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Anita Mahadevan - One of the best experts on this subject based on the ideXlab platform.

  • Neuropathy in elderly: lessons learnt from Nerve Biopsy.
    Age and ageing, 2014
    Co-Authors: Lawrence Anish, Madhu Nagappa, Anita Mahadevan, Arun B. Taly
    Abstract:

    Objective: To study the utilityof Nerve Biopsy in providing diagnostic, therapeutic or prognostic information that aid in clinical management in elderly subjects with peripheral neuropathy. Methods: Clinico-pathological data of 100 elderly subjects aged 65 and above with peripheral neuropathy who underwent Nerve Biopsy in the last decade (2002–2011) was reviewed. Results: The study included 100 subjects (M : F 78 : 22). Mean age at Biopsy and symptom duration was 69.62 ± 4.8 years and 24.17 ± 40.4 months, respectively. The most common pattern of was distal symmetric sensorimotor polyneuropathy (35%), followed by multiple mononeuropathy (29%) and asymmetric sensorimotor neuropathy (15%). The Nerve Biopsy was ‘diagnostic’ in 24%, (definite vasculitis in 12, leprosy in 10 and acute inflammatory demyelinating polyradiculoneuropathy in 2) and proved ‘essential’ or ‘helpful’ in therapeutic management in 81% subjects. In 60 (60%) patients, where a pre-Biopsy aetiological diagnosis could be arrived at based on the available data, Nerve Biopsy confirmed the diagnosis in 29 of 60 (48.3%), and offered a new diagnosis in 25 (41.7%). A higher yield of Biopsy was noted in subjects with asymmetric/multiple mononeuropathy compared with symmetric neuropathies (32.7% versus 17.7%). In 40 (40%) patients without a pre-Biopsy aetiological diagnosis, Nerve Biopsy was ‘essential’ in 7 of 40 (17.5%) as it provided a definitive diagnosis (definite vasculitis: 5, leprosy: 2), and ‘helpful’ in 21 of 40 (52.5%) (ischaemic neuropathy: 10, possible vasculitis: 9, probable vasculitis: 2). Conclusion: Nerve Biopsy aided in the detection of potentially treatable disorders and influenced patient management in a significant proportion of elderly subjects with peripheral neuropathy (81%), particularly in subset with undiagnosed neuropathies confirming that it’s a useful tool in diagnosis of neuropathy in the elderly. With minor differences, the aetiological profile in our biopsied neuropathic elderly subjects may reflect the findings in other similar cohorts.

  • clinical Nerve conduction and Nerve Biopsy study in vitamin b12 deficiency neurological syndrome with a short term follow up
    Nutritional Neuroscience, 2014
    Co-Authors: Jayantee Kalita, Satish Chandra, Sanjeev Bhoi, Ritu Agarwal, Usha K Misra, Surala K Shankar, Anita Mahadevan
    Abstract:

    AbstractObjectiveThe frequency and type of neuropathy in vitamin B12 deficiency neurological syndrome (VBDNS) is controversial. This study reports the frequency and type of Nerve dysfunction in VBDNS using Nerve conduction and sural Nerve Biopsy and its response to treatment.MethodSixty-six patients with VBDNS diagnosed on the basis of low serum vitamin B12 level and/or megaloblastic bone marrow were subjected to clinical evaluation, hemoglobin, mean corpuscular volume, thyroid function test, HIV serology, and vasculitic profile. Peroneal motor and sural sensory Nerve conduction studies were done. Sural Nerve Biopsy was done in six patients. The patients were treated with cyanocobalamin injection and followed up clinically and with Nerve conduction study at 3 and 6 months.ResultsThe median age of the patients was 46 (12–80) years and 11 patients were females. The duration of symptoms was 1–96 (median 7) months. Clinical features of neuropathy were present in 46 (69.7%) patients and Nerve conduction was ab...

John D England - One of the best experts on this subject based on the ideXlab platform.

