Años , Vasos Sanguíneos/diagnóstico por imagen , Síndrome del Túnel Carpiano/fisiopatología , Diagnóstico por Imagen de Elasticidad/normas , Electrodiagnóstico/métodos , Electrodiagnóstico/normas , Femenino , Humanos , Masculino , Nervio Mediano/irrigación sanguínea , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Conducción Nerviosa , Sensibilidad y Especificidad , Ultrasonografía Doppler en Color/normasRESUMEN
We evaluate existing spike sorters and present a new one that resolves many sorting challenges. The new sorter, called "full binary pursuit" or FBP, comprises multiple steps. First, it thresholds and clusters to identify the waveforms of all unique neurons in the recording. Second, it uses greedy binary pursuit to optimally assign all the spike events in the original voltages to separable neurons. Third, it resolves spike events that are described more accurately as the superposition of spikes from two other neurons. Fourth, it resolves situations where the recorded neurons drift in amplitude or across electrode contacts during a long recording session. Comparison with other sorters on ground-truth data sets reveals many of the failure modes of spike sorting. We examine overall spike sorter performance in ground-truth data sets and suggest postsorting analyses that can improve the veracity of neural analyses by minimizing the intrusion of failure modes into analysis and interpretation of neural data. Our analysis reveals the tradeoff between the number of channels a sorter can process, speed of sorting, and some of the failure modes of spike sorting. FBP works best on data from 32 channels or fewer. It trades speed and number of channels for avoidance of specific failure modes that would be challenges for some use cases. We conclude that all spike sorting algorithms studied have advantages and shortcomings, and the appropriate use of a spike sorter requires a detailed assessment of the data being sorted and the experimental goals for analyses.NEW & NOTEWORTHY Electrophysiological recordings from multiple neurons across multiple channels pose great difficulty for spike sorting of single neurons. We propose methods that improve the ability to determine the number of individual neurons present in a recording and resolve near-simultaneous spike events from single neurons. We use ground-truth data sets to demonstrate the pros and cons of several current sorting algorithms and suggest strategies for determining the accuracy of spike sorting when ground-truth data are not available.
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Potenciales de Acción/fisiología , Cerebelo/fisiología , Electrodiagnóstico , Neuronas/fisiología , Neurofisiología , Procesamiento de Señales Asistido por Computador , Animales , Electrodos Implantados , Electrodiagnóstico/métodos , Electrodiagnóstico/normas , Neurofisiología/métodos , Neurofisiología/normasRESUMEN
Automated analysis and quantification of physiological signals in clinical practice and medical research can reduce manual labor, increase efficiency, and provide more objective, reproducible results. To build a novel platform for the analysis of muscle sympathetic nerve activity (MSNA), we employed state-of-the-art data processing and machine learning applications. Data processing methods for integrated MSNA recordings were developed to evaluate signals regarding the overall quality of the signal, the validity of individual signal peaks regarding the potential to be MSNA bursts and the timing of their occurrence. An overall probability score was derived from this flexible platform to evaluate each individual signal peak automatically. Overall, three deep neural networks were designed and trained to validate individual signal peaks randomly sampled from recordings representing only electrical noise and valid microneurography recordings. A novel data processing method for the whole signal was developed to differentiate between periods of valid MSNA signal recordings and periods in which the signal was not available or lost due to involuntary movement of the recording electrode. A probabilistic model for timing of the signal bursts was implemented as part of the system. Machine Learning algorithms and data processing tools were implemented to replicate the complex decision-making process of manual MSNA analysis. Validation of manual MSNA analysis including intra- and inter-rater validity and a comparison with automated MSNA tools is required. The developed toolbox for automated MSNA analysis can be extended in a flexible way to include algorithms based on other datasets.
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Electrodiagnóstico/métodos , Aprendizaje Automático , Músculo Liso Vascular/inervación , Sistema Nervioso Simpático/fisiología , Adolescente , Adulto , Anciano , Electrodiagnóstico/normas , Humanos , Persona de Mediana Edad , Músculo Liso Vascular/fisiología , Conducción Nerviosa , Relación Señal-RuidoRESUMEN
The addition of ultrasound (US) to electrodiagnostic (EDX) tests can significantly enhance the accuracy of testing for ulnar neuropathy at the elbow (UNE). We aimed to obtain expert consensus to guide clinicians on the combined use of EDX and US in UNE investigation. Consensus was achieved using the Delphi method. Two consecutive anonymised questionnaires were submitted to 15 experts, who were asked to choose their level of agreement with each statement. Consensus was pre-defined as ≥ 80% rating agreement. The experts concluded that all investigations of UNE should include both nerve conduction studies and US. There was consensus that US should include cross-sectional area measurement and assessment of nerve mobility at the elbow, and that the entire ulnar nerve should be imaged. This study defined expert opinion on the 'core' techniques that should be used routinely in the UNE investigation using EDX and US. Areas with lack of consensus highlighted some controversial issues in the current use of these diagnostic modalities and the need for future research. This document is an initial step to guide clinicians on the combined investigation of UNE using EDX and US, to be regularly updated as new research emerges.
