An update on electrophysiological studies in neuropathy

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Abstract from Curr Opin Neurol. 2003 Oct;16(5):603-12.

An update on electrophysiological studies in neuropathy.

Krarup C.

SUMMARY: PURPOSE OF REVIEW The review concentrates on the use of

clinical neurophysiology in peripheral nerve disorders covered in the

present issue. It is pertinent to distinguish different types of

involvement of fibers in diabetic neuropathy, including the involvement

of small and large fibers, to outline the diagnostic criteria of

inflammatory neuropathies, and to describe the spectrum of peripheral

nerve pathophysiology in inherited neuropathies. Painful neuropathies

represent a particular challenge to clinical neurophysiology since it is

mainly small fibers, which are difficult to study, that are affected.

RECENT FINDINGS Electrodiagnostic studies have relevance in

distinguishing neuropathies with different etiologies in diabetes

mellitus, and different strategies and methods are necessary to study

patients with autonomic and small-fiber involvement. The

involvement of motor or sensory fibers, or both, and primary axonal or

demyelinative pathology are important questions relating to

immune-mediated neuropathies studied in the context of the specificity

of antibodies against various neuronal and Schwann-cell structures. In

hereditary neuropathy, electrophysiological studies are also used to

distinguish axonal neuropathies from demyelinating neuropathies, though

overlap and 'intermediate' patterns have become well recognized. In pain

syndromes, conventional electrophysiological studies may give normal

results if large fibers are not involved, and the use of autonomic

measures in these situations has particular relevance.

SUMMARY The usefulness of electrodiagnostic measures depends on the

clinical, diagnostic, or pathophysiological question involved, and the

strategy employed should reflect the advantages and limitations of these

methods. If adequate consideration is paid to these

properties, then such studies have a central role in the diagnosis and

adequate treatment of patients with neuromuscular disorders.