  • practice parameter evaluation of distal symmetric polyneuropathy role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology american association of neuromuscular and electrodiagnostic m
    Neurology, 2009
    Co-Authors: Jeffrey A. Cohen, John D England, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski
    Abstract:

    Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. Methods: A literature review using MEDLINE, EMBASE, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Recommendations: 1) Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. Neurology ® 2009;72:177–184

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology the american association of neuromuscular and electro
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Background Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy and skin Biopsy for the assessment of polyneuropathy. Methods A literature review using MEDLINE, EMBASE, Science Citation Index and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Conclusions 1. Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2. Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3. Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

  • evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review
    Muscle & Nerve, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. A literature review using MEDLINE, EMBASE, Science Citation Index, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. (1) Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). (2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). (3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    2009;72;177-184 Published Online before print December 3, 2008 Neurology J. D. England, G. S. Gronseth, G. Franklin, et al. Physical Medicine and Rehabilitation and Electrodiagnostic Medicine, and American Academy of Academy of Neurology, American Association of Neuromuscular Biopsy (an evidence-based review): Report of the American skin polyneuropathy: Role of autonomic testing, Nerve Biopsy, and Practice Parameter: Evaluation of distal symmetric

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology the american association of neuromuscular and electro
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. Methods: A literature review using MEDLINE, EMBASE, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Recommendations: 1) Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. Neurology ® 2009;72:177–184

James P B Dyck - One of the best experts on this subject based on the ideXlab platform.

  • novel imaging techniques using 18 f florbetapir pet mri can guide fascicular Nerve Biopsy in amyloid multiple mononeuropathy
    Muscle & Nerve, 2021
    Co-Authors: Kamal Shouman, Janean K Engelstad, Stephen M Broski, Eli Muchtar, Courtney Pendleton, Geoffrey B Johnson, Jennifer A Tracy, Robert J Spinner, James P B Dyck
    Abstract:

    BACKGROUND Multiple mononeuropathy is a rare presentation of primary (AL) amyloidosis and Nerve Biopsy is usually needed for diagnosis. Conventional imaging is useful to identify proximal Nerve involvement but may be inadequate. We report a patient with multiple mononeuropathy whose presentation was suggestive of AL amyloid neuropathy and in whom repeated tissue biopsies were negative for amyloid (including two sensory Nerves and one muscle). METHODS The patient underwent magnetic resonance imaging (MRI) and whole body 18 F-florbetapir positron emission tomography (PET)/MRI. RESULTS Whole body 18 F-florbetapir PET/MRI revealed abnormal low-level florbetapir uptake in the right proximal tibial and peroneal Nerves, which provided a target for a sciatic bifurcation fascicular Nerve Biopsy that was diagnostic of AL amyloidosis. CONCLUSIONS 18 F-florbetapir PET/MRI imaging is a promising diagnostic tool for patients with suspected peripheral Nerve amyloidosis (including multiple mononeuropathy) in whom conventional imaging and Nerve and muscle biopsies miss the pathology.

  • pediatric Nerve Biopsy diagnostic and treatment utility in tertiary care referral
    Pediatric Neurology, 2016
    Co-Authors: Cristiane M Ida, Peter J Dyck, James P B Dyck, Janean K Engelstad, Wei Wang, Duygu Selcen, John B Bodensteiner, Michelle M Mauermann, Christopher J Klein
    Abstract:

