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July2007 Vol.44 Issue:        2        Table of Contents
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Evaluation of The Clinical and Neurophysiologic Parameters of Peripheral Nerve Functions in Uremic Egyptian Patients

Lobna Ibrahim Sultan

Department of Neurology, Alexandria University



ABSTRACT

Polyneuropathy (PNP) is one of the most frequent neurological manifestations of chronic renal failure (CRF). Uremic neuropathy has attracted great interest, however, some debate is still present about many of its aspects. The aim of the present work was to study the prevalence and the patterns of peripheral neuropathy in Egyptian CRF patients treated with and without dialysis. Also to establish which of the electrophysiologic parameters are the most sensitive in demonstrating PNP. Patients and Methods: Forty CRF patients were enrolled in this study (21 males, 19 females) with average age 43.64±11.5 years. They were divided into two equal groups according to the scheduled treatment protocol: the hemodialysis group [HG] and conservative group [CG]. The study also included 20 volunteers as a control group. Electrophysiological parameters for motor and sensory evaluation of nerve functions were executed. Motor conduction studies were performed for the median, ulnar, tibial and peroneal nerves. F wave studies were done for the aforementioned nerves. Sural, ulnar and radial sensory conduction nerve studies as well as H reflex study were also included. The severity of polyneuropathy were graded on clinical basis using total clinical neuropathy score [TNSc] as well as both clinical and electrophysiological basis using total neuropathy score [TNSr]. Results: The prevalence of PNP was 65% in the HG and 60% in the CG with no significant difference between them. The overall prevalence of PNP in CRF patients was 62.5%. It was commoner and severer in males than females. It was evident clinically in 37.5%. No significant difference was found between the clinical and electrophysiological severity of PNP in both groups. The TNSr showed only mild to moderate PNP. The pattern of uremic neuropathy was axonopathic affecting the sensory fibers more than the motor ones, distal more than proximal portions of peripheral nerves. Both large and small fibers populations were affected but with large fiber predominance. Peroneal and sural nerves showed the highest rate of pathologic electrophysiologic parameters (62.5% each), followed by the tibial nerve (60%). The least affected nerves were the radial and median (20% & 27.5%respectively) followed by the ulnar and facial nerves (32.5% each). H reflex latency, peroneal minimal F latency as well as both sural nerve peak latency and sensory nerve action potential (SNAP) showed a 100% sensitivity in detecting PNP. Followed by tibial minimal F latency, peroneal compound motor action potential (CMAP) amplitude and sural nerve conduction velocity (CV) (96% sensitivity each). Then came the tibial CMAP amplitude and peroneal CV (92% sensitivity reciprocally). A positive correlation was found between blood urea, serum creatinine, serum potassium and severity of PNP. More close negative correlation was found between creatinine clearance, hemoglobin concentration and uremic neuropathy. The study revealed that neither the prevalence nor the severity of uremic neuropathy were related to the patient’s age, nature of the underlying kidney disease or duration of dialysis treatment. Conclusion: The prevalence of PNP in CRF patients is still considerable despite of the considerable awareness of the problem and the recent advancement in treatment. Hyperkalemia emerges as a contributing factor to the development of neuropathy as well as urea and creatinine levels seem to act synergistically with other potential neuro toxins. The most sensitive electrophysiologic parameters were abnormalities in H reflex latency, sural nerve parameters and F wave minimal latency of the peroneal and tibial nerves. (Egypt J. Neurol. Psychiat. Neurosurg., 2007, 44(2): 473-487)





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