Pub Date : 2025-12-04DOI: 10.1016/j.neucli.2025.103124
Katy Jerčinović , Katarina Tešija , Mašan Sredanović , Ivan Adamec , Tereza Gabelić , Barbara Barun , Magdalena Krbot Skorić , Mario Habek
Objective
To characterize sweating issues in people with multiple sclerosis (pwMS) using the Quantitative Sudomotor Axon Reflex Test (QSART) and SUDOSCAN.
Methods
In 75 pwMS, sweating symptoms were evaluated using the Composite Autonomic Symptom Score (COMPASS-31). Sweating function was assessed with QSART and SUDOSCAN.
Results
Symptomatic sweating problems were observed in 22 (29.3 %) pwMS. Pathological results of the QSART (sudomotor index (SI) >0) were identified in 13 (17.3 %) pwMS, while SUDOSCAN results showed pathology in 8 (10.7 %) pwMS. We found a positive correlation between the QSART volume of the foot and the SUDOSCAN electrochemical skin conductance (ESC) results for the corresponding leg (r = 0.282, p = 0.015). pwMS with cervical spinal cord lesions had higher ESC values for the hand mean, left, and right (69.88±12.84 vs 76.15±9.29, p = 0.022; 69.88±12.82 vs 76.22±9.36, p = 0.021; and 70.33±13.00 vs 76.52±9.27, p = 0.024; respectively).
Conclusions
People with MS frequently experience sweating problems. Using various methods to identify sweating issues in pwMS reveals differences in the causes of these problems in pwMS.
目的利用定量Sudomotor轴突反射试验（QSART）和SUDOSCAN分析多发性硬化症（pwMS）患者的出汗问题。方法采用自主神经症状综合评分（COMPASS-31）对75例pwMS患者的出汗症状进行评价。采用QSART和SUDOSCAN评估排汗功能。结果22例（29.3%）患者出现有症状的出汗问题。QSART （sudomotor index (SI) >0）的病理结果在13例（17.3%）的pwMS中被发现，而SUDOSCAN结果在8例（10.7%）的pwMS中被发现。我们发现足部的QSART体积与相应腿部的SUDOSCAN电化学皮肤电导（ESC）结果呈正相关（r = 0.282, p = 0.015）。pwMS伴颈脊髓病变患者的手、左、右平均ESC值较高（69.88±12.84 vs 76.15±9.29,p = 0.022; 69.88±12.82 vs 76.22±9.36,p = 0.021; 70.33±13.00 vs 76.52±9.27,p = 0.024）。结论多发性硬化症患者经常出现出汗问题。使用各种方法来识别pwMS中的出汗问题，揭示了pwMS中这些问题的原因的差异。
{"title":"Characterizing sweating problems in multiple sclerosis: insights from QSART, SUDOSCAN, and COMPASS-31","authors":"Katy Jerčinović , Katarina Tešija , Mašan Sredanović , Ivan Adamec , Tereza Gabelić , Barbara Barun , Magdalena Krbot Skorić , Mario Habek","doi":"10.1016/j.neucli.2025.103124","DOIUrl":"10.1016/j.neucli.2025.103124","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize sweating issues in people with multiple sclerosis (pwMS) using the Quantitative Sudomotor Axon Reflex Test (QSART) and SUDOSCAN.</div></div><div><h3>Methods</h3><div>In 75 pwMS, sweating symptoms were evaluated using the Composite Autonomic Symptom Score (COMPASS-31). Sweating function was assessed with QSART and SUDOSCAN.</div></div><div><h3>Results</h3><div>Symptomatic sweating problems were observed in 22 (29.3 %) pwMS. Pathological results of the QSART (sudomotor index (SI) >0) were identified in 13 (17.3 %) pwMS, while SUDOSCAN results showed pathology in 8 (10.7 %) pwMS. We found a positive correlation between the QSART volume of the foot and the SUDOSCAN electrochemical skin conductance (ESC) results for the corresponding leg (<em>r</em> = 0.282, <em>p</em> = 0.015). pwMS with cervical spinal cord lesions had higher ESC values for the hand mean, left, and right (69.88±12.84 vs 76.15±9.29, <em>p</em> = 0.022; 69.88±12.82 vs 76.22±9.36, <em>p</em> = 0.021; and 70.33±13.00 vs 76.52±9.27, <em>p</em> = 0.024; respectively).</div></div><div><h3>Conclusions</h3><div>People with MS frequently experience sweating problems. Using various methods to identify sweating issues in pwMS reveals differences in the causes of these problems in pwMS.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"56 1","pages":"Article 103124"},"PeriodicalIF":2.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.neucli.2025.103122
Oliver Bichsel , Stephen Bacchi , Mehdi Hajiabadi , Franziska Schmidt , Lennart Stieglitz
Objectives
Increased beta-oscillations (13–35 Hz) in the basal ganglia have been linked to Parkinsonian motor symptoms. Deep brain stimulation (DBS) approaches have been proposed to mitigate pathological beta-activity, with some leading to a global suppression of this activity and others selectively trimming beta-bursts leading to a redistribution of beta-bursts towards shorter, more physiological, durations. Recently, DBS electrode-guided neurofeedback has been explored as an alternative, endogenous technique enabling patients to acquire mental strategies to modulate ongoing subthalamic beta-activity. Here, we investigated the effect of DBS-neurofeedback on beta-burst prevalence, amplitude, and duration.
