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A nomogram-based diabetic sensorimotor polyneuropathy severity prediction using Michigan neuropathy screening instrumentations

Haque F, Ibne Reaz MB, Chowdhury MEH, Md Ali SH, Ashrif A Bakar A, Rahman T, et al.

Comput Biol Med, 2021 12;139:104954.
PMID: 34715551 DOI: 10.1016/j.compbiomed.2021.104954

BACKGROUND: Diabetic Sensorimotor polyneuropathy (DSPN) is one of the major indelible complications in diabetic patients. Michigan neuropathy screening instrumentation (MNSI) is one of the most common screening techniques used for DSPN, however, it does not provide any direct severity grading system.
METHOD: For designing and modeling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. Different Machine learning-based feature ranking techniques were investigated to identify the important MNSI features associated with DSPN diagnosis. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading using the best performing top-ranked MNSI features.
RESULTS: Top-10 ranked features from MNSI features: Appearance of Feet (R), Ankle Reflexes (R), Vibration perception (L), Vibration perception (R), Appearance of Feet (L), 10-gm filament (L), Ankle Reflexes (L), 10-gm filament (R), Bed Cover Touch, and Ulceration (R) were identified as important features for identifying DSPN by Multi-Tree Extreme Gradient Boost model. The nomogram-based prediction model exhibited an accuracy of 97.95% and 98.84% for the EDIC test set and an independent test set, respectively. A DSPN severity score technique was generated for MNSI from the DSPN severity prediction model. DSPN patients were stratified into four severity levels: absent, mild, moderate, and severe using the cut-off values of 17.6, 19.1, 20.5 for the DSPN probability less than 50%, 75%-90%, and above 90%, respectively.
CONCLUSIONS: The findings of this work provide a machine learning-based MNSI severity grading system which has the potential to be used as a secondary decision support system by health professionals in clinical applications and large clinical trials to identify high-risk DSPN patients.

Matched MeSH terms: Polyneuropathies*
Clinical and electrophysiological characteristics of symmetric polyneuropathy in a cohort of systemic lupus erythematosus patients

Jasmin R, Sockalingam S, Ramanaidu LP, Goh KJ

Lupus, 2015 Mar;24(3):248-55.
PMID: 25253567 DOI: 10.1177/0961203314552115

OBJECTIVE: Peripheral neuropathy in systemic lupus erythematosus (SLE) is heterogeneous and its commonest pattern is symmetrical polyneuropathy. The aim of this study was to describe the prevalence, clinical and electrophysiological features, disease associations and effects on function and quality of life of polyneuropathy in SLE patients, defined using combined clinical and electrophysiological diagnostic criteria.
METHODS: Consecutive SLE patients seen at the University of Malaya Medical Centre were included. Patients with medication and other disorders known to cause neuropathy were excluded. Demographic, clinical and laboratory data were obtained using a pre-defined questionnaire. Function and health-related quality of life was assessed using the modified Rankin scale and the SF-36 scores. Nerve conduction studies (NCS) were carried out in both upper and lower limbs. Polyneuropathy was defined as the presence of bilateral clinical symptoms and/or signs and bilateral abnormal NCS parameters.
RESULTS: Of 150 patients, 23 (15.3%) had polyneuropathy. SLE-related polyneuropathy was mainly characterized by sensory symptoms of numbness/tingling and pain with mild signs of absent ankle reflexes and reduced pain sensation. Function was minimally affected and there were no differences in quality of life scores. NCS abnormalities suggested mild length-dependent axonal neuropathy, primarily in the distal lower limbs. Compared to those without polyneuropathy, SLE-related polyneuropathy patients were significantly older but had no other significant demographic or disease associations.
CONCLUSIONS: SLE-related polyneuropathy is a chronic, axonal and predominantly sensory neuropathy, associated with older age. Its underlying pathogenetic mechanisms are unknown, although a possibility could be an increased susceptibility of peripheral nerves in SLE patients to effects of aging.

Matched MeSH terms: Polyneuropathies/etiology*; Polyneuropathies/epidemiology; Polyneuropathies/physiopathology
Relationship between ultrasonographic nerve morphology and severity of diabetic sensorimotor polyneuropathy

Arumugam T, Razali SN, Vethakkan SR, Rozalli FI, Shahrizaila N

Eur J Neurol, 2016 Feb;23(2):354-60.
PMID: 26498575 DOI: 10.1111/ene.12836

In the current study, the aim was to characterize the nerve ultrasound cross-sectional areas (CSAs) of type 2 diabetic patients with diabetic sensorimotor polyneuropathy (DSP) of different severities.

Matched MeSH terms: Polyneuropathies
Fulltext Acute intermittent porphyria presenting atypically as chronic, progressive, predominantly motor peripheral neuropathy of the lower limbs; a case report.

Raymond, A.A., Azarisman S.M.S.

International Medical Journal Malaysia, 2007;6(2):1-5.
MyJurnal

Peripheral, predominantly motor polyneuropathy is associated with a plethora of possible aetiologies and the investigative procedures to rule them out are extensive. A 31 year old lady presented with progressive lower limb weakness over a period of 2 years. Examination revealed symmetrical weakness (3+/5) of all distal muscle groups in the lower limbs with absent ankle jerk. There was no sensory loss. The nerve conduction study revealed a predominantly axonal motor neuropathy. Cerebrospinal fluid examination and other investigations to rule out potential causes of predominantly motor peripheral neuropathy were normal. The only positive findings were multiple qualitative assays for porphobilinogen in her urine.

