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Retrospective study of a TTR FAP cohort to modify NIS+7 for therapeutic trials.

Abstract
Protein stabilization and oligonucleotide therapies are being tested in transthyretin amyloid polyneuropathy (TTR FAP) trials. From retrospective analysis of 97 untreated TTR FAP patients, we test the adequacy of Neuropathy Impairment Score+7 tests (NIS+7) and modifications to comprehensively score impairments for use in such therapeutic trials. Our data confirms that TTR FAP usually is a sensorimotor polyneuropathy with autonomic features which usually is symmetric, length dependent, lower limb predominant and progressive. NIS+7 adequately assesses weakness and muscle stretch reflexes without ceiling effects but not sensation loss, autonomic dysfunction or nerve conduction abnormalities. Three modifications of NIS+7 are suggested: 1) use of Smart Somatotopic Quantitative Sensation Testing (S ST QSTing); 2) choice of new autonomic assessments, e.g., sudomotor testing of distributed anatomical sites; and 3) use of only compound muscle action potential amplitudes (of ulnar, peroneal and tibial nerves) and sensory nerve action potentials of ulnar and sural nerve - than the previously recommended attributes suggested for the sensitive detection of diabetic sensorimotor polyneuropathy. These modifications of NIS+7 if used in therapeutic trials should improve characterization and quantification of sensation and autonomic impairment in TTR FAP and provide better nerve conduction tests.
AuthorsN Suanprasert, J L Berk, M D Benson, P J B Dyck, C J Klein, J A Gollob, B R Bettencourt, V Karsten, P J Dyck
JournalJournal of the neurological sciences (J Neurol Sci) Vol. 344 Issue 1-2 Pg. 121-8 (Sep 15 2014) ISSN: 1878-5883 [Electronic] Netherlands
PMID25012480 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2014 Elsevier B.V. All rights reserved.
Topics
  • Adult
  • Aged
  • Amyloid Neuropathies, Familial (diagnosis, physiopathology)
  • Autonomic Pathways (physiopathology)
  • Cohort Studies
  • Female
  • Humans
  • Lower Extremity (physiopathology)
  • Male
  • Middle Aged
  • Neural Conduction (physiology)
  • Neurologic Examination
  • Neurophysiology
  • Young Adult

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