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Conferencias de Consenso como Asunto , Electrodiagnóstico/métodos , Neuropatías Cubitales/diagnóstico , Ultrasonografía/métodos , Codo/diagnóstico por imagen , Codo/fisiopatología , Electrodiagnóstico/normas , Humanos , Guías de Práctica Clínica como Asunto , Neuropatías Cubitales/diagnóstico por imagen , Neuropatías Cubitales/fisiopatología , Ultrasonografía/normasRESUMEN
INTRODUCTION/AIMS: The initial surge of the coronavirus disease-2019 (COVID-19) pandemic in early 2020 led to widespread cancellation of elective medical procedures in the United States, including nonurgent outpatient and inpatient electrodiagnostic (EDx) studies. As certain regions later showed a downtrend in daily new cases, EDx laboratories have reopened under the guidance of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). In our reopening experience guided by the AANEM, we measured relevant outcomes to determine further workflow adaptations. We aimed to detail our experience and share the lessons learned. METHODS: We reviewed the clinical volumes, billing data, diagnosis distributions, and rates of COVID-19 exposure and transmission among patients and staff in our EDx laboratory during the first 6 months of reopening, starting on June 1, 2020. For context, we detailed the recent AANEM guidelines we adopted at our laboratory, supplemented by other consensus statements. RESULTS: We completed 816 outpatient studies from June 1 to December 1, 2020, reaching 97% of the total volume and 97% of total billing compared with the same time period in 2019. The average relative value units per study were similar. There were no major shifts in diagnosis distributions. We completed 10 of 12 requested inpatient studies during this period. There were no known COVID-19 transmissions between patients and staff. DISCUSSION: Our experience suggests that it is possible to safely operate an EDx laboratory under the guidance of the AANEM and other experts, with clinical volume and billing rates comparable to pre-pandemic baselines.
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Centros Médicos Académicos/normas , COVID-19/prevención & control , Electrodiagnóstico/normas , Conducción Nerviosa/fisiología , Flujo de Trabajo , Centros Médicos Académicos/métodos , Centros Médicos Académicos/tendencias , COVID-19/epidemiología , Electrodiagnóstico/métodos , Electrodiagnóstico/tendencias , Humanos , Factores de TiempoRESUMEN
Electrophysiology plays a determinant role in Guillain-Barré syndrome (GBS) diagnosis, classification, and prognostication. However, traditional electrodiagnostic (EDX) criteria for GBS rely on motor nerve conduction studies (NCS) and are suboptimal early in the course of the disease or in the setting of GBS variants. Sensory nerve conduction studies, including the sural-sparing pattern and the sensory ratio are not yet included in EDX criteria despite their well-established role in GBS diagnosis. The aim of this review is to discuss the diagnostic value of sensory NCS in GBS, their role in establishing the diagnosis and predicting the outcome according to the various subtypes of the disease.
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Electrodiagnóstico/métodos , Síndrome de Guillain-Barré/diagnóstico , Conducción Nerviosa , Células Receptoras Sensoriales/fisiología , Electrodiagnóstico/normas , Humanos , Nervios Periféricos/fisiopatologíaRESUMEN
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
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Sistema Nervioso Autónomo/fisiología , Conferencias de Consenso como Asunto , Electrodiagnóstico/métodos , Guías de Práctica Clínica como Asunto , Electrodiagnóstico/normas , Humanos , Neurología/organización & administración , Neurofisiología/organización & administración , Sociedades Médicas , Sociedades CientíficasRESUMEN
The use of spontaneous bursts of muscle sympathetic nerve activity (MSNA) to assess arterial baroreflex control of sympathetic nerve activity has seen increased utility in studies of both health and disease. However, methods used for analyzing spontaneous MSNA baroreflex sensitivity are highly variable across published studies. Therefore, we sought to comprehensively examine methods of producing linear regression slopes to quantify spontaneous MSNA baroreflex sensitivity in a large cohort of subjects (n = 150) to support a standardized procedure for analysis that would allow for consistent and comparable results across laboratories. The primary results demonstrated that 1) consistency of linear regression slopes was considerably improved when the correlation coefficient was above -0.70, which is more stringent compared with commonly reported criterion of -0.50, 2) longer recording durations increased the percentage of linear regressions producing correlation coefficients above -0.70 (1 min = 15%, 2 min = 28%, 5 min = 53%, 10 min = 67%, P < 0.001) and reaching statistical significance (1 min = 40%, 2 min = 69%, 5 min = 78%, 10 min = 89%, P < 0.001), 3) correlation coefficients were improved with 3-mmHg versus 1-mmHg and 2-mmHg diastolic blood pressure (BP) bin size, and 4) linear regression slopes were reduced when the acquired BP signal was not properly aligned with the cardiac cycle triggering the burst of MSNA. In summary, these results support the use of baseline recording durations of 10 min, a correlation coefficient above -0.70 for reliable linear regressions, 3-mmHg bin size, and importance of properly time-aligning MSNA and diastolic BP. Together, these findings provide best practices for determining spontaneous MSNA baroreflex sensitivity under resting conditions for improved rigor and reproducibility of results.
