Contribution of Nerve Biopsy to Unclassified Neuropathy

Schweikert, Kathi; Fuhr, Peter; Probst, A.; Tolnay, M.; Renaud, Susanne; Steck, Andreas

doi:10.1159/000098057

Cited by 14 publications

(5 citation statements)

References 35 publications

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“…Previous studies investigating the utility of nerve biopsy determined that a significant proportion of nerve biopsies do not provide clinically useful information. In one study of 38 patients with peripheral neuropathy of unknown cause, 15 nerve biopsy led to a confirmed diagnosis in 37%, usually among patients with asymmetric, non‐chronic phenotypes. In another study of 67 patients who underwent nerve biopsies, the results influenced the eventual diagnosis and management in 33% and 27% respectively 16 .…”

Section: Methodsmentioning

confidence: 99%

“…Diagnostic yield is also influenced by the pre‐biopsy provisional diagnosis with studies showing higher yields with provisional diagnoses of vasculitic neuropathy, inflammatory demyelinating polyneuropathy, and hereditary motor and sensory neuropathy 155,156 . The yield of nerve biopsies in cryptogenic neuropathies, while low, is not insignificant (0%‐37%) 3,15,155,157 . Indeed, important diagnoses like vasculitis have been made in such patients 18 …”

Section: Methodsmentioning

confidence: 99%

“… 155 , 156 The yield of nerve biopsies in cryptogenic neuropathies, while low, is not insignificant (0%‐37%). 3 , 15 , 155 , 157 Indeed, important diagnoses like vasculitis have been made in such patients. 18 …”

Section: Methodsmentioning

confidence: 99%

“…155,156 The yield of nerve biopsies in cryptogenic neuropathies, while low, is not insignificant (0%-37%). 3,15,155,157 Indeed, important diagnoses like vasculitis have been made in such patients. 18 With regard to neuropathology techniques, there is debate regarding the value that teased fiber analysis adds in the evaluation of nerve biopsies.…”

Section: Pure Motor Neuropathiesmentioning

confidence: 99%

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Nerve biopsy: Current indications and decision tools

et al. 2021

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After initial investigation of patients presenting with symptoms suggestive of neuropathy, a clinical decision is made for a minority of patients to undergo further assessment with nerve biopsy. Many nerve biopsies do not demonstrate a definitive pathological diagnosis and there is considerable cost and morbidity associated with the procedure. This highlights the need for appropriate selection of patients, nerves and neuropathology techniques. Additionally, concomitant muscle and skin biopsies may improve the diagnostic yield in some cases. Several advances have been made in diagnostics in recent years, particularly in genomics. The indications for nerve biopsy have consequently changed over time. This review explores the current indications for nerve biopsies and some of the issues surrounding its use. Also included are comments on alternative diagnostic modalities that may help to supplant or reduce the use of nerve biopsy as a diagnostic test. These primarily include extraneural biopsy and neuroimaging techniques such as magnetic resonance neurography and nerve ultrasound. Finally, we propose an algorithm to assist in deciding when to perform nerve biopsies.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Pure Motor Neuropathiesmentioning

confidence: 99%

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Nerve biopsy: Current indications and decision tools

et al. 2021

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“…Indeed, given the 20% prevalence of distal symmetric polyneuropathy among reported patients with NSVN, nerve biopsy should be considered in all patients with progressive axonal neuropathies, irrespective of symmetry. That said, among patients with an idiopathic, chronic, symmetric polyneuropathy, nerve biopsy yields a diagnosis of definite vasculitis in only 3% [109][110][111] , much lower than the 20% yield among patients with a clinical phenotype that raises suspicion of vasculitis [112][113][114] . This low yield must, therefore, be weighed against the risks of biopsy.…”

Section: Brighton Collaboration Case Definition Of Vasculitic Neuropamentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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The vasculitides are a clinically diverse group of diseases with the histopathological signature of blood vessel-centred inflammation that results in vascular damage and ischaemic injury to the affected tissues 1 . Vasculitis can be caused by drugs, infections and cancers, but diagnostic workup reveals no trigger in most patients. Autoimmune mechanisms are active in all vasculitides, except those caused by direct infection of vessel walls. Most vasculitides are systemic and involve multiple organs and tissues. Those affecting small-to medium-sized vessels often manifest with a vasculitic neuropathy. For example, neuropathies occur in 60-70% of patients with polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis and cryoglobulinaemic vasculitis, and 40-50% of those with microscopic polyangiitis and rheumatoid vasculitis 2 .Vasculitic neuropathy can also occur without systemic vasculitis. This single-organ vasculitis of the PNS has commonly been referred to as nonsystemic vasculitic neuropathy (NSVN), but other forms of clinically isolated PNS vasculitis are now recognized and can be considered variants of NSVN 3 . Although NSVN is classically an acute, relapsing, multifocal neuropathy, it can present as a slowly progressive neuropathy without distinct asymmetries. As such, it should be considered as a possible cause of any progressive axonal neur opathy. NSVN can be diagnosed only with a nerve biopsy, with or without a concomitant muscle or skin biopsy; as nerve biopsies are seldom performed, the condition is under-recognized. The disorder must be distinguished from many other causes of multifocal neuropathy, the definition of which is itself not standardized and requires clarification.A Peripheral Nerve Society guideline group reviewed the literature on vasculitic neuropathy and published consensus recommendations on the classification, diagnosis and immunosuppressive treatment of NSVN in 2010 (REF. 4) Abstract | Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves that can only be diagnosed with a nerve biopsy. A Peripheral Nerve Society guideline group published consensus recommendations on the classification, diagnosis and treatment of NSVN in 2010, and new diagnostic criteria for vasculitic neuropathy were developed by the Brighton Collaboration in 2015. In this Review, we provide an update on the classification, diagnosis and treatment of NSVN. NSVN subtypes include Wartenberg migratory sensory neuropathy and postsurgical inflammatory neuropathy. Variants include diabetic radiculoplexus neuropathy and -arguably -neuralgic amyotrophy. NSVN with proximal involvement is sometimes termed nondiabetic lumbosacral radiculoplexus neuropathy. Cutaneous polyarteritis nodosa and other skin-nerve vasculitides overlap with NSVN clinically. Three patterns of involvement in NSVN have been identified: multifocal neuropathy, distal symmetric polyneuropathy, and overlapping multifocal neuropathy (asymmetric polyneuropathy). These patterns lack standard defi...

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