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The ulnar ratio as a sensitive and specific marker of acute inflammatory demyelinating polyneuropathy.
Clin Neurophysiol. 2018 08; 129(8):1699-1703.CN

Abstract

OBJECTIVES

To explore the value of a novel sensory criterion, the ulnar ratio - defined as the SNAP amplitude of the palmar cutaneous (pUN) over that of the dorsal branch (dUN) of the ulnar nerve - as a predictor of Acute Inflammatory Demyelinating Polyneuropathy (AIDP).

METHODS

We prospectively included 22 patients with AIDP, 20 patients with diabetic peripheral neuropathy (DPN), and 18 controls. Eligible subjects underwent nerve conduction studies including, among others, the dUN, pUN, and sural nerve.

RESULTS

A sural sparing pattern was found in 72% of AIDP cases. The ulnar ratio was significantly lower in patients with AIDP compared to those with DPN or controls. The ROC curve area to discriminate AIDP (versus controls and diabetics together) was higher with the ulnar ratio and pUN compared to dUN. An ulnar ratio ≥ 0.78 seems to be the best threshold to rule out the diagnosis of AIDP, with a specificity of 100% and a sensitivity of 87%. The ulnar ratio was equally reliable in the subgroup of patients presenting within a week of symptoms onset.

CONCLUSION

The ulnar ratio is a highly sensitive and specific marker of AIDP and can help confirm the diagnosis when direct signs of demyelination are lacking.

SIGNIFICANCE

Incorporating specific sensory abnormalities, such as the ulnar ratio, in the electrodiagnostic criteria of AIDP could enhance their reliability.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Ahdab R
Division of Neurology, Lebanese American University Medical Center, Beirut, Lebanon; Hamidy Charitable Medical Center, Tripoli, Lebanon. Electronic address: rechdi.ahdab@laumcrh.com.
Noureldine MHA
Division of Neurosurgery, Lebanese American University Medical Center, Beirut, Lebanon. Electronic address: mohammadhassan.noureldine@lau.edu.
Mohammedi K
University Hospital and Faculty of Medicine of Bordeaux, France; The George Institute for Global Health, Sydney, Australia.
Nader M
Division of Neurology, Lebanese American University Medical Center, Beirut, Lebanon.
Zouari HG
EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France; Service d'Explorations Fonctionnelles, CHU Habib Bourguiba, Sfax, Tunisia.
Nordine T
EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France. Electronic address: tarik.nordine@hmn.aphp.fr.
Créange A
EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France. Electronic address: alain.creange@hmn.aphp.fr.
Lefaucheur JP
EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France. Electronic address: jean-pascal.lefaucheur@hmn.aphp.fr.
Ayache SS
Division of Neurology, Lebanese American University Medical Center, Beirut, Lebanon; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France. Electronic address: samarayache@gmail.com.

MeSH

Action PotentialsAdultAgedFemaleGuillain-Barre SyndromeHumansMaleMiddle AgedNeural ConductionProspective StudiesUlnar Nerve

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29940481

Citation

Ahdab, Rechdi, et al. "The Ulnar Ratio as a Sensitive and Specific Marker of Acute Inflammatory Demyelinating Polyneuropathy." Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, vol. 129, no. 8, 2018, pp. 1699-1703.
Ahdab R, Noureldine MHA, Mohammedi K, et al. The ulnar ratio as a sensitive and specific marker of acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol. 2018;129(8):1699-1703.
Ahdab, R., Noureldine, M. H. A., Mohammedi, K., Nader, M., Zouari, H. G., Nordine, T., Créange, A., Lefaucheur, J. P., & Ayache, S. S. (2018). The ulnar ratio as a sensitive and specific marker of acute inflammatory demyelinating polyneuropathy. Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 129(8), 1699-1703. https://doi.org/10.1016/j.clinph.2018.05.017
Ahdab R, et al. The Ulnar Ratio as a Sensitive and Specific Marker of Acute Inflammatory Demyelinating Polyneuropathy. Clin Neurophysiol. 2018;129(8):1699-1703. PubMed PMID: 29940481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The ulnar ratio as a sensitive and specific marker of acute inflammatory demyelinating polyneuropathy. AU - Ahdab,Rechdi, AU - Noureldine,Mohammad Hassan A, AU - Mohammedi,Kamel, AU - Nader,Manal, AU - Zouari,Hela G, AU - Nordine,Tarik, AU - Créange,Alain, AU - Lefaucheur,Jean-Pascal, AU - Ayache,Samar S, Y1 - 2018/06/11/ PY - 2018/01/01/received PY - 2018/04/20/revised PY - 2018/05/23/accepted PY - 2018/6/26/pubmed PY - 2019/6/27/medline PY - 2018/6/26/entrez KW - Acute inflammatory demyelinating polyneuropathy KW - Sensory nerve action potentials KW - Sural sparing KW - Ulnar ratio SP - 1699 EP - 1703 JF - Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology JO - Clin Neurophysiol VL - 129 IS - 8 N2 - OBJECTIVES: To explore the value of a novel sensory criterion, the ulnar ratio - defined as the SNAP amplitude of the palmar cutaneous (pUN) over that of the dorsal branch (dUN) of the ulnar nerve - as a predictor of Acute Inflammatory Demyelinating Polyneuropathy (AIDP). METHODS: We prospectively included 22 patients with AIDP, 20 patients with diabetic peripheral neuropathy (DPN), and 18 controls. Eligible subjects underwent nerve conduction studies including, among others, the dUN, pUN, and sural nerve. RESULTS: A sural sparing pattern was found in 72% of AIDP cases. The ulnar ratio was significantly lower in patients with AIDP compared to those with DPN or controls. The ROC curve area to discriminate AIDP (versus controls and diabetics together) was higher with the ulnar ratio and pUN compared to dUN. An ulnar ratio ≥ 0.78 seems to be the best threshold to rule out the diagnosis of AIDP, with a specificity of 100% and a sensitivity of 87%. The ulnar ratio was equally reliable in the subgroup of patients presenting within a week of symptoms onset. CONCLUSION: The ulnar ratio is a highly sensitive and specific marker of AIDP and can help confirm the diagnosis when direct signs of demyelination are lacking. SIGNIFICANCE: Incorporating specific sensory abnormalities, such as the ulnar ratio, in the electrodiagnostic criteria of AIDP could enhance their reliability. SN - 1872-8952 UR - https://www.unboundmedicine.com/medline/citation/29940481/The_ulnar_ratio_as_a_sensitive_and_specific_marker_of_acute_inflammatory_demyelinating_polyneuropathy_ DB - PRIME DP - Unbound Medicine ER -