Role of Pain-Related Evoked Potential in the Diagnosis of Meralgia Paresthetica

Shaikh, Atif; Das, Monika; Roy, Anupama; Baby, Bini; Dhar, Dolcy; Abigayil, Jebalin; Varghese, Vitty Susan; Mathew, Vivek; Aaron, Sanjith; Sivadasan, Ajith; Premkumar, Paul; Suresh, Tharan; Prabhakar, Appaswamy Thirumal

doi:10.4103/aian.aian_441_20

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…There is currently interest in developing PREPs with noninvasive electrical stimulation for indexing nociceptive Aδ fibers. Utility of the concentric planar electrode has been reported in the screening of mixed and single fiber polyneuropathies, 54 meralgia paraesthesica, 55 and central nervous system disease. 56 Work is in progress to improve techniques to activate Aδ fibers.…”

Section: Discussionmentioning

confidence: 99%

Pain-Related Vertex Evoked Potentials. Comparison of Surface Electrical to Heat Stimulation

Guiloff

Campero

Barraza

et al. 2022

Journal of Clinical Neurophysiology

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Introduction: Demonstration of nociceptive fiber abnormality is important for diagnosing neuropathic pain and small fiber neuropathies. This is usually assessed by brief heat pulses using lasers, contact heat, or special electrodes. We hypothesized that pain-related evoked potentials to conventional surface electrical stimulation (PREPse) can index Ad afferences despite tactile Aß fibers coactivation. PREPse may be more readily used clinically than contact heat evoked potentials (CHEPS).Methods: Twenty-eight healthy subjects. Vertex (Cz-A1/A2) recordings. Electrical stimulation of middle finger and second toe with conventional ring, and forearm/leg skin with cup, electrodes. Contact heat stimulation to forearm and leg. Compression ischemic nerve blockade.Results: PREPse peripheral velocities were within the midrange of Ad fibers. N1-P1 amplitude increased with pain numerical rating scale graded (0-10) electrical stimulation (n ¼ 25) and decreased with increasing stimulation frequency. Amplitudes were unchanged by different presentation orders of four stimulation intensities. PREPse N1 (w130 milliseconds) and N2 (w345 milliseconds) peaks were approximately 40 milliseconds earlier than that with CHEPS. PREPse and CHEPS N1-N2 interpeak latency (w207 milliseconds) were similar. PREPse became unrecordable with nerve blockade of Ad fibers.Conclusions: PREPse earlier N1 and N2 peaks, and similar interpeak N1-N2 latencies and central conduction velocities, or synaptic delays, to CHEPS are consistent with direct stimulation of Ad fibers. The relation of vertex PREPse amplitude and pain, or the differential effects of frequency stimulation, is similar to pain-related evoked potential to laser, special electrodes, or contact heat stimulation. The relationship to Ad was validated by conduction velocity and nerve block. Clinical utility of PREPse compared with CHEPS needs validation in somatosensory pathways lesions.

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Section: Discussionmentioning

confidence: 99%

Pain-Related Vertex Evoked Potentials. Comparison of Surface Electrical to Heat Stimulation

Guiloff

Campero

Barraza

et al. 2022

Journal of Clinical Neurophysiology

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“…In the study conducted by Shaikh AI and colleagues [6], it was interpreted that the role of pain can be recorded related to somatosensory-evoked potentials (SSEPs) in the diagnosis of paresthesia meralgia and, in addition, show latency in the electrophysiological study [7,8]. For a better sensitivity and specificity of the test, it is necessary to carry out the test by an experienced • Sequels of surgery: Orthopedist surgeries involving the pelvis may damage the nerve due to anatomical variations.…”

Section: Meralgia Parestheticamentioning

confidence: 99%

Differential Etiological Diagnosis of Meralgia Paresthetica: A Concise Review

Pereira¹,

Stefhani²,

Fanine³

et al. 2023

Int J Neurol Neurother

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Paresthesia meralgia (MP) is a condition in which there is compression of the lateral femoral cutaneous nerve (LFCN), with its entrapment. Clinically presents with burning pain and dysesthesia in the anterolateral region of the thigh. Due to the multiple etiological diagnoses different from MP, this review aims to show systemic and non-systemic causes and also explains some tests of the condition. This article is a non-systematic review. All articles used were researched in the public databases PubMed, Medline, ScienceDirect, SciELO and Cochrane. The process of locating these articles was done by searching for terms related to paresthesia meralgia, selecting the most relevant articles available in English or Portuguese. The presentation of MP is usually unilateral, with subacute onset (days to weeks), and may be associated with prolonged hip extension, in addition to flexion relief. There is a wide spectrum of non-systemic diseases that may be responsible for the development of paresthetic meralgia, ranging from surgical sequelae and direct mechanical nerve compression. In addition, diabetes mellitus and Covid-19 infection may be systemic causes of MP. Diabetes mellitus is associated with endothelial dysfunction and peripheral neuropathy. Covid-19 increases the inflammatory state and consequent pain of the intensive care unit patient causing neurological sequelae. In sum, the etiological diagnosis of MP is important, since the treatment varies according to the cause of this neuropathy. In addition, it helps to rationalize the process of diagnosis, investigation, treatment and follow-up of these patients.

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“…However, both studies recommend the association of SSEP and sensory NCS for a comprehensive and accurate assessment of MP patients. PREP is a relatively new technique, having an AUC = 0.97, with a sensitivity of 91.7% and a specificity of 100% for MP diagnosis [67]. Thus, although sensory NCS studies were considered to be superior EDX methods, recent studies have concluded that modern techniques such as SSEP and PREP provide better accuracy [66,67].…”

Section: Electrodiagnostic and Imaging Techniquesmentioning

confidence: 99%

Diagnostic Approach to Lower Limb Entrapment Neuropathies: A Narrative Literature Review

Drăghici,

Văcăraș,

Bolchis

et al. 2023

Diagnostics

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Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases.

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Role of Pain-Related Evoked Potential in the Diagnosis of Meralgia Paresthetica

Cited by 5 publications

References 12 publications

Pain-Related Vertex Evoked Potentials. Comparison of Surface Electrical to Heat Stimulation

Pain-Related Vertex Evoked Potentials. Comparison of Surface Electrical to Heat Stimulation

Differential Etiological Diagnosis of Meralgia Paresthetica: A Concise Review

Diagnostic Approach to Lower Limb Entrapment Neuropathies: A Narrative Literature Review

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