Methods
We characterised the local field potential (LFP) in the subthalamic nucleus (STN) in terms of beta-burst prevalence, amplitude and length during DBS electrode-guided neurofeedback-modulation of ongoing subthalamic beta-activity.
Results
We previously showed that a cohort of eight Parkinson’s disease (PD) patients with externalised DBS electrodes was able to volitionally control ongoing beta-oscillatory activity by visual neurofeedback within minutes of training, which was also accompanied by an improvement in motor performance. Here, we additionally demonstrate a decrease in beta-burst (> 0.1 s) durations, amplitude and prevalence when transitioning from rest to downregulation after neurofeedback-learning. In addition, downregulation vs. upregulation also resulted in shorter and lower amplitude beta-bursts (>0.1 s) after neurofeedback.
Discussion
DBS electrode-guided neurofeedback enabled patients with PD to exert control over subthalamic beta-oscillations, with downregulation in particular leading to a redistribution of beta-burst characteristics towards more physiological states. This technique may represent a complementary approach to existing DBS strategies by providing patients with an endogenous means of modulating pathological beta-activity.
{"title":"The effect of beta-neurofeedback on beta-bursts in Parkinson’s disease patients as evidenced through deep brain recordings","authors":"Oliver Bichsel , Stephen Bacchi , Mehdi Hajiabadi , Franziska Schmidt , Lennart Stieglitz","doi":"10.1016/j.neucli.2025.103122","DOIUrl":"10.1016/j.neucli.2025.103122","url":null,"abstract":"<div><h3>Objectives</h3><div>Increased beta-oscillations (13–35 Hz) in the basal ganglia have been linked to Parkinsonian motor symptoms. Deep brain stimulation (DBS) approaches have been proposed to mitigate pathological beta-activity, with some leading to a global suppression of this activity and others selectively trimming beta-bursts leading to a redistribution of beta-bursts towards shorter, more physiological, durations. Recently, DBS electrode-guided neurofeedback has been explored as an alternative, endogenous technique enabling patients to acquire mental strategies to modulate ongoing subthalamic beta-activity. Here, we investigated the effect of DBS-neurofeedback on beta-burst prevalence, amplitude, and duration.</div></div><div><h3>Methods</h3><div>We characterised the local field potential (LFP) in the subthalamic nucleus (STN) in terms of beta-burst prevalence, amplitude and length during DBS electrode-guided neurofeedback-modulation of ongoing subthalamic beta-activity.</div></div><div><h3>Results</h3><div>We previously showed that a cohort of eight Parkinson’s disease (PD) patients with externalised DBS electrodes was able to volitionally control ongoing beta-oscillatory activity by visual neurofeedback within minutes of training, which was also accompanied by an improvement in motor performance. Here, we additionally demonstrate a decrease in beta-burst (> 0.1 s) durations, amplitude and prevalence when transitioning from rest to downregulation after neurofeedback-learning. In addition, downregulation vs. upregulation also resulted in shorter and lower amplitude beta-bursts (>0.1 s) after neurofeedback.</div></div><div><h3>Discussion</h3><div>DBS electrode-guided neurofeedback enabled patients with PD to exert control over subthalamic beta-oscillations, with downregulation in particular leading to a redistribution of beta-burst characteristics towards more physiological states. This technique may represent a complementary approach to existing DBS strategies by providing patients with an endogenous means of modulating pathological beta-activity.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"56 1","pages":"Article 103122"},"PeriodicalIF":2.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.neucli.2025.103120
Ah-hyeon Kim , Ga Yang Shim , Yunsoo Soh , Myung Chul Yoo
Introduction
The House-Brackmann grading system exhibits inherent subjectivity despite widespread clinical adoption. Although electrophysiological assessments provide objective neurophysiological data, their correlation with initial clinical severity remains inadequately characterized in large-scale cohorts with standardized methodologies. This study aimed to evaluate the diagnostic utility of electrodiagnostic parameters in determining initial severity among Bell's palsy patients.
