Skip to main content

Advertisement

SpringerLink
Log in

Nerve ultrasound may help predicting response to immune treatment in chronic inflammatory demyelinating polyradiculoneuropathy

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Backgrounds

Nerve ultrasound has been proven to be an accurate tool in diagnosing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). However, its value in guiding treatment has not been well evaluated. The aim of this study was to explore whether nerve ultrasound and its changing trend could predict the response to immune treatment in CIDP.

Methods

Eighty-nine therapy-naive CIDP patients were recruited prospectively and treated with steroids and/or intravenous immunoglobulin (IVIG). Ultrasonographic and electrophysiological studies were performed on the median and ulnar nerves before treatment in all patients and followed up in 45 patients. The cross-sectional area (CSA) was measured at ten sites on both the median and ulnar nerves.

Results

The response rate to steroids (95%) was significantly higher than that to IVIG (70%) (P = 0.001) in patients with normal or moderately enlarged CSA, while there was no significant difference in the response rate between steroid therapy (84%) and IVIG (75%) (P = 0.653) in patients with markedly enlarged CSA. CSAs decreased in 15 patients during follow-up, most of whom had good IVIG and steroid responses (83%) and no need for immune suppressant treatment (82%).

Conclusions

Nerve ultrasonography could help guide treatment strategies in patients with CIDP. Patients with normal or moderately enlarged CSA may respond better to steroids than to IVIG. The decrease in CSA after treatment may also indicate better prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mathey EK, Park SB, Hughes RA, Pollard JD, Armati PJ, Barnett MH et al (2015) Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry 86:973–985. https://doi.org/10.1136/jnnp-2014-309697

    Article  PubMed  Google Scholar 

  2. Allen JA, Merkies ISJ, Lewis RA (2020) Monitoring clinical course and treatment response in chronic inflammatory demyelinating polyneuropathy during routine care: a review of clinical and laboratory assessment measures. JAMA Neurol. https://doi.org/10.1001/jamaneurol.2020.0781

    Article  PubMed  PubMed Central  Google Scholar 

  3. Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I et al (2010) European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revision. Eur J Neurol 17:356–363. https://doi.org/10.1111/j.1468-1331.2009.02930.x

    Article  PubMed  Google Scholar 

  4. Delmont E, Brodovitch A, Kouton L, Allou T, Beltran S, Brisset M et al (2020) Antibodies against the node of Ranvier: a real-life evaluation of incidence, clinical features and response to treatment based on a prospective analysis of 1500 sera. J Neurol 267:3664–3672. https://doi.org/10.1007/s00415-020-10041-z

    Article  CAS  PubMed  Google Scholar 

  5. Fargeot G, Viala K, Theaudin M, Labeyrie MA, Costa R, Léger JM et al (2019) Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination. Eur J Neurol 26:631–638. https://doi.org/10.1111/ene.13868

    Article  CAS  PubMed  Google Scholar 

  6. Ishikawa T, Asakura K, Mizutani Y, Ueda A, Murate KI, Hikichi C et al (2017) MR neurography for the evaluation of CIDP. Muscle Nerve 55:483–489. https://doi.org/10.1002/mus.25368

    Article  PubMed  Google Scholar 

  7. van Rosmalen MHJ, Goedee HS, van der Gijp A, Witkamp TD, van Eijk RPA, Asselman FL et al (2020) Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies. J Neurol. https://doi.org/10.1007/s00415-020-10232-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Oudeman J, Eftimov F, Strijkers GJ, Schneiders JJ, Roosendaal SD, Engbersen MP et al (2020) Diagnostic accuracy of MRI and ultrasound in chronic immune-mediated neuropathies. Neurology 94:e62–e74. https://doi.org/10.1212/wnl.0000000000008697

    Article  PubMed  Google Scholar 

  9. Herraets IJT, Goedee HS, Telleman JA, van Eijk RPA, van Asseldonk JT, Visser LH et al (2020) Nerve ultrasound improves detection of treatment-responsive chronic inflammatory neuropathies. Neurology 94:e1470–e1479. https://doi.org/10.1212/WNL.0000000000008978

    Article  CAS  PubMed  Google Scholar 

  10. Bunschoten C, Jacobs BC, Van den Bergh PYK, Cornblath DR, van Doorn PA (2019) Progress in diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy. Lancet Neurol. https://doi.org/10.1016/S1474-4422(19)30144-9

    Article  PubMed  Google Scholar 

  11. Iijima M, Yamamoto M, Hirayama M, Tanaka F, Katsuno M, Mori K et al (2005) Clinical and electrophysiologic correlates of IVIg responsiveness in CIDP. Neurology 64:1471–1475. https://doi.org/10.1212/01.Wnl.0000158680.89323.F8

    Article  CAS  PubMed  Google Scholar 

  12. Bril V, Banach M, Dalakas MC, Deng C, Donofrio P, Hanna K et al (2010) Electrophysiologic correlations with clinical outcomes in CIDP. Muscle Nerve 42:492–497. https://doi.org/10.1002/mus.21733

    Article  PubMed  Google Scholar 

  13. Chin RL, Deng C, Bril V, Hartung HP, Merkies IS, Donofrio PD et al (2015) Follow-up nerve conduction studies in CIDP after treatment with IGIV-C: comparison of patients with and without subsequent relapse. Muscle Nerve 52:498–502. https://doi.org/10.1002/mus.24624

