150. Proposal for a multicenter protocol on the role of ultrasound in immune-mediated neuropathies

Abstract

Immune-mediated neuropathies include Guillain–Barré syndrome (GBS) and its variants, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN), paraproteinemic neuropathies. High-resolution ultrasound (US) is a helpful technique for the evaluation of peripheral nerves. In previous studies on immune-mediated neuropathies, nerve US showed diffuse enlargement of cross sectional area (CSA) of peripheral nerves trunks and cervical roots and morphological alterations at conduction block site. Data are however heterogeneous, correlations with clinical history or disease severity are lacking and there are no longitudinal studies in literature. The objective is to prospectively evaluate, through a multicenter longitudinal study, US findings in newly diagnosed patients with immune-mediated neuropathies and changes during time and relationship with clinical and neurophysiological findings. The proposal of the protocol is to enroll patients with immune-mediated neuropathies. We will perform clinical assessment, neurophysiological examination; US examination will study median, ulnar, radial, fibular, tibial, sural nerves (and brachial plexus in extended protocol). Maximal/minimal CSA for each nerve, inter- and intra-nerve variability, classification depending on echogenicity and fascicles enlargement will be considered. The protocol and its timing of follow-up evaluations, depending on acute/subacute or chronic disease, will be discussed so that the final version will be based on consensus among expert committees or clinical experience.