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Journal of Neurology, Neurosurgery, and... Oct 1996To characterise cultured T lymphocytes from nerve biopsies in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP).
OBJECTIVES
To characterise cultured T lymphocytes from nerve biopsies in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP).
METHODS
Sural nerve biopsies, obtained from six patients with Guillain-Barré syndrome, four with CIDP, and six controls with other neuropathies, were cultured with 20 U/ml recombinant interleukin-2 (IL-2) for eight weeks. Flow cytometry was used to determine the phenotype of cultured T lymphocytes. Their proliferative responses to a range of bacterial antigens were also examined.
RESULTS
T cell lines were established from four of six patients with Guillain-Barré syndrome, one of four with CIDP, one patient with peripheral nerve vasculitis, and none of five controls with non-inflammatory neuropathies. One of these T cell lines from a patient with Guillain-Barré syndrome, preceded by Campylobacter jejuni infection, consisted entirely of gamma delta TCR+ T lymphocytes. The peripheral blood of this patient also contained an increased frequency of gamma delta T cells when stimulated with C jejuni. The nerve derived T cell lines failed to show a proliferative response to bacterial antigens or to a preparation of myelin proteins.
CONCLUSIONS
A new technique to isolate T cells from nerve biopsies in patients with Guillain-Barré syndrome and CIDP is reported. This technique may prove to be a useful tool in the investigation of the pathogenesis of other inflammatory neuropathies such as peripheral nerve vasculitis. The isolation of a gamma delta TCR+ nerve T cell line is of interest because of the possibility that these cells might respond to glycolipid epitopes common to C jejuni and peripheral nerve gangliosides.
Topics: Antigens, CD; Campylobacter jejuni; Cell Culture Techniques; Cell Movement; Cytomegalovirus; Demyelinating Diseases; Enzyme-Linked Immunosorbent Assay; Humans; Polyradiculoneuropathy; Sural Nerve; T-Lymphocytes
PubMed: 8890774
DOI: 10.1136/jnnp.61.4.362 -
European Journal of Trauma and... Jun 2022Recovery of sensibility after digital nerve injury is crucial for restoring normal hand function. We evaluated long-term outcomes of digital nerve reconstruction with...
BACKGROUND
Recovery of sensibility after digital nerve injury is crucial for restoring normal hand function. We evaluated long-term outcomes of digital nerve reconstruction with autografts.
METHODS
This retrospective study included patients who underwent secondary reconstruction of digital nerves with nerve autografting. Recovery of sensibility was evaluated based on the following: patient self-assessment, two-point discrimination (2PD), and a total sensation score (sum of proprioception, temperature sensation, and sharp/dull discrimination). Mixed models regression was used to study predictors of sensibility outcomes. The predictors analyzed were age, sex, smoking status, number of fingers involved in a patient (as a measure of injury severity), time to reconstruction, and time to follow-up.
RESULTS
In 61 patients, 174 digital nerves in 126 fingers were reconstructed after an average of 33.1 weeks from injury. The mean follow-up was 6.4 years from reconstruction. The mean graft length was 3.6 cm. Self-rated sensibility in the affected area was very good in 13% of patients, good in 33%, satisfactory in 40%, and poor in 24%. 2PD at 6 mm was present in 17% of patients, at 10 mm in 12%, and at 15 mm in 18% (mean 2PD was 10.8). Proprioception was preserved in 107 (85%) fingers, sensation of temperature was preserved in 99 (75%) of fingers, and sharp/dull discrimination in 88 (70%) fingers. Time from injury to reconstruction was the only significant predictor of the total sensation score.
CONCLUSION
Our data indicate that earlier reconstruction is associated with a favorable outcome.
Topics: Autografts; Finger Injuries; Fingers; Humans; Retrospective Studies; Sural Nerve; Transplantation, Autologous
PubMed: 34279668
DOI: 10.1007/s00068-021-01747-4 -
Scientific Reports Sep 2019Patients suffer bilateral sacral plexus injuries experience severe problems with incontinence. We performed a cadaveric study to explore the anatomical feasibility of...
