An Aberrant Abductor Digiti Minimi Muscle Crossing Guyon's Canal with Intermittent Compression of Nerve: Crucial Diagnostic Role of Nerve and Muscle Ultrasound

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CAN ELECTROPHYSIOLOGY PREDICT CLINICAL OUTCOMES IN CIDP?

This report examined data from a multicentre, randomised, double-blind, placebo controlled, parallel-group study in patients with CIDP: 45 patients, 24 intravenous immunoglobulin (IVIg), 21 intravenous methylprednisolone (IMP) completed the study. The study is registered under the EUDRACT number 2005-001136-76 and was approved by the ethics committees of all the participating centres. At present, few data are available on correlations between changes in nerve motor and sensory conduction study and clinical outcomes; particularly, can electrophysiology predict treatment response? Before enrollment and six months after, the nerve-conduction measurement on a minimum of eight motor and six sensory nerves were performed. The analysis of the variations in the two most relevant motor nerves for the diagnosis of CIDP showed a marginal non-significant improvement in both groups in distal and proximal amplitude of compound muscle action potentials, in motor conduction velocities, but not in the number of nerves with conduction block. The only significant difference was in the reduction in the distal latency in the IVIg group. The analysis of the per-protocol population showed a significant improvement in motor nerve conduction velocity and reduction in distal latency in the IVIg group but also an increase in the number of nerves with conduction block; there was no significant difference compared with the IMP group. In addition, the analysis of our data documented that: 1) there is no difference in the clinical response to IMP in patients with a pattern of focal demyelination, and 2) the amplitude or conduction velocity of the most affected motor nerves and the other electrophysiological parameters evaluated before therapy were not predictive of responder status. These findings are partially in accordance with those made by Bril et al. (2010) and recommend to treat with IVIg or IMP also the patients presenting serious electrophysiological alterations before therapy. S2

Immunosuppressive treatment in refractory chronic inflammatory demyelinating polyradiculoneuropathy. A nationwide retrospective analysis.

BACKGROUND AND PURPOSE: There are other options open to patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who are non-responders to conventional treatment, including immunosuppressive and immunomodulatory agents (IA). The aim of this study was to assess whether the use of IA is able to increase the number of responders. METHODS: Clinical and electrophysiological data of patients with refractory CIDP, followed at 10 Italian centres, were collected, and the clinical outcome (Rankin Scale) and drug side effects (SE) for the different therapies were analysed. RESULTS: A total of 110 patients were included. These patients underwent 158 different therapeutic procedures with IA. Seventy-seven patients were treated with azathioprine, 18 rituximab, 13 cyclophosphamide, 12 mycophenolate mofetil, 12 cyclosporine, 12 methotrexate, 11 interferon-alpha and three interferon beta-1a. The percentage of patients who responded to azathioprine (27%) was comparable to the percentage of responders to other therapies, after the exclusion of interferon beta-1a that was not effective in any of the three patients treated. The percentage of SE ranges from 8% (methotrexate) to 50% (cyclosporine). CONCLUSIONS: One-fourth of patients, refractory to conventional treatment, showed an improvement in their disability with IA. Methotrexate had the lowest SE; cyclosporine was associated with severe SE and often led to drug discontinuation