Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects

Xavier, Jady Wroblewski; Galbraith, Robert G.; Winter, Earl F.

doi:10.5152/eurjrheum.2018.17109

Cited by 29 publications

(38 citation statements)

References 28 publications

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“…Thus, the fibular nerve is more vulnerable to external compression, such as prolonged periods of immobilization or incorrect positioning of the legs, which may be more common in these patients. 24 Additionally, in our cohort, S1-innervated Hoffmann reflexes were delayed in 41% of the PFM, which was in accordance with the findings of Caro et al, 2 who detected delayed Hoffmann reflexes in 35% of PFM. Delayed Hoffmann reflexes may be due to sensory S1 radiculopathy.…”

Section: Dovepresssupporting

confidence: 92%

“…Up to 94% of patients with FM (PFM) present with neurological complaints, such as paresthesia (prickling, needles, numbness), electric shocks and bursts, evoked pain when wearing tight clothes or when touching the skin, hot and burning pain sensations, sensitivity to temperature, severe pressure pain, and weakness in the arms and legs. [1][2][3] Moreover, in PFM, multiple objective neurological symptoms can be detected, such as sensory abnormalities (impairments in vibration, temperature, or pinprick sensation), elevated temperature and mechanical detection thresholds, muscle weakness, poor balance, and walking difficulties (sensory ataxia). 1,2,[4][5][6][7][8] Since 2013, microscopic studies of skin biopsies, corneal confocal microscopy and electrodiagnostic (EDX) studies have detected small fiber neuropathy (SFNP) in up to 50% of PFM.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Moreover, in PFM, multiple objective neurological symptoms can be detected, such as sensory abnormalities (impairments in vibration, temperature, or pinprick sensation), elevated temperature and mechanical detection thresholds, muscle weakness, poor balance, and walking difficulties (sensory ataxia). 1,2,[4][5][6][7][8] Since 2013, microscopic studies of skin biopsies, corneal confocal microscopy and electrodiagnostic (EDX) studies have detected small fiber neuropathy (SFNP) in up to 50% of PFM. 5,6,[9][10][11][12][13][14] Recently, EDX evidence for large nerve involvement in 90% of PFM was reported.…”

Section: Introductionmentioning

confidence: 99%

“…5,6,[9][10][11][12][13][14] Recently, EDX evidence for large nerve involvement in 90% of PFM was reported. 2 Previously, we hypothesized that at least some FM cases may be caused by moderately longstanding or intermittently increased cerebrospinal fluid pressure, forcing cerebrospinal fluid (CSF) into the nerve root sheaths. This increased pressure inside the nerve root sheaths may irritate or damage the nerve root fibers and the sensory neurons in the dorsal root ganglion (DRG), causing widespread radicular pain.…”

Section: Introductionmentioning

confidence: 99%

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<p>Electrodiagnostic Abnormalities Associated with Fibromyalgia</p>

Hulens¹,

Bruyninckx²,

Rasschaert³

et al. 2020

JPR

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Increasing evidence suggests that fibromyalgia most likely represents a neurological dysfunction. We previously hypothesized that at least some fibromyalgia cases may be caused by irritation of nerve root fibers and sensory neurons due to moderately increased cerebrospinal pressure. Because of the rostro-caudal hydrostatic pressure gradient, neurogenic abnormalities are expected to be most pronounced in sacral nerve roots. The purpose was to review electrodiagnostic tests of patients with fibromyalgia. Methods: A retrospective review of electrodiagnostic test results, including the lumbar and sacral nerve root myotomes of patients diagnosed with fibromyalgia according to the 1990 criteria of the American College of Rheumatology was done. Results: All 17 patients were female. Sural nerve responses could not be elicited in 12% and S1-Hoffmann reflex latencies were increased in 41%. In 12% of the patients, fibular motor nerve distal latency and conduction velocity were outside normal limits. Needle-EMG revealed neurogenic motor unit potentials in 0% of L2, 6% of L3, 29% of L4, 71% of L5, 47% of S1, 94% of S2, and 76% of S3-S4 myotomes. S3-S4 nerve-supplied anal reflexes were delayed in 94%. Conclusion: This is the first time that electrodiagnostic data of both lumbar and sacral nerve root myotomes in fibromyalgia patients are presented. All patients showed neurogenic abnormalities that were more pronounced in the sacral than in the lumbar myotomes with a rather patchy distribution pattern. We propose that, in addition to skin punch biopsies to assess small fiber neuropathy, assessment of the anal reflex may be a useful part of the diagnostic pathway in patients with fibromyalgia.

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Section: Dovepresssupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Electrodiagnostic Abnormalities Associated with Fibromyalgia</p>

Hulens¹,

Bruyninckx²,

Rasschaert³

et al. 2020

JPR

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“…We are not aware of any other study reporting systemic neuropathy in patients with gout. In contrast, for patients with fibromyalgia, one study has reported the prevalence of PNP near 90%; also small fiber neuropathy has been reported . Despite the small numbers of patients in our study we suggest that patients with fibromyalgia and neuropathic symptoms be investigated for peripheral neuropathy.…”

Section: Discussioncontrasting

confidence: 73%

Peripheral neuropathies in rheumatic diseases: More diverse and frequent than expected. A cross‐sectional study

et al. 2019

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Background/objective Peripheral neuropathies (PN) are heterogeneous nerve disorders; frequently rheumatic patients have neuropathic symptoms. In some rheumatic diseases (RD) PN are secondary to nerve compression while others are related to metabolic abnormalities, inflammation or vasculitis. Our aim was to explore the frequency of neuropathic symptoms with three neuropathy questionnaires (NQ) and nerve conduction studies (NCS) in RD. Methods This is a cross‐sectional study in patients with any RD attending for the first time to a rheumatology outpatient clinic. We included all patients who accepted to participate and who answered three NQ and received a physical evaluation. Twenty patients were randomly selected to perform NCS and 10 healthy subjects were included as controls. The topographic diagnoses were: mononeuropathy, multiplex mononeuropathy, and/or polyneuropathy. Statistical analysis: descriptive statistics (mean, median, standard deviation, interquartile range and frequency, odds ratios and Pearson correlation test). Results One hundred patients and 10 healthy subjects were included. Sixty‐nine were female, mean age 40.6 ± 15.7 years. Rheumatic diagnoses were: systemic lupus erythematosus (26%), rheumatoid arthritis (16%), gout (14%), and osteoarthritis (11%). Fifty‐two patients had neuropathic signs during physical examination and 67% had positive questionnaires with variable scores among several RD. Abnormal NCS was reported in 14 patients (70%): 6 (42.8%) median nerve mononeuropathies, 4 (28.5%) multiplex mononeuropathies and 4 (28.5%) polyneuropathies. None of the healthy subjects had neuropathy (NQ, physical evaluation, or NCS). Risk of being NCS positive is higher when the patients were NQ positive. Conclusion PN has variable distribution and high frequency in patients with RD; NQ+ increases the risk of presenting NCS+ for PN.

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