Matched MeSH terms: Polyneuropathies
Fulltext A case of Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss, EGPA) presenting with relapsed Mononeuritis multiplex

Hilmi, B.A., Ainon, M.M.

International Medical Journal Malaysia, 2014;13(1):69-72.
MyJurnal

We report a case of eosinophilic granulomatosis with polyangiitis (EGPA), a rare multisystem disorder characterized by difficult-to-control asthma, hypereosinophilia and polyneuropathy. We also discuss the Five Factor Score (FFS) risk stratification strategy, which is used to quantitate the extent of the disease and guide treatment strategy.

Matched MeSH terms: Polyneuropathies
Transthyretin Glu18. A new variant associated with familial amyloid polyneuropathy

Tan SY, Hawkins PN, Pepys MB

JUMMEC, 1998;3:54-55.

Familial amyloid polyneuropathy is most commonly associated with variant plasma transthyretin (TTR) although it has been described in association with variant apolipoprotein A1 and gelsolin. More than 40 TTR variants, all consisting of single amino acid substitutions diskibuted widely along the length of the 127 residue TTR subunit have now been described. We report here a novel TTR variant, Glu18, in a Colombian woman with TTR amyloidosis.

Matched MeSH terms: Polyneuropathies
Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations

Tawfik EA, Cartwright MS, van Alfen N, Axer H, Boon AJ, Crump N, et al.

Muscle Nerve, 2023 Oct;68(4):375-379.
PMID: 37074101 DOI: 10.1002/mus.27830

Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.

Matched MeSH terms: Polyneuropathies*
Fulltext Thyrotoxic neuropathy- an under diagnosed condition

Sahni V, Gupta N, Anuradha S, Tatke M, Kar P

Med J Malaysia, 2007 Mar;62(1):76-7.
PMID: 17682580

Many neurological diseases like myopathy, periodic paralysis, ophthalmoplegia, and myasthenia gravis are known associations of thyrotoxicosis. However the association of neuropathy with thyrotoxicosis is not frequently recognized. First described by Charcot in 1889, thyrotoxic neuropathy or 'Basedow's Paraplegia' is a rarely reported entity. We describe here a case of a young woman with subacute distal neuropathy as the presenting manifestation of thyrotoxicosis. The neuropathy improved on antithyroid treatment. A careful literature search leads us to believe that peripheral neuropathy in thyrotoxicosis is under recognised. Thyroid function tests can be helpful in the diagnosis of this treatable neuropathy and should be included in the routine work up.

Matched MeSH terms: Polyneuropathies/diagnosis*; Polyneuropathies/physiopathology
Systemic lupus erythematosus may have an early effect on peripheral nerve function in patients without clinical or electrophysiological neuropathy: comparison with age- and gender-matched controls

Fong SY, Raja J, Wong KT, Goh KJ

Rheumatol Int, 2021 02;41(2):355-360.
PMID: 32488429 DOI: 10.1007/s00296-020-04610-8

Asymptomatic electrophysiological peripheral neuropathy is described in systemic lupus erythematosus (SLE) patients. To determine if SLE could have an even earlier effect on peripheral nerve function even before the development of electrophysiological abnormalities, we compared nerve conduction studies (NCS) of SLE patients without electrophysiological or clinical peripheral neuropathy with healthy controls. Consecutive SLE patients without clinical neuropathy (or other known causes of neuropathy) underwent sensory and motor NCS of all four limbs. Results of 61 patients without electrophysiological criteria of neuropathy were compared with age- and gender-matched controls. Although still within the laboratory's range of normal values, significant differences were found in several NCS parameters between patients and controls. SLE patients had lower amplitudes for ulnar, fibular, and tibial compound muscle action potentials (CMAP) and sural sensory nerve action potentials (SNAP); slower conduction velocities for median, ulnar, and fibular motor nerves, and median, ulnar and sural sensory nerves. SLE patients also had longer minimum F-wave latencies for median, ulnar, fibular, and tibial nerves. H reflexes were more often absent in patients. Correlations were found between the number of disease relapses and motor conduction velocities of the fibular and tibial nerves. SLE may have early effect on peripheral nerve function in patients even before they develop electrophysiological or clinical neuropathy.

Matched MeSH terms: Polyneuropathies/etiology*
Fulltext A longitudinal study of the effects of ART on plasma chemokine levels in Malaysian HIV patients

Chew CS, Cherry CL, Kamarulzaman A, Yien TH, Aghafar Z, Price P

Dis Markers, 2011;31(5):303-9.
PMID: 22048272 DOI: 10.3233/DMA-2011-0844

Chemokines influence the migration of leukocytes to secondary lymphoid tissue and sites of inflammation. In HIV patients, they are implicated in inflammatory complications of antiretroviral therapy (ART), notably Immune Reconstitution Disease (IRD) and Sensory Neuropathy (SN). However most chemokines have not been monitored as patients begin ART or correlated with IRD and SN.

Matched MeSH terms: Polyneuropathies/blood; Polyneuropathies/chemically induced*