Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.
Hospital Alemão Oswaldo Cruz, Setor de Neurofisiologia Clínica, São Paulo SP, Brazil.
Arq Neuropsiquiatr. 2023 Sep;81(9):785-794. doi: 10.1055/s-0043-1772599. Epub 2023 Oct 4.
The distinction between sensory neuronopathies (SN), which is by definition purely sensory, and sensory polyneuropathies (SP) and sensory multineuropathies (SM) is important for etiologic investigation and prognosis estimation. However, this task is often challenging in clinical practice. We hypothesize that F-wave assessment might be helpful, since it is able to detect subtle signs of motor involvement, which are found in SP and SM, but not in SN.
The aim of the present study was to determine whether F-waves are useful to distinguish SN from SP and SM.
We selected 21 patients with SP (12 diabetes mellitus, 4 transthyretin familial amyloid polyneuropathy, 4 others), 22 with SM (22 leprosy), and 26 with SN (13 immune-mediated, 10 idiopathic, 3 others) according to clinical-electrophysiological-etiological criteria. For every subject, we collected data on height and performed 20 supramaximal distal stimuli in median, ulnar, peroneal, and tibial nerves, bilaterally, to record F-waves. Latencies (minimum and mean) and persistences were compared across groups using the Kruskal-Wallis and Bonferroni tests. -values < 0.05 were considered significant.
All groups were age, gender, and height-matched. Overall, there were no significant between-group differences regarding F-wave latencies. In contrast, F-wave persistence was able to stratify the groups. Peroneal F-wave persistence was higher, bilaterally, in the SN group compared to SM and SP ( < 0.05). In addition, F-waves persistence of the ulnar and tibial nerves was also helpful to separate SN from SP ( < 0.05).
F-wave persistence of the peroneal nerves might be an additional and useful diagnostic tool to differentiate peripheral sensory syndromes.
感觉神经元病（SN）的定义纯粹是感觉性的，与感觉性多发性神经病（SP）和感觉性多发性神经病（SM）之间的区别对于病因调查和预后估计很重要。然而，在临床实践中，这一任务往往具有挑战性。我们假设 F 波评估可能会有所帮助，因为它能够检测到 SP 和 SM 中存在的运动受累的细微迹象，但在 SN 中则没有。
本研究旨在确定 F 波是否有助于区分 SN 与 SP 和 SM。
我们根据临床电生理病因标准选择了 21 例 SP（12 例糖尿病，4 例转甲状腺素家族性淀粉样多神经病，4 例其他）、22 例 SM（22 例麻风病）和 26 例 SN（13 例免疫介导，10 例特发性，3 例其他）患者。对每位患者，我们收集了身高数据，并在正中、尺、腓和胫神经的双侧进行了 20 次最大远端刺激，以记录 F 波。使用 Kruskal-Wallis 和 Bonferroni 检验比较组间潜伏期（最小和平均）和持续时间。p 值<0.05 被认为具有统计学意义。
所有组在年龄、性别和身高方面均匹配。总体而言，各组之间的 F 波潜伏期没有显著差异。相比之下，F 波持续时间能够对组进行分层。与 SM 和 SP 相比，双侧 SN 组的腓总神经 F 波持续时间较高（p<0.05）。此外，尺神经和胫神经的 F 波持续时间也有助于将 SN 与 SP 区分开来（p<0.05）。
腓总神经的 F 波持续时间可能是一种额外的有用的诊断工具，可用于区分周围性感觉综合征。