Methods
This retrospective study analyzed 3219 patients with unilateral Bell's palsy who underwent electrodiagnostic testing within 14 days of symptom onset. Patients were stratified using House-Brackmann (H-B) grades into mild (2–3) and moderate-to-severe (4–6) groups. Five electrophysiological parameters were evaluated: electroneurography degeneration index (ENoG DI), motor unit action potential (MUAP) interference patterns, compound muscle action potential latency, blink reflex, and abnormal spontaneous activity. Associations were analyzed using logistic regression and ROC analyses.
Results
ENoG DI and MUAP interference patterns in orbicularis oculi showed strongest association with initial H-B grade (area under curve = 0.75). Patients with moderate-to-severe paralysis (H-B grades 4–6) had significantly higher prevalence of severe axonal degeneration (ENoG DI ≥ 90 %) compared to mild paralysis (34.9 % vs. 8.3 %, p < 0.0001). MUAP interference grades ≤3 were strongly associated with increased severity.
Conclusion
ENoG DI and MUAP interference patterns serve as reliable early electrophysiological indicators of facial paralysis severity, providing objective markers for patient stratification. These findings establish standardized electrodiagnostic criteria for severity assessment, enabling evidence-based early rehabilitation decisions in Bell's palsy management.
简介：House-Brackmann评分系统表现出固有的主观性，尽管广泛的临床应用。尽管电生理评估提供了客观的神经生理学数据，但在采用标准化方法的大规模队列研究中，电生理评估与初始临床严重程度的相关性仍不充分。本研究旨在评估电诊断参数在贝尔麻痹患者中确定初始严重程度的诊断效用。方法：回顾性分析3219例单侧贝尔麻痹患者在症状出现后14天内进行电诊断试验。采用House-Brackmann （H-B）分级将患者分为轻度（2-3）和中度至重度（4-6）组。评估五项电生理参数：神经电图变性指数（ENoG DI）、运动单位动作电位（MUAP）干扰模式、复合肌肉动作电位潜伏期、眨眼反射和异常自发活动。采用logistic回归和ROC分析分析相关性。结果：ENoG DI和MUAP干涉模式与眼轮匝肌初始H-B分级相关性最强（曲线下面积= 0.75）。中重度瘫痪患者（H-B分级4-6）的严重轴突变性患病率（ENoG DI≥90%）明显高于轻度瘫痪患者（34.9% vs. 8.3%, p < 0.0001）。MUAP干扰等级≤3与严重程度增加密切相关。结论：ENoG DI和MUAP干扰模式可作为判断面瘫严重程度的可靠早期电生理指标，为患者分层提供客观标志。这些发现为严重程度评估建立了标准化的电诊断标准，为贝尔麻痹管理提供了基于证据的早期康复决策。
{"title":"Diagnostic value of electrodiagnostic parameters for assessing initial severity in Bell’s Palsy: A retrospective study of 3219 patients","authors":"Ah-hyeon Kim , Ga Yang Shim , Yunsoo Soh , Myung Chul Yoo","doi":"10.1016/j.neucli.2025.103120","DOIUrl":"10.1016/j.neucli.2025.103120","url":null,"abstract":"<div><h3>Introduction</h3><div>The House-Brackmann grading system exhibits inherent subjectivity despite widespread clinical adoption. Although electrophysiological assessments provide objective neurophysiological data, their correlation with initial clinical severity remains inadequately characterized in large-scale cohorts with standardized methodologies. This study aimed to evaluate the diagnostic utility of electrodiagnostic parameters in determining initial severity among Bell's palsy patients.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 3219 patients with unilateral Bell's palsy who underwent electrodiagnostic testing within 14 days of symptom onset. Patients were stratified using House-Brackmann (H-B) grades into mild (2–3) and moderate-to-severe (4–6) groups. Five electrophysiological parameters were evaluated: electroneurography degeneration index (ENoG DI), motor unit action potential (MUAP) interference patterns, compound muscle action potential latency, blink reflex, and abnormal spontaneous activity. Associations were analyzed using logistic regression and ROC analyses.</div></div><div><h3>Results</h3><div>ENoG DI and MUAP interference patterns in orbicularis oculi showed strongest association with initial H-B grade (area under curve = 0.75). Patients with moderate-to-severe paralysis (H-B grades 4–6) had significantly higher prevalence of severe axonal degeneration (ENoG DI ≥ 90 %) compared to mild paralysis (34.9 % vs. 8.3 %, <em>p</em> < 0.0001). MUAP interference grades ≤3 were strongly associated with increased severity.