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Unmyelinated and myelinated skin nerve damage in Guillain–Barré syndrome: correlation with pain and recovery

Unmyelinated and myelinated skin nerve damage in Guillain–Barré syndrome: correlation with pain and recovery
Unmyelinated and myelinated skin nerve damage in Guillain–Barré syndrome: correlation with pain and recovery
We performed a prospective study in 32 patients with Guillain–Barré syndrome (GBS) or its variants to correlate intraepidermal nerve fiber density (IENFD) at the distal leg and lumbar region with pain, autonomic dysfunction, and outcome. In the acute phase, IENFD was reduced in 60% and 61.9% of patients at the distal leg and lumbar region, respectively. In the acute phase, 43.7% of patients complained of neuropathic pain. Their IENFD at the distal leg was significantly lower than in patients without pain (P < .001) and correlated with pain intensity (rs = ?0.51; P = .003). Intriguingly, also patients with the pure motor variant of GBS and pain had low IENFD. At 6-month follow-up, only 3 patients complained of persisting neuropathic pain, whereas 3 patients reported late-onset pain symptoms. IENFD in the acute phase did not predict presence or intensity of pain at 6-month follow-up. IENFD in the acute phase did not correlate with clinical dysautonomia or GBS severity at nadir. However, it correlated with poorer GBS disability score at 6 months (P = .04), GBS score at nadir (P = .03), and clinically probable dysautonomia (P = .004). At 6-month follow-up, median IENFD remained significantly low both at the distal leg (P = .024) and lumbar region (P = .005). Double and triple staining confocal microscope studies showed diffuse damage of myelinated dermal nerves along with axonal degeneration, and mononuclear cell infiltration. Unmyelinated and myelinated skin nerves are diffusely affected in GBS and its variants, including the pure motor form. IENFD declines early, remains low over time, correlates with pain severity in the acute phase, and may predict long-term disability.

0304-3959
Ruts, Liselotte
29539144-45f1-4bb4-bb21-25f3aa0658a2
Van Doorn, Pieter A.
0265bdab-2177-4f92-898c-d48165080547
Lombardi, Raffaella
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Haasdijk, Elize D.
9ec5504e-c3ef-4b5a-9131-363994a8c5b1
Penza, Paola
4b95a35a-916c-4deb-a5ad-07569e8045c7
Tulen, Joke H.M.
a8198529-bb60-493e-9800-066aae0b68cf
Hempel, Roelie J.
2dfa9856-74dd-49b5-86e6-f78eace6727f
Van den Meiracker, Anton H.
7549b0a7-946f-414b-91ab-e7666577da31
Lauria, Guiseppe
c1b3cd93-7f6a-406c-bf20-c19e402f802d
Ruts, Liselotte
29539144-45f1-4bb4-bb21-25f3aa0658a2
Van Doorn, Pieter A.
0265bdab-2177-4f92-898c-d48165080547
Lombardi, Raffaella
95a51f38-b22b-4140-b8f5-2e133540319c
Haasdijk, Elize D.
9ec5504e-c3ef-4b5a-9131-363994a8c5b1
Penza, Paola
4b95a35a-916c-4deb-a5ad-07569e8045c7
Tulen, Joke H.M.
a8198529-bb60-493e-9800-066aae0b68cf
Hempel, Roelie J.
2dfa9856-74dd-49b5-86e6-f78eace6727f
Van den Meiracker, Anton H.
7549b0a7-946f-414b-91ab-e7666577da31
Lauria, Guiseppe
c1b3cd93-7f6a-406c-bf20-c19e402f802d

Ruts, Liselotte, Van Doorn, Pieter A., Lombardi, Raffaella, Haasdijk, Elize D., Penza, Paola, Tulen, Joke H.M., Hempel, Roelie J., Van den Meiracker, Anton H. and Lauria, Guiseppe (2011) Unmyelinated and myelinated skin nerve damage in Guillain–Barré syndrome: correlation with pain and recovery. Pain. (doi:10.1016/j.pain.2011.10.037). (In Press)

Record type: Article

Abstract

We performed a prospective study in 32 patients with Guillain–Barré syndrome (GBS) or its variants to correlate intraepidermal nerve fiber density (IENFD) at the distal leg and lumbar region with pain, autonomic dysfunction, and outcome. In the acute phase, IENFD was reduced in 60% and 61.9% of patients at the distal leg and lumbar region, respectively. In the acute phase, 43.7% of patients complained of neuropathic pain. Their IENFD at the distal leg was significantly lower than in patients without pain (P < .001) and correlated with pain intensity (rs = ?0.51; P = .003). Intriguingly, also patients with the pure motor variant of GBS and pain had low IENFD. At 6-month follow-up, only 3 patients complained of persisting neuropathic pain, whereas 3 patients reported late-onset pain symptoms. IENFD in the acute phase did not predict presence or intensity of pain at 6-month follow-up. IENFD in the acute phase did not correlate with clinical dysautonomia or GBS severity at nadir. However, it correlated with poorer GBS disability score at 6 months (P = .04), GBS score at nadir (P = .03), and clinically probable dysautonomia (P = .004). At 6-month follow-up, median IENFD remained significantly low both at the distal leg (P = .024) and lumbar region (P = .005). Double and triple staining confocal microscope studies showed diffuse damage of myelinated dermal nerves along with axonal degeneration, and mononuclear cell infiltration. Unmyelinated and myelinated skin nerves are diffusely affected in GBS and its variants, including the pure motor form. IENFD declines early, remains low over time, correlates with pain severity in the acute phase, and may predict long-term disability.

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Accepted/In Press date: 10 December 2011
Organisations: Psychology

Identifiers

Local EPrints ID: 206139
URI: http://eprints.soton.ac.uk/id/eprint/206139
ISSN: 0304-3959
PURE UUID: 85cda264-8228-43fc-8623-8df36eb7d537

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Date deposited: 15 Dec 2011 10:23
Last modified: 14 Mar 2024 04:36

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Contributors

Author: Liselotte Ruts
Author: Pieter A. Van Doorn
Author: Raffaella Lombardi
Author: Elize D. Haasdijk
Author: Paola Penza
Author: Joke H.M. Tulen
Author: Roelie J. Hempel
Author: Anton H. Van den Meiracker
Author: Guiseppe Lauria

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