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Barorreflejo , Electrodiagnóstico/normas , Músculo Esquelético/inervación , Sistema Nervioso Simpático/fisiología , Adolescente , Adulto , Anciano , Presión Arterial , Femenino , Voluntarios Sanos , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos , Adulto JovenRESUMEN
INTRODUCTION: In everyday clinical neurophysiology practice, mononeuropathies are evaluated primarily by traditional electrodiagnostic testing. We sought to assess the additional benefit of neuromuscular ultrasound (US) in this scenario. METHODS: All consecutive mononeuropathies undergoing combined US and electrodiagnostic evaluation over a 23-mo period at a single neurophysiology practice were reviewed. Three independent examiners assessed how often US was: (a) "contributory" - enabling a definite diagnosis not made by electrophysiology alone and/or impacting on the therapeutic decision, (b) "confirmatory" of the electrodiagnostic findings, but not adding further diagnostic or therapeutic information, or (c) "negative" - missed the diagnosis. RESULTS: There were 385 studies included. US was "contributory" in 36%, "confirmatory" in 61% and "negative" in 3%. DISCUSSION: In this study of everyday neurophysiology practice, neuromuscular US contributed significant diagnostic or therapeutic information in over 1/3 of the investigations for common mononeuropathies. False negative US studies were uncommon in this setting.
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Mononeuropatías , Neurofisiología , Ultrasonografía , Electrodiagnóstico/métodos , Electrodiagnóstico/normas , Electromiografía/métodos , Guías como Asunto , Humanos , Mononeuropatías/diagnóstico , Mononeuropatías/fisiopatología , Neurofisiología/normas , Ultrasonografía/métodos , Ultrasonografía/normasRESUMEN
Limited literature is available on stimulus induced after discharges (SIAD) in patients with peripheral nerve hyperexcitability (PNH). The aim of the study was to examine the diagnostic utility of SIAD in the diagnosis and monitoring of primary PNH disorders. In this retrospective study, we studied 26 patients who were admitted with a diagnosis of primary PNH to the department of Neurology from January 2013 to April 2019. Their clinical profile, immunological characteristics were extracted from the database and nerve conduction studies were relooked for the presence of SIAD. 76% of patients in the primary PNH cohort had SIAD with 90% of them being voltage-gated potassium channel complex antibody positive; predominantly against contactin-associated protein-2 antigen and rest being paraneoplastic. There was also resolution of SIAD following treatment indicating reversible hyperexcitability. SIAD is a sensitive marker for Primary PNH syndrome with monitoring and diagnostic implications.
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Potenciales de Acción/fisiología , Electrodiagnóstico/normas , Enfermedades Musculares/diagnóstico , Enfermedades Musculares/fisiopatología , Conducción Nerviosa/fisiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Nervio Tibial/fisiología , Adulto , Electrodiagnóstico/métodos , Electromiografía , Femenino , Estudios de Seguimiento , Humanos , Síndrome de Isaacs/diagnóstico , Síndrome de Isaacs/fisiopatología , Masculino , Persona de Mediana Edad , Miocimia/diagnóstico , Miocimia/fisiopatología , Estudios RetrospectivosRESUMEN
Peripheral neuropathies can be classified as typical or atypical. Patients with atypical neuropathy have one or more of the following features: acute/subacute onset, non-length dependence, motor predominance, or asymmetry. This classification is important because it informs the appropriate diagnostic evaluation of this highly prevalent condition. The evaluation of a typical peripheral neuropathy, also known as distal symmetric polyneuropathy, requires a thorough history, neurologic examination, and focused laboratory testing. Electrodiagnostic testing and MRI account for the majority of costs but rarely lead to changes in diagnosis or management. These costs are increasingly being passed on to patients, especially those with high-deductible health plans. In contrast, patients with atypical neuropathy require more extensive testing, including electrodiagnostic tests. These tests are much more likely to lead to the use of disease-modifying therapies in these patients compared to in those with typical peripheral neuropathy. This article describes two cases to illustrate the appropriate diagnostic workup of those with typical or atypical neuropathy.