    Abstract Background Pediatric neuropathies are both unique and similar to their adult counterparts, with genetic varieties thought to be more common. The objective of this work was to assess the utility of Nerve Biopsy in children at a tertiary referral center in light of availability of current genetic testing. Methods We retrospectively reviewed the clinical, Nerve Biopsy, and genetic testing findings of 316 pediatric (age ≤18 years) patients. Results Median age at diagnosis was 9.8 years (4 days to 18 years). Nerve Biopsy was nontargeted in 198 (182 whole sural, seven superficial peroneal, and nine other), targeted in 21 (14 fascicular sciatic and seven brachial plexus), and unknown in 97 cases. PreBiopsy localizations and diagnoses were diverse, most commonly with length-dependent localizations (n = 150). Median follow-up was 6 months (0 to 480 months). A distinctive histopathologic diagnosis was made in 106 cases (33%), including inflammatory or immune (n = 30), neoplastic (n = 19), hereditary (n = 41), vasculitis (n = 10), and other (n = 6). Nerve Biopsy confirmed the suspected diagnosis in 91 (29%) individuals and changed or refined the initial diagnosis in 182 (58%). Treatment modifications as a result of Biopsy occurred in 80 (25%) cases; 59 (19% of the entire cohort) with clinical improvements noted, most commonly by immunotherapy (n = 30). Low diagnostic yield occurred in "hypotonic infants" without Nerve conduction abnormalities. Pain at the Biopsy site beyond 1 month was rare (n = 3; 1%). Forty-four patients underwent genetic testing. Among demyelinating varieties, mutations were identified in five of 11 (46%) cases compared with only six of 33 (18%) cases of axonal varieties. Conclusion Pediatric Nerve Biopsy provides diagnostic information that frequently alters treatment recommendations. Furthermore, it leads to clinical improvements, especially in inflammatory immune neuropathies. For suspected inherited varieties, genetic testing has the highest diagnostic yield in demyelinating phenotypes.

  • pediatric Nerve Biopsy in tertiary referral frequently assists in diagnosis and therapeutic management p2 001
    Neurology, 2015
    Co-Authors: Cris Ida, Peter J Dyck, James P B Dyck, Duygu Selcen, John B Bodensteiner, Michelle M Mauermann, Christopher J Klein
    Abstract:

    OBJECTIVE: To evaluate the usefulness of peripheral Nerve biopsies in children refereed to a tertiary care center BACKGROUND: Childhood peripheral Nerve diseases are both unique and similar to their adult counterparts. Comprehensive evaluation of the utility of Nerve biopsies in affected children has not been reported. DESIGN/METHODS: Utilizing an electronic-medical-record retrieval system we identified 316 pediatric (≤18 yo) Nerve biopsies from children where clinical information was available. RESULTS: : Median age at Biopsy was 9.8 yrs (4days-18yrs). Median follow up was 6 months (0-480 months). Ten children died in the study period related to their neurological illnesses. Cutaneous sensory Nerves were most commonly biopsied, but 18 underwent targeted fascicular proximal biopsies. Pre-Biopsy diagnoses were diverse including; polyneuropathy n=150, CNS disease and polyneuropathy n=34; hypotonia n=15; polyradiculoneuropathy n=18; plexopathy n=15; sciatic neuropathy n=13; mononeuropathy n=22, among others. A distinct histopathologic diagnosis was possible in 113 (36[percnt]) most commonly: inflammatory/autoimmune, including CIDP n=29; neoplasm n=22; hypertrophic inherited neuropathy n=19; vasculitis n=14; giant axonal neuropathy n=5, among others. Nerve Biopsy confirmed the suspected clinical diagnosis in 91 cases (29[percnt]), changed or refined the initial clinical diagnosis in 182 cases (58[percnt]) and was non-contributory in 43 cases (13[percnt]). Only 3 children reported difficulty with postoperative pain at the Biopsy site beyond 1 month. Patient treatment was modified in 80 cases (25[percnt]) as a direct result of the Biopsy. Of these 80 cases, 59 (19[percnt] of the entire cohort) were documented to have a direct clinical improvement related to a change in treatment most commonly by immunotherapy, but also by radiation, surgery for excision of tumor, chemotherapy and direct medical council. Certain pre-Biopsy diagnosis provided low yield including, hypotonic infant. CONCLUSIONS: Tertiary Nerve Biopsy referral among select children has a high diagnostic yield frequently altering treatment with clinical improvements. Study Supported by: NINDS K08NS065007 (C.J.K.) Disclosure: Dr. Ida has nothing to disclose. Dr. Dyck has nothing to disclose. Dr. Selcen has nothing to disclose. Dr. Bodensteiner has received personal compensation in an editorial capacity for Pediatric Neurology. Dr. Mauermann has nothing to disclose. Dr. Dyck has nothing to disclose. Dr. Klein has nothing to disclose.