Patients suffer bilateral sacral plexus injuries experience severe problems with incontinence. We performed a cadaveric study to explore the anatomical feasibility of transferring ipsilateral S2 nerve root combined with a sural nerve graft to pudendal nerve for restoration of external anal and urethral sphincter function. The sacral nerve roots and pudendal nerve roots on the right side were exposed in 10 cadavers. The length from S2 nerve root origin to pudendal nerve at inferior border of piriformis was measured. The sural nerve was used as nerve graft. The diameters and nerve cross-sectional areas of S2 nerve root, pudendal nerve and sural nerve were measured and calculated, so as the number of myelinated axons of three nerves on each cadaver specimen. The length from S2 nerve root to pudendal nerve was 10.69 ± 1.67 cm. The cross-sectional areas of the three nerves were 8.57 ± 3.03 mm for S2, 7.02 ± 2.04 mm for pudendal nerve and 6.33 ± 1.61 mm for sural nerve. The pudendal nerve contained approximately the same number of axons (5708 ± 1143) as the sural nerve (5607 ± 1305), which was a bit less than that of the S2 nerve root (6005 ± 1479). The S2 nerve root in combination with a sural nerve graft is surgically feasible to transfer to the pudendal nerve for return of external urethral and anal sphincter function, and may be suitable for clinical application in patients suffering from incontinence following sacral plexus injuries.
Topics: Adult; Anal Canal; Feasibility Studies; Fecal Incontinence; Female; Humans; Male; Pudendal Nerve; Spinal Nerve Roots; Sural Nerve; Urethra; Urinary Incontinence
PubMed: 31570751
DOI: 10.1038/s41598-019-50484-7 -
Scientific Reports Nov 2023We aimed to assess DPNCheck's reliability for repeated sural nerve conduction (NC) parameters. This post hoc analysis used data from the randomized controlled ACUDPN...
We aimed to assess DPNCheck's reliability for repeated sural nerve conduction (NC) parameters. This post hoc analysis used data from the randomized controlled ACUDPN trial assessing NC of the N. Suralis every eight weeks over a 6-month period in 62 patients receiving acupuncture against diabetic peripheral neuropathy (DPN) symptoms. The reliability of DPNCheck for nerve conduction velocity and amplitude was assessed using intraclass correlation coefficients (ICC) and was calculated using data from single time points and repeated measures design. The results of the NC measurements were correlated with the Total Neuropathy Score clinical (TNSc). Overall, for both nerve velocity and amplitude, the reliability at each measurement time point can be described as moderate to good and the reliability using repeated measures design can be described as moderate. Nerve velocity and amplitude showed weak correlation with TNSc. DPNCheck's reliability results question its suitability for monitoring DPN's progression. Given the limitation of our analysis, a long-term, pre-specified, fully crossed study should be carried out among patients with DPN to fully determine the suitability of the device for DPN progression monitoring. This was the first analysis assessing the reliability of the DPNCheck for DPN progression monitoring using data from multiple collection time points.
Topics: Humans; Diabetes Mellitus; Diabetic Neuropathies; Neural Conduction; Point-of-Care Systems; Reproducibility of Results; Sural Nerve; Randomized Controlled Trials as Topic
PubMed: 37923763
DOI: 10.1038/s41598-023-45841-6 -
Archives of Physical Medicine and... Apr 2014To assess whether sensorimotor peripheral nerve function is associated with muscle power in community-dwelling older men.
OBJECTIVE
To assess whether sensorimotor peripheral nerve function is associated with muscle power in community-dwelling older men.
DESIGN
Longitudinal cohort study with 2.3±0.3 years of follow-up.
SETTING
One clinical site.
PARTICIPANTS
Participants (n=372; mean age ± SD, 77.2±5.1y; 99.5% white; body mass index, 27.9±3.7kg/m(2); power, 1.88±0.6W/kg) at 1 site of the Osteoporotic Fractures in Men Study (N=5994).