</div></div><div><h3>Conclusion</h3><div>ENoG DI and MUAP interference patterns serve as reliable early electrophysiological indicators of facial paralysis severity, providing objective markers for patient stratification. These findings establish standardized electrodiagnostic criteria for severity assessment, enabling evidence-based early rehabilitation decisions in Bell's palsy management.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"55 6","pages":"Article 103120"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.neucli.2025.103119
Lina Jeantin , Louis Cousyn , Vincent Navarro , Vi-Huong Nguyen-Michel
Sleep disturbances in anti-NMDAR encephalitis evolve dynamically across disease phases. We monitored a patient longitudinally from the acute phase through remission, relapse, and recovery, using video-EEG and polysomnography. No sleep complaints were reported during the prodromal phase, whereas coma was characterized by rhythmic theta-delta activity devoid of sleep patterns. Sleep stages gradually emerged after teratoma removal and immunotherapy, paralleling clinical improvement. A second teratoma caused relapse with severe sleep disruption and agrypnia excitata, then residual status dissociatus persisted before normalization. Sleep changes mirrored disease progression, suggesting that sleep patterns may serve as biomarkers and potential therapeutic targets in anti-NMDAR encephalitis.
{"title":"Dynamics of sleep-wake cycles and architecture in anti-NMDAR encephalitis","authors":"Lina Jeantin , Louis Cousyn , Vincent Navarro , Vi-Huong Nguyen-Michel","doi":"10.1016/j.neucli.2025.103119","DOIUrl":"10.1016/j.neucli.2025.103119","url":null,"abstract":"<div><div>Sleep disturbances in anti-NMDAR encephalitis evolve dynamically across disease phases. We monitored a patient longitudinally from the acute phase through remission, relapse, and recovery, using video-EEG and polysomnography. No sleep complaints were reported during the prodromal phase, whereas coma was characterized by rhythmic theta-delta activity devoid of sleep patterns. Sleep stages gradually emerged after teratoma removal and immunotherapy, paralleling clinical improvement. A second teratoma caused relapse with severe sleep disruption and <em>agrypnia excitata</em>, then residual <em>status dissociatus</em> persisted before normalization. Sleep changes mirrored disease progression, suggesting that sleep patterns may serve as biomarkers and potential therapeutic targets in anti-NMDAR encephalitis.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"55 6","pages":"Article 103119"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.neucli.2025.103112
Bade Güleç , Melda Acar , Yeşim Oruç , Ceren Aliş , Melih Tütüncü , Ayşegül Gündüz , Eyyüp Kara , Rişvan Deniz , Ahmet Özdoğan , Feray Karaali Savrun , Nurten Uzun Adatepe , Ahmet Ataş
Aims
Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by progressive motor neuron degeneration, leading to symmetrical proximal weakness, bulbar dysfunction, and respiratory involvement. Although extraocular muscles (EOMs) are typically spared, there are conflicting reports regarding oculomotor abnormalities in SMA. This study aimed comprehensively to assess eye movement function in patients with SMA types II and III using videonystagmography (VNG).
Methods
We included 18 SMA patients and 21 healthy subjects of similar ages and sexes. All participants underwent an otoscopic/audiological examination before the VNG recording. In VNG testing, we analyzed and compared optokinetic nystagmus (OKN), saccade parameters, and smooth pursuit movement (SPM) gain.
