Druzhinina E S, Druzhinin D S, Tikhonova O A, Zavadenko N N
Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia.
Yaroslavl State Medical University, Yaroslavl, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(3):39-45. doi: 10.17116/jnevro202512503139.
To evaluate the outcomes of patients with neuralgic amyotrophy (NA) depending on the type of treatment received - surgical or glucocorticosteroid administration.
The outcome of 101 patients with verified NA was analyzed. The mean age of NA patients was 38.21±16.09 years (8 to 76 years), of which 69.3% were males (=70) and 30.7% were females (=31). The diagnosis was confirmed by electromyography, cervical spine MRI, and clinical data evaluation: pain according to VAS, duration of pain, timing of diagnosis from the disease onset, and severity of muscle weakness using the MRC scale. Most patients had a classic form (50.5%, =51), followed by a distal form (39.6%, =40), and nerve damage above the elbow joint or cranial nerves (9.9%, =10). Most patients were examined during the phase of pain and muscle weakness (59.4%, =60) and in the recovery phase (40.6%, =41). 48.5% (=49) of patients received steroids. Surgical treatment was performed in 15.8% of cases (=16). The median follow-up of all patients was 12 months (Q-Q 6.00-20.00).
Patients who received GCS recovered better - 67.7% had a complete recovery compared to patients who did not receive pathogenetic therapy. Regardless of the GCS use, the outcome also depended on the NA form and the initial severity of muscle weakness (0.001 and =0.001, respectively). Comparing the outcomes in the groups with and without surgery showed no statistically significant differences. However, in the non-surgery group, a higher percentage of non-recovery was found (71.4%) compared to the group receiving surgical treatment (28.6%). In 97.4% (=38) of cases of distal NA, ultrasound revealed focal changes in the nerves, which initially indicated a poor prognosis for recovery.
Steroid therapy affects muscle strength recovery in patients with NA. The NA form and the initial severity of motor deficit also affect the outcome. Surgical treatment is indicated for patients with distal NA.
根据接受的治疗类型——手术治疗或糖皮质激素给药，评估神经性肌萎缩（NA）患者的治疗结果。
分析101例经证实的NA患者的治疗结果。NA患者的平均年龄为38.21±16.09岁（8至76岁），其中69.3%为男性（n = 70），30.7%为女性（n = 31）。通过肌电图、颈椎MRI和临床数据评估确诊：根据视觉模拟评分法（VAS）评估疼痛程度、疼痛持续时间、从疾病发作到诊断的时间以及使用医学研究委员会（MRC）量表评估肌肉无力的严重程度。大多数患者为经典型（50.5%，n = 51），其次为远端型（39.6%，n = 40），以及肘关节以上神经或颅神经损伤型（9.9%，n = 10）。大多数患者在疼痛和肌肉无力阶段接受检查（59.4%，n = 60），在恢复阶段接受检查（40.6%，n = 41）。48.5%（n = 49）的患者接受了类固醇治疗。15.8%（n = 16）的病例进行了手术治疗。所有患者的中位随访时间为12个月（四分位数间距6.00 - 20.00）。
接受糖皮质激素（GCS）治疗的患者恢复情况更好——与未接受病因治疗的患者相比，67.7%的患者完全康复。无论是否使用GCS，治疗结果还取决于NA的类型和肌肉无力的初始严重程度（分别为P = 0.001和P = 0.001）。比较手术组和非手术组的治疗结果，未发现统计学上的显著差异。然而，在非手术组中，未恢复的比例（71.4%）高于接受手术治疗的组（28.6%）。在97.4%（n = 38）的远端NA病例中，超声显示神经有局灶性改变，这最初表明恢复预后较差。
类固醇治疗影响NA患者的肌肉力量恢复。NA的类型和运动功能缺损的初始严重程度也会影响治疗结果。远端NA患者适合进行手术治疗。