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURES
A nerve function ancillary study was performed 4.6±0.4 years after baseline. Muscle power was measured using a power rig. Peroneal motor nerve conduction amplitude, distal motor latency, and mean f-wave latency were measured. Sensory nerve function was assessed using 10-g and 1.4-g monofilaments and sural sensory nerve conduction amplitude and distal latency. Peripheral neuropathy symptoms at the leg and feet were assessed by self-report.
RESULTS
After adjustments for age, height, and total body lean and fat mass, 1 SD lower motor (β=-.07, P<.05) and sensory amplitude (β=-.09, P<.05) and 1.4-g (β=-.11, P<.05) and 10-g monofilament insensitivity (β=-.17, P<.05) were associated with lower muscle power/kg. Compared with the effect of age on muscle power (β per year, -.05; P<.001), this was equivalent to aging 1.4 years for motor amplitude, 1.8 years for sensory amplitude, 2.2 years for 1.4-g monofilament detection, and 3.4 years for 10-g detection. Baseline 1.4-g monofilament detection predicted a greater decline in muscle power/kg. Short-term change in nerve function was not associated with concurrent short-term change in muscle power/kg.
CONCLUSIONS
Worse sensory and motor nerve function were associated with lower muscle power/kg and are likely important for impaired muscle function in older men. Monofilament sensitivity was associated with a greater decline in muscle power/kg, and screening may identify an early risk for muscle function decline in late life, which has implications for disability.
Topics: Action Potentials; Aged; Aged, 80 and over; Aging; Cohort Studies; Humans; Linear Models; Longitudinal Studies; Lower Extremity; Male; Muscle Strength; Neural Conduction; Peroneal Nerve; Sural Nerve
PubMed: 24355427
DOI: 10.1016/j.apmr.2013.11.018 -
Neurology Jul 2016To investigate the involvement of small nerve fibers in Ehlers-Danlos syndrome (EDS).
OBJECTIVE
To investigate the involvement of small nerve fibers in Ehlers-Danlos syndrome (EDS).
METHODS
Patients diagnosed with EDS underwent clinical, neurophysiologic, and skin biopsy assessment. We recorded sensory symptoms and signs and evaluated presence and severity of neuropathic pain according to the Douleur Neuropathique 4 (DN4) and ID Pain questionnaires and the Numeric Rating Scale (NRS). Sensory action potential amplitude and conduction velocity of sural nerve was recorded. Skin biopsy was performed at distal leg and intraepidermal nerve fiber density (IENFD) obtained and referred to published sex- and age-adjusted normative reference values.
RESULTS
Our cohort included 20 adults with joint hypermobility syndrome/hypermobility EDS, 3 patients with vascular EDS, and 1 patient with classic EDS. All except one patient had neuropathic pain according to DN4 and ID Pain questionnaires and reported 7 or more symptoms at the Small Fiber Neuropathy Symptoms Inventory Questionnaire. Pain intensity was moderate (NRS ≥4 and <7) in 8 patients and severe (NRS ≥7) in 11 patients. Sural nerve conduction study was normal in all patients. All patients showed a decrease of IENFD consistent with the diagnosis of small fiber neuropathy (SFN), regardless of the EDS type.
CONCLUSIONS
SFN is a common feature in adults with EDS. Skin biopsy could be considered an additional diagnostic tool to investigate pain manifestations in EDS.
Topics: Adult; Biopsy; Cohort Studies; Ehlers-Danlos Syndrome; Female; Humans; Male; Middle Aged; Neural Conduction; Pain; Pain Measurement; Small Fiber Neuropathy; Sural Nerve
PubMed: 27306637
DOI: 10.1212/WNL.0000000000002847 -
Brain and Behavior Feb 2024The assessment of the normative values of sensory nerve action potentials (SNAP) and their diagnostic accuracies using validated neuropathy-assessment tools to classify...
Values and diagnostic accuracy of sensory nerve action potentials in control participants and participants with diabetes with and without clinical diabetic neuropathy, based on neuropathy scale measurements.
BACKGROUND
The assessment of the normative values of sensory nerve action potentials (SNAP) and their diagnostic accuracies using validated neuropathy-assessment tools to classify participants into groups with and without neuropathy was not previously described in the literature.