    Article  PubMed  Google Scholar 

  14. Hartig F, Ross M, Dammeier NM, Fedtke N, Heiling B, Axer H et al (2018) Nerve ultrasound predicts treatment response in chronic inflammatory demyelinating polyradiculoneuropathy-a prospective follow-Up. Neurotherapeutics 15:439–451. https://doi.org/10.1007/s13311-018-0609-4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hughes R, Bensa S, Willison H, Van den Bergh P, Comi G, Illa I et al (2001) Randomized controlled trial of intravenous immunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol 50:195–201. https://doi.org/10.1002/ana.1088

    Article  CAS  PubMed  Google Scholar 

  16. Niu J, Li Y, Zhang L, Ding Q, Cui L, Liu M (2020) Cross-sectional area reference values for sonography of nerves in the upper extremities. Muscle Nerve 61:338–346. https://doi.org/10.1002/mus.26781

    Article  PubMed  Google Scholar 

  17. Niu J, Li Y, Liu T, Ding Q, Cui L, Guan Y et al (2019) Serial nerve ultrasound and motor nerve conduction studies in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 60:254–262. https://doi.org/10.1002/mus.26611

    Article  PubMed  Google Scholar 

  18. American Association of Electrodiagnostic M, Olney RK (1999) Guidelines in electrodiagnostic medicine. Consensus criteria for the diagnosis of partial conduction block. Muscle Nerve Suppl 8:S225–S229

    Google Scholar 

  19. Goedee HS, Herraets IJT, Visser LH, Franssen H, van Asseldonk JH, van der Pol WL et al (2019) Nerve ultrasound can identify treatment-responsive chronic neuropathies without electrodiagnostic features of demyelination. Muscle Nerve 60:415–419. https://doi.org/10.1002/mus.26629

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bril V, Katzberg H, Donofrio P, Banach M, Dalakas MC, Deng C et al (2009) Electrophysiology in chronic inflammatory demyelinating polyneuropathy with IGIV. Muscle Nerve 39:448–455. https://doi.org/10.1002/mus.21236

    Article  CAS  PubMed  Google Scholar 

  21. Kerasnoudis A, Pitarokoili K, Gold R, Yoon MS (2015) Nerve ultrasound and electrophysiology for therapy monitoring in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging 25:931–939. https://doi.org/10.1111/jon.12279

    Article  PubMed  Google Scholar 

  22. Granata G, Pazzaglia C, Calandro P, Luigetti M, Martinoli C, Sabatelli M et al (2009) Ultrasound visualization of nerve morphological alteration at the site of conduction block. Muscle Nerve 40:1068–1070. https://doi.org/10.1002/mus.21449

    Article  CAS  PubMed  Google Scholar 

  23. Di Pasquale A, Morino S, Loreti S, Bucci E, Vanacore N, Antonini G (2015) Peripheral nerve ultrasound changes in CIDP and correlations with nerve conduction velocity. Neurology 84:803–809. https://doi.org/10.1212/WNL.0000000000001291

    Article  PubMed  Google Scholar 

  24. Padua L, Granata G, Sabatelli M, Inghilleri M, Lucchetta M, Luigetti M et al (2014) Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol 125:160–165. https://doi.org/10.1016/j.clinph.2013.07.023

    Article  CAS  PubMed  Google Scholar 

  25. Lehmann HC, Hartung HP (2011) Plasma exchange and intravenous immunoglobulins: mechanism of action in immune-mediated neuropathies. J Neuroimmunol 231:61–69. https://doi.org/10.1016/j.jneuroim.2010.09.015

    Article  CAS  PubMed  Google Scholar 

  26. Stangel M, Toyka KV, Gold R (1999) Mechanisms of high-dose intravenous immunoglobulins in demyelinating diseases. Arch Neurol 56:661–663

    Article  CAS  Google Scholar 

  27. Pazirandeh A, Xue Y, Prestegaard T, Jondal M, Okret S (2002) Effects of altered glucocorticoid sensitivity in the T cell lineage on thymocyte and T cell homeostasis. FASEB J 16:727–729. https://doi.org/10.1096/fj.01-0891fje

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The study was funded by PUMCH Youth Research Fund (pumch-2016–2.15 and pumch-2016–2.17), Innovative drug Fund (2019ZX09734-001), CAMS Innovation Fund for Medical Sciences (CIFMS 2021–I2M-1-003), and the National Natural Science Foundation of China Youth Fund (81801250).

Author information

Authors and Affiliations

  1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China

    Jingwen Niu, Lei Zhang, Jing Fan, Jingwen Liu, Qingyun Ding, Yuzhou Guan, Shuang Wu, Liying Cui & Mingsheng Liu

Authors
  1. Jingwen Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jing Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jingwen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qingyun Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuzhou Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shuang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liying Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mingsheng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by Jingwen Niu. The first draft of the manuscript was written by Jingwen Niu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mingsheng Liu.

Ethics declarations

Ethical approval

The ethics committee of Peking Union Medical College Hospital approved our study protocol.

Consent to participate

All patients and HCs signed informed consent in accordance with the Declaration of Helsinki.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niu, J., Zhang, L., Fan, J. et al. Nerve ultrasound may help predicting response to immune treatment in chronic inflammatory demyelinating polyradiculoneuropathy. Neurol Sci 43, 3929–3937 (2022). https://doi.org/10.1007/s10072-022-05882-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-022-05882-7

Keywords

Search

Navigation