Results
There were no statistical differences between the OKN gain and saccade velocity between groups. There was a lower percentage of saccade accuracy in the SMA group than in the control group (p = 0.017). SPM gain was lower in the SMA group than in the control group (p < 0.0001). The correlation analyses revealed a positive correlation between age and saccade latency (r = 0.613, p < 0.0001) and a negative correlation between age and SPM gain (r = -0.487, p = 0.003).
Discussion
In this study, we performed a comprehensive evaluation of eye movement function with VNG in patients with SMA. Our findings indicate that while extraocular muscles remain unaffected in SMA, subtle central oculomotor control abnormalities—likely involving supranuclear and/or cerebellar pathways—may accompany the disease and can be quantitatively detected using VNG.
目的：脊髓性肌萎缩症（SMA）是一种遗传性神经肌肉疾病，以进行性运动神经元变性为特征，导致对称性近端无力、球功能障碍和呼吸受累。虽然眼外肌（EOMs）通常不受影响，但关于SMA的动眼肌异常有相互矛盾的报道。本研究旨在利用视频眼震图（VNG）全面评估II型和III型SMA患者的眼动功能。方法：纳入18例SMA患者和21例年龄、性别相近的健康受试者。所有参与者在VNG记录前都进行了耳镜/听力学检查。在VNG测试中，我们分析和比较了光动性眼球震颤（OKN）、扫视参数和平滑追踪运动（SPM）增益。结果：两组间OKN增益和扫视速度无统计学差异。SMA组的扫视准确率低于对照组（p = 0.017）。SMA组的SPM增益低于对照组（p < 0.0001）。相关分析显示，年龄与扫视潜伏期呈正相关（r = 0.613, p < 0.0001），年龄与SPM增益呈负相关（r = -0.487, p = 0.003）。讨论：在本研究中，我们使用VNG对SMA患者的眼动功能进行了综合评估。我们的研究结果表明，尽管SMA患者眼外肌不受影响，但细微的中枢动眼肌控制异常（可能涉及核上和/或小脑通路）可能伴随该疾病，并可通过VNG定量检测。
{"title":"Central eye movement abnormalities in patients with SMA types II and III","authors":"Bade Güleç , Melda Acar , Yeşim Oruç , Ceren Aliş , Melih Tütüncü , Ayşegül Gündüz , Eyyüp Kara , Rişvan Deniz , Ahmet Özdoğan , Feray Karaali Savrun , Nurten Uzun Adatepe , Ahmet Ataş","doi":"10.1016/j.neucli.2025.103112","DOIUrl":"10.1016/j.neucli.2025.103112","url":null,"abstract":"<div><h3>Aims</h3><div>Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by progressive motor neuron degeneration, leading to symmetrical proximal weakness, bulbar dysfunction, and respiratory involvement. Although extraocular muscles (EOMs) are typically spared, there are conflicting reports regarding oculomotor abnormalities in SMA. This study aimed comprehensively to assess eye movement function in patients with SMA types II and III using videonystagmography (VNG).</div></div><div><h3>Methods</h3><div>We included 18 SMA patients and 21 healthy subjects of similar ages and sexes. All participants underwent an otoscopic/audiological examination before the VNG recording. In VNG testing, we analyzed and compared optokinetic nystagmus (OKN), saccade parameters, and smooth pursuit movement (SPM) gain.</div></div><div><h3>Results</h3><div>There were no statistical differences between the OKN gain and saccade velocity between groups. There was a lower percentage of saccade accuracy in the SMA group than in the control group (<em>p</em> = 0.017). SPM gain was lower in the SMA group than in the control group (<em>p</em> < 0.0001). The correlation analyses revealed a positive correlation between age and saccade latency (<em>r</em> = 0.613, <em>p</em> < 0.0001) and a negative correlation between age and SPM gain (<em>r</em> = -0.487, <em>p</em> = 0.003).</div></div><div><h3>Discussion</h3><div>In this study, we performed a comprehensive evaluation of eye movement function with VNG in patients with SMA. Our findings indicate that while extraocular muscles remain unaffected in SMA, subtle central oculomotor control abnormalities—likely involving supranuclear and/or cerebellar pathways—may accompany the disease and can be quantitatively detected using VNG.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"55 6","pages":"Article 103112"},"PeriodicalIF":2.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145302554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the diagnostic utility of distal sural (DSUR) sensory responses and amplitude ratios compared with conventional proximal sural (PSUR) studies in diabetic polyneuropathy (DPN).