METHODS
The Utah Early Neuropathy Scale (UENS), Michigan neuropathy-screening instrument, and nerve conduction data were collected prospectively. We described and compared the values of the sural, superficial peroneal sensory (SPS), and superficial radial SNAP amplitude in different age groups for three groups. Group 1 (G1)-control participants (UENS <5), group 2 (G2)-participants with diabetes without clinical diabetic neuropathy (UENS <5), and group 3 (G3)-participants with clinical diabetic neuropathy (UENS ≥5). We also described the diagnostic accuracy of single-nerve amplitude and a combined sensory polyneuropathy index (CSPNI) that consists of four total points (one point for each of the following nerves if their amplitude was <25% lower limit of normal: right sural, left sural, right SPS, and left SPS potentials).
RESULTS
We assessed 135 participants, including 41, 37, and 57 participants in G1, G2, and G3, respectively, with age median (interquartile ranges) of 51 (45-56), 47 (38-56), and 54 (51-61) years, respectively, whereas 19 (46.3%), 18 (48.7%), and 32 (56.14%) of them were males, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) scores were 68.4%, 92.3%, 86.7%, and 80% for the sural amplitude; 86%, 58.3%, 62%, and 84% for the SPS amplitude; 66.7%, 94.4%, 90.5%, and 78.2% for the CSPNI of 3; and 54.4%, 98.6%, 96.9%, and 73.2% for the CSPNI of 4, respectively.
CONCLUSION
Sural nerve had a high specificity for neuropathy; however, the CSPNI had the highest specificity and PPV, whereas the SPS had the highest sensitivity and NPV.
Topics: Male; Humans; Female; Diabetic Neuropathies; Action Potentials; Neural Conduction; Sural Nerve; Evoked Potentials; Polyneuropathies; Diabetes Mellitus
PubMed: 38351301
DOI: 10.1002/brb3.3423 -
Journal of Diabetes and Its... 1993Tolrestat is a well tolerated nonhydantoin aldose reductase inhibitor that has been reported to improve nerve conduction in diabetic animals and humans. Its effects on... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Effect of hyperglycemia and the aldose reductase inhibitor tolrestat on sural nerve biochemistry and morphometry in advanced diabetic peripheral polyneuropathy. The Tolrestat Study Group.
Tolrestat is a well tolerated nonhydantoin aldose reductase inhibitor that has been reported to improve nerve conduction in diabetic animals and humans. Its effects on nerve biochemistry and structure have not been studied in patients with diabetic neuropathy. Patients with advanced diabetic neuropathy treated with long-term open-label tolrestat were randomly assigned to continuation on drug treatment or to placebo-controlled drug withdrawal for 12 months. At the end of this period, sural nerve biopsies were obtained for measurement of glucose, sorbitol, and fructose content, and for detailed morphometric analysis. Tolrestat ameliorated the glucose-mediated increase in sorbitol and fructose in sural nerve tissue. No statistically significant differences in nerve morphometry emerged between the two groups; however, both treatment groups exhibited increased nerve-fiber regeneration and normalization of axo-glial dysfunction and segmental demyelination following long-term tolrestat treatment. These findings are similar to those previously reported in a placebo-controlled sequential nerve biopsy study with the aldose reductase inhibitor sorbinil. Thus tolrestat is a biochemically effective aldose reductase inhibitor in human diabetic nerve with potential therapeutic efficacy for diabetic neuropathy.
Topics: Aldehyde Reductase; Axons; Biopsy; Blood Glucose; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Double-Blind Method; Erythrocytes; Female; Glucose; Humans; Hyperglycemia; Male; Microscopy, Electron; Middle Aged; Naphthalenes; Neural Conduction; Neuroglia; Peripheral Nerves; Sorbitol; Sural Nerve
PubMed: 8343610
DOI: 10.1016/1056-8727(93)90041-v -
The Journal of Physiology Nov 19811. The background activity was observed in gamma and alpha efferent fibres and in group I and II fibres innervating the muscle gastrocnemius lateralis or medialis. The...