  • teaching neuroimages eosinophilic infiltration and necrotizing vasculitis on Nerve Biopsy in churg strauss syndrome
    Neurology, 2014
    Co-Authors: Charles D Kassardjian, Narupat Suanprasert, Dayan E Sandler, Elliot L Dimberg, James P B Dyck
    Abstract:

    A 57-year-old woman with asthma, nasal polyps, and allergies presented with acute lancinating pain and patchy weakness in the distribution of multiple upper and lower limb peripheral Nerves. She had peripheral eosinophilia (2 × 109/L). Sural Nerve Biopsy demonstrated Nerve large arteriolar necrotizing vasculitis with eosinophils (figure), consistent with Churg-Strauss syndrome (CSS), renamed eosinophilic granulomatosis with polyangiitis. The authors thank JaNean Engelstad and Peggy Chihak for assistance with obtaining and preparing the images.

  • Nerve Biopsy supports ischemic axonal neuropathy in meralgia paresthetica p02 178
    Neurology, 2013
    Co-Authors: Sarah E Berini, James P B Dyck, Narupat Suanprasert, Robert J Spinner, Mark E Jentoft, Janean Engelstad, Nathan P Staff, Christopher J Klein
    Abstract:

    OBJECTIVE: To evaluate the pathologic and clinical features of MP patients undergoing lateral femoral cutaneous neurectomy. BACKGROUND: Pathologic descriptions of meralgia paresthetica (MP) are lacking. Utilizing a population-based approach, we recently confirmed an association between diabetes, obesity, advancing age and the common occurrence of MP (32.6 per 100,000 patient years). Many patients had monophasic, non-positional symptoms raising the question of an inflammatory or immune mononeuropathy. DESIGN/METHODS: Utilizing a Nerve Biopsy database, four lateral femoral cutaneous Nerve biopsies were identified in patients who underwent neurectomy for intractable MP pain. Autopsy Nerve was obtained for control. Clinical features and testing were reviewed and correlated with the pathologic findings. RESULTS: In the group undergoing neurectomy, preoperative symptoms included non-positional, severe intractable hypesthesias, burning pain and thigh numbness. The duration of symptoms prior to surgery ranged from 1 to 15 years. BMI9s varied from 20 kg/m2-41 kg/m2 (normal to morbid obesity). No patients were diabetic. Lateral femoral cutaneous Nerve conductions were abnormal in 3 of 4 patients. One patient had fusiform enlargement and T2 hyperintensity of the lateral femoral cutaneous Nerve on MRI. At time of neurectomy, two patients had grossly abnormal enlargement of the lateral femoral cutaneous Nerve with compression and scarring at and proximal to the Biopsy site. Multifocal fiber loss, selective loss of large myelinated fibers, thinly myelinated profiles, perineurial thickening, subperineurial edema and Renault corpuscles were found. These features were not seen in the autopsied Nerve. Three patients had varying degrees of intraneural and epineurial inflammation without vessel wall destruction. All patients reported symptomatic improvement after neurectomy. CONCLUSIONS: Meralgia paresthetica cases biopsied have axonal degeneration and regeneration, varying degrees of inflammation and features of chronic ischemia. In select patients, neurectomy may be helpful for symptomatic pain relief. Supported by: National Institute of Neurologic Disorders and Strokes (NINDS) K08 (NS065007). Disclosure: Dr. Berini has nothing to disclose. Dr. Spinner has nothing to disclose. Dr. Jentoft has nothing to disclose. Dr. Engelstad has nothing to disclose. Dr. Suanprasert has nothing to disclose. Dr. Dyck has nothing to disclose. Dr. Staff has nothing to disclose. Dr. Klein has received personal compensation for activities with Pfizer Inc. Dr. Klein has received personal compensation in an editorial capacity for the Journal of the Peripheral Nervous System.