Methods
Fifty-eight patients with diabetes and clinical evidence of polyneuropathy (neuropathic symptoms and/or signs, median Neuropathy Impairment Score of the Lower Limbs (NIS-LL) score 6 [IQR 2–8]) and 44 healthy controls underwent bilateral nerve conduction studies of the PSUR and DSUR, and the right radial nerve. Amplitudes, conduction velocities (CV), and amplitude ratios [sural-to-radial amplitude ratio (SRAR), distal sural-to-radial amplitude ratio (DSRAR), and proximal-to-distal sural amplitude ratio (PDSR)] were analysed.
Results
PSUR and DSUR amplitudes were significantly lower and conduction velocities slower in patients compared with controls (p < 0.001). DSUR amplitude achieved diagnostic accuracy comparable to PSUR amplitude (AUC 0.762 vs. 0.775), with higher sensitivity (58.5% vs. 41.5 %) and preserved specificity (91 % vs. 93%). SRAR and DSRAR were reduced in patients, but their diagnostic performance was modest (AUC < 0.65). PDSR did not differ significantly between groups (p > 0.05) and was therefore not included in ROC analysis. Amplitude ratios showed weak correlations with diabetes duration, vibration threshold, and NIS-LL.
Conclusion
DSUR amplitude is a feasible and reliable parameter that increases sensitivity in the electrophysiological detection of DPN while maintaining high specificity. In contrast, PDSR did not provide significant diagnostic value, suggesting that absolute amplitude measures are more informative than ratio-based indices in routine clinical practice.
{"title":"Comparison of sural and distal sural nerve responses: Diagnostic role of the amplitude ratio in diabetic polyneuropathy","authors":"Canan Duman İlki , Ege Çadırcı , Zerin Özaydın Aksun , Esra Eraslan Aydemir , Asena Gökçay Canpolat , Hüseyin Özden Şener","doi":"10.1016/j.neucli.2025.103114","DOIUrl":"10.1016/j.neucli.2025.103114","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the diagnostic utility of distal sural (DSUR) sensory responses and amplitude ratios compared with conventional proximal sural (PSUR) studies in diabetic polyneuropathy (DPN).</div></div><div><h3>Methods</h3><div>Fifty-eight patients with diabetes and clinical evidence of polyneuropathy (neuropathic symptoms and/or signs, median Neuropathy Impairment Score of the Lower Limbs (NIS-LL) score 6 [IQR 2–8]) and 44 healthy controls underwent bilateral nerve conduction studies of the PSUR and DSUR, and the right radial nerve. Amplitudes, conduction velocities (CV), and amplitude ratios [sural-to-radial amplitude ratio (SRAR), distal sural-to-radial amplitude ratio (DSRAR), and proximal-to-distal sural amplitude ratio (PDSR)] were analysed.</div></div><div><h3>Results</h3><div>PSUR and DSUR amplitudes were significantly lower and conduction velocities slower in patients compared with controls (<em>p</em> < 0.001). DSUR amplitude achieved diagnostic accuracy comparable to PSUR amplitude (AUC 0.762 vs. 0.775), with higher sensitivity (58.5% vs. 41.5 %) and preserved specificity (91 % vs. 93%). SRAR and DSRAR were reduced in patients, but their diagnostic performance was modest (AUC < 0.65). PDSR did not differ significantly between groups (<em>p</em> > 0.05) and was therefore not included in ROC analysis. Amplitude ratios showed weak correlations with diabetes duration, vibration threshold, and NIS-LL.</div></div><div><h3>Conclusion</h3><div>DSUR amplitude is a feasible and reliable parameter that increases sensitivity in the electrophysiological detection of DPN while maintaining high specificity. In contrast, PDSR did not provide significant diagnostic value, suggesting that absolute amplitude measures are more informative than ratio-based indices in routine clinical practice.</div></div>","PeriodicalId":19134,"journal":{"name":"Neurophysiologie Clinique/Clinical Neurophysiology","volume":"55 6","pages":"Article 103114"},"PeriodicalIF":2.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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