1. The background activity was observed in gamma and alpha efferent fibres and in group I and II fibres innervating the muscle gastrocnemius lateralis or medialis. The reflex effects of ipsilateral and contralateral sural nerve stimulations on the muscle efferents were analysed together with their consequences upon the afferents of the same muscle. The observations were made in the decerebrated cat without opening the neural loops between the muscle and the spinal cord.2. The multi-unit discharges of each category of fibres were obtained, on line, by an original electronic device (Joffroy, 1975, 1980) that sorted the action potentials from the whole electrical activity of a small branch of gastrocnemius lateralis or medialis nerve according to the direction and velocity of propagation of the potentials.3. The small nerve may be regarded as a representative sample of different functional groups of fibres conducting faster than 12 m.sec(-1) and supplying gastrocnemius muscles.4. Some gamma efferents were always tonically firing except when a transient flaccid state developed. Usually the alpha efferents were silent, probably because the muscle was fixed close to the minimal physiological length.5. Separate and selective stimulations of Abeta, Adelta and C fibres of ipsilateral and contralateral sural nerve showed that each group could induce the excitation of gamma neurones. The reciprocal inhibition period of alpha efferents during a flexor reflex was only once accompanied by a small decrease in gamma-firing.6. The reflex increase of over-all frequency of gamma efferents resulted from an increased firing rate of tonic gamma neurones and from the recruitment of gamma neurones previously silent. When the gamma efferents in the small nerve naturally occurred in two subgroups, the slower-conducting subgroup (mainly composed of tonic gamma axons) was activated before the faster-conducting subgroup (mostly composed by gamma axons with no background discharge). Some rare exceptions were found, however.7. The selective activation of gamma efferents could be obtained with short-and low-frequency stimulation. When, with stronger stimulations, gamma-alpha co-activation was observed, the onset of the gamma-firing increase preceded by 100-600 msec that of the alpha discharge in the small nerve. Likewise, the onset of the gamma-efferent response preceded the increase of over-all electromyographic activity of the whole triceps muscle but only by 10-100 msec. The discrepancy could be due to the soleus alpha motoneurones being activated earlier than the alpha-motoneurones of gastrocnemius muscle, according to the size principle. In only one experiment, the alpha-firing onset preceded the gamma-firing increase.8. Stimulations of ipsilateral or contralateral nerve, whatever the alpha or gamma reflex patterns, always led to increased firing rates of group I and II fibres of the small nerve. The origins of the discharge of group I and II muscle afferents and the excitation mechanisms of the receptors involved are considered. Some aspects of the mechanism of the reflex control of movement are discussed in the light of these results.
Topics: Action Potentials; Animals; Axons; Cats; Decerebrate State; Motor Neurons; Motor Neurons, Gamma; Muscles; Neurons, Afferent; Neurons, Efferent; Reflex, Stretch; Sural Nerve
PubMed: 7320946
DOI: 10.1113/jphysiol.1981.sp013936 -
Journal of Neurology, Neurosurgery, and... Jul 1984Ten male alcoholics aged 38-72 years with clear clinical and electroneurographical signs of peripheral neuropathy were re-examined three to five years later. Conduction...
Ten male alcoholics aged 38-72 years with clear clinical and electroneurographical signs of peripheral neuropathy were re-examined three to five years later. Conduction velocities, latencies and nerve action potential amplitudes were measured from median, peroneal and sural nerves on both occasions and the results were compared with age-matched reference values from 80 healthy men. Seven of the alcoholics showed normal or nearly normal scores in electroneurographical and clinical examination and they had all managed to stop drinking alcohol. The results suggest that the prognosis of alcoholic peripheral neuropathy is good and independent of age provided that intake of alcohol is discontinued and other causes of neuropathy (malignancy, diabetes, nerve trauma) are carefully excluded.
Topics: Adult; Aged; Alcoholism; Evoked Potentials; Follow-Up Studies; Humans; Median Nerve; Middle Aged; Motor Neurons; Muscles; Neural Conduction; Peripheral Nervous System Diseases; Peroneal Nerve; Prognosis; Reaction Time; Sural Nerve
PubMed: 6086844
DOI: 10.1136/jnnp.47.7.699