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Técnicas de Laboratorio Clínico , Electrodiagnóstico , Examen Neurológico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/economía , Técnicas de Laboratorio Clínico/economía , Técnicas de Laboratorio Clínico/normas , Electrodiagnóstico/economía , Electrodiagnóstico/normas , Electromiografía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Conducción Nerviosa/fisiología , Examen Neurológico/economía , Examen Neurológico/normas , Polineuropatías/diagnóstico , Polineuropatías/economía , Valor Predictivo de las PruebasAsunto(s)
Técnicas de Diagnóstico Neurológico/normas , Electrodiagnóstico/normas , Conducción Nerviosa , Potenciales de Acción , Electromiografía , Potenciales Evocados Auditivos del Tronco Encefálico , Potenciales Evocados Somatosensoriales , Potenciales Evocados Visuales , Reflejo H , Humanos , Neurología/educación , Neurología/normas , Medicina Física y Rehabilitación/educación , Medicina Física y Rehabilitación/normasRESUMEN
INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.
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Síndrome del Túnel Carpiano/cirugía , Electrodiagnóstico/normas , Gastos en Salud/normas , Servicios de Salud del Trabajador/normas , Medición de Resultados Informados por el Paciente , Indicadores de Calidad de la Atención de Salud/normas , Adulto , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/economía , Electrodiagnóstico/economía , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Servicios de Salud del Trabajador/economía , Indicadores de Calidad de la Atención de Salud/economía , Resultado del TratamientoRESUMEN
OBJECTIVE: To comprehensively describe patient-reported, functional and neurophysiological outcomes to elucidate the phenotypic profile of taxane-induced neuropathy. METHODS: Taxane-treated patients (n = 47) completed cross-sectional bilateral clinical and sensory assessments and nerve conduction studies. Patients reported symptom severity via Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx13) questionnaire. RESULTS: Symptoms of neuropathy were reported by 81% of patients. On clinical examination, 62% had 2 or more abnormalities, with 20% indicating significant symptomatic and objective neuropathy. Nerve conduction studies were consistent with a sensory predominant axonal neuropathy. However, features more typical of entrapment neuropathy were also present in > 50%, which were not associated with overall severity of chemotherapy-induced peripheral neuropathy (CIPN) or clinical risk factors. CONCLUSIONS: There is considerable variation in CIPN phenotypes associated with taxane-treatment. Understanding their clinical associations may assist in identification of patients at risk of severe neurotoxicity. This would enable treatment modification decisions but also limit early cessation of effective anti-cancer treatment in patients with less severe neurological sequelae. SIGNIFICANCE: Understanding the CIPN phenotype may inform treatment decisions which could impact clinical and survival outcomes.
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Antineoplásicos/toxicidad , Hidrocarburos Aromáticos con Puentes/toxicidad , Electrodiagnóstico/métodos , Síndromes de Neurotoxicidad/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Fenotipo , Taxoides/toxicidad , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Hidrocarburos Aromáticos con Puentes/administración & dosificación , Hidrocarburos Aromáticos con Puentes/uso terapéutico , Electrodiagnóstico/normas , Femenino , Humanos , Persona de Mediana Edad , Síndromes de Neurotoxicidad/diagnóstico , Síndromes de Neurotoxicidad/etiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/etiología , Taxoides/administración & dosificación , Taxoides/uso terapéutico , Neoplasias Urogenitales/tratamiento farmacológicoRESUMEN
BACKGROUND: Increment of compound muscle action potential amplitude is a diagnostic hallmark of Lambert-Eaton myasthenic syndrome (LEMS). Making a diagnosis can be challenging, therefore, a proper cutoff for abnormal increment is highly relevant for improved recognition of this rare disease. METHODS: We determined the sensitivity and specificity of 60% and 100% cutoff values in all consecutive patients who underwent increment testing in our hospital from 1999 to 2016. RESULTS: We included 156 patients, 63 with LEMS and 93 without LEMS. Sensitivity of a 60% cutoff for increment testing was 77.8% (95% confidence interval 65.5%-87.3%) and 58.7% (45.6%-71.0%) for 100%. Specificity was 98.9% (94.2%-100%) and 100% (96.1%-100%) using a threshold of 60% and 100%, respectively. CONCLUSIONS: Lowering the cutoff value for abnormal increment to 60% greatly increases sensitivity to diagnose LEMS without an overt loss in specificity.