Norman Latov - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review
    Muscle & Nerve, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. A literature review using MEDLINE, EMBASE, Science Citation Index, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. (1) Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). (2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). (3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology the american association of neuromuscular and electro
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Background Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy and skin Biopsy for the assessment of polyneuropathy. Methods A literature review using MEDLINE, EMBASE, Science Citation Index and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Conclusions 1. Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2. Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3. Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    2009;72;177-184 Published Online before print December 3, 2008 Neurology J. D. England, G. S. Gronseth, G. Franklin, et al. Physical Medicine and Rehabilitation and Electrodiagnostic Medicine, and American Academy of Academy of Neurology, American Association of Neuromuscular Biopsy (an evidence-based review): Report of the American skin polyneuropathy: Role of autonomic testing, Nerve Biopsy, and Practice Parameter: Evaluation of distal symmetric

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology the american association of neuromuscular and electro
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. Methods: A literature review using MEDLINE, EMBASE, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Recommendations: 1) Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. Neurology ® 2009;72:177–184

  • Motor Nerve Biopsy studies in motor neuropathy and motor neuron disease
    Muscle & Nerve, 1997
    Co-Authors: Massimo Corbo, M. Kamel Abouzahr, Angelo Quattrini, Nicola Canal, Sandro Iannaccone, Raffaello Nemni, Norman Latov, Arthur P Hays
    Abstract:

    The clinical presentation of motor neuropathy often resembles that of motor neuron disease, sometimes leading to an erroneous diagnosis. Moreover, the underlying pathological process in motor neuropathy has been rarely investigated and there are no systematic studies of the affected motor Nerves. We describe a new motor Nerve Biopsy procedure, performed in 15 patients: 6 with motor neuropathy and 9 with motor neuron disease. The motor branch from the anterior division of the obturator Nerve to the gracilis muscle in the thigh was biopsied. In both groups of patients the motor Nerves exhibited depletion of myelinated Nerve fibers. In motor neuropathy there was a significantly higher density of regenerative clusters of small myelinated fibers in comparison to motor Nerves from patients with motor neuron disease. In addition, in 3 patients with motor neuropathy there was evidence for demyelination with thinly myelinated axons and small onion bulb formations. These pathological studies of motor Nerve biopsies can help to differentiate motor neuropathy from motor neuron disease. © 1997 John Wiley & Sons, Inc.

James R Lupski - One of the best experts on this subject based on the ideXlab platform.

  • practice parameter evaluation of distal symmetric polyneuropathy role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology american association of neuromuscular and electrodiagnostic m
    Neurology, 2009
    Co-Authors: Jeffrey A. Cohen, John D England, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski
    Abstract:

    Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. Methods: A literature review using MEDLINE, EMBASE, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Recommendations: 1) Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. Neurology ® 2009;72:177–184

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology the american association of neuromuscular and electro
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Background Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy and skin Biopsy for the assessment of polyneuropathy. Methods A literature review using MEDLINE, EMBASE, Science Citation Index and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Conclusions 1. Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2. Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3. Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

  • evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review
    Muscle & Nerve, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. A literature review using MEDLINE, EMBASE, Science Citation Index, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. (1) Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). (2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). (3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    2009;72;177-184 Published Online before print December 3, 2008 Neurology J. D. England, G. S. Gronseth, G. Franklin, et al. Physical Medicine and Rehabilitation and Electrodiagnostic Medicine, and American Academy of Academy of Neurology, American Association of Neuromuscular Biopsy (an evidence-based review): Report of the American skin polyneuropathy: Role of autonomic testing, Nerve Biopsy, and Practice Parameter: Evaluation of distal symmetric

  • practice parameter the evaluation of distal symmetric polyneuropathy the role of autonomic testing Nerve Biopsy and skin Biopsy an evidence based review report of the american academy of neurology the american association of neuromuscular and electro
    Pm&r, 2009
    Co-Authors: John D England, Jeffrey A. Cohen, Gary S Gronseth, Gary M Franklin, Arthur K Asbury, Gregory T Carter, Laurence J Kinsella, Kinga Szigeti, James R Lupski, Norman Latov
    Abstract:

    Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, Nerve Biopsy, and skin Biopsy for the assessment of polyneuropathy. Methods: A literature review using MEDLINE, EMBASE, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Recommendations: 1) Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2) Nerve Biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a Nerve Biopsy may be useful in the evaluation of DSP (Level U). 3) Skin Biopsy is a validated technique for determining intraepidermal Nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. Neurology ® 2009;72:177–184