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DOI 10.23648/UMBJ.2018.32.22690

УДК 616.833.002

 

БИОПСИЯ ПЕРИФЕРИЧЕСКИХ НЕРВОВ В ДИАГНОСТИКЕ ПОЛИНЕЙРОПАТИЙ

 

Д.А. Семикова1, Н.А. Супонева1, Д.А. Гришина1, Р.В. Уренева2, Н.В. Белова1, А.М. Максимов1, Е.В. Слесарева2, В.В. Машин2

1 ФГБНУ «Научный центр неврологии», г. Москва, Россия;

2 ФГБОУ ВО «Ульяновский государственный университет», г. Ульяновск, Россия

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Методика выделения нерва и спектр исследований был разработан более полувека назад в лаборатории патоморфологии нервов клиники Мэйо, (Миннесота) Питером Диком и коллегами. Несмотря на большое количество методов исследований, имеющихся сегодня в арсенале врача, биопсия нерва сохранила свое диагностическое значение. К ней прибегают в тех случаях, когда не удается установить причину нейропатии с помощью рутинных методов обследования.

Целью настоящего обзора является обсуждение информативности биопсии при различных заболеваниях периферических нервов. При направлении пациентов на эту процедуру необходимо четко понимать, на какие вопросы она может ответить. Изложенные морфологические методы исследования биоптатов нерва и получаемые при их использовании результаты позволят специалисту-неврологу оценить необходимость проведения такого рода диагностики. Спектр нозологий, приведенный в настоящем обзоре, показывает возможности использования морфологической диагностики при полинейропатиях неясного генеза.

Ключевые слова: полинейропатия, нейропатия, икроножный нерв, биопсия нерва, микроскопия.

 

Литература

1. Курушина О.В., Барулин А.Е. Полинейропатия при соматических заболеваниях: роль невролога в диагностике и лечении. РМЖ. Медицинское обозрение. 2013; 36: 1843–1848.

2. Mathis S., Magy L., Le Masson G. Value of nerve biopsy in the management of peripheral neuropathies. Expert Review of Neurotherapeutics. 2018; 18 (7): 589–602.

3. Гринберг М.С. Нейрохирургия. М.: МЕДпрессинформ; 2010. 667.

4. Dyck P.J., Dyck P.J.B., Englestad J. Pathologic alterations of nerves. In: Dyck P.J., Thomas P.K., eds. Peripheral Neuropathy. Philadelphia: Elsevier Saunders; 2005: 733–741.

5. Weis J., Brandner S., Lammens M. Processing of nerve biopsies: A practical guide for neuropathologists. Clinical Neuropathology. 2012; 31 (1): 7–23.

6. Mellgren S.I., Lindal S. Nerve biopsy – some comments on procedures and indications. Acta Neurol Scand. 2011; 124 (Suppl. 191): 64–70.

7. Grant I.A. Differential diagnosis of diabetic neuropathies. In: Dyck P.J., Thomas P.K., eds. Diabetic Neuropathy. Ed 2. Philadelphia: WB Saunders; 1999: 415–444.

8. King R., Ginsberg L. The nerve biopsy: indications, technical aspects, and contribution. In: Said G., Krarup C., eds. Handbook of Clinical Neurology. Vol. 115 (3rd series): Peripheral Nerve Disorders. The Netherlands: Elsevier BV; 2013: 155–170.

9. Mathis S., Goizet C., Tazir M. Charcot-Marie-Tooth diseases: An update and some new proposals for the classification. J. Med. Genet. 2015; 52: 681–690.

10. Иллариошкин С.Н., Дадали Е.Л., Федотов В.П. Новая форма наследственной невропатии: болезнь Шарко–Мари–Тута типа 2F. Нервные болезни. 2005; 2: 42–46.

11. Vallat J.M., Mathis S., Funalot B. The various Charcot-Marie-Tooth diseases. Curr. Opin. Neurol. 2013; 26: 473–480.

12. Lewis R.A., Sumner A.J., Shy M.E. Electrophysiological features of inherited demyelinating neuropathies: a reappraisal in the era of molecular diagnosis. Muscle nerve. 2000; 23: 1472–1487.

13. Duchesne M., Mathis S., Richard L. Nerve Biopsy Is Still Useful in Some Inherited Neuropathies. Journal of Neuropathology & Experimental Neurology. 2018; 77 (2): 88–99.

14. Ericson U., Ansved T., Borg K. Charcot-Marie-Tooth disease: muscle biopsy findings in relation to neurophysiology. Neuromuscul. Disord. 1998; 8: 175–181.

15. Said G. Indications and usefulness of nerve biopsy. Archives of neurology. 2002; 59 (10): 1532–1535.

16. Conceição I., González-Duarte A., Obici L. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J. Peripher. Nerv. Syst. 2016; 21: 5–9.

17. Mathis S., Magy L., Vallat J.M. Neuromuscular disorders in tropical areas. In: Preux P.M., Dumas M., eds. Neuroepidemiology in tropical health. 1st ed. Elsevier-Academic Press (AP); 2018: 195–211.

18. Hui M., Uppin M.S., Challa S. Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India. Ann Indian Acad Neurol. 2015; 18: 292–297.

19. Kulshreshtha D., Malhotra K.P., Malhotra H.S. Mandating nerve biopsy: A step towards personalizing therapy in pure neuritic leprosy. Journal of the Peripheral Nervous System. 2018. DOI: 10.1111/jns.12283.

20. Sommer C., Geber C., Young P. Polyneuropathies – etiology, diagnosis, and treatment options. Dtsch Arztebl Int. 2018; 115: 83–90.

21. Collins M.P., Hadden R.D. The nonsystemic vasculitic neuropathies. Nat Rev Neurol. 2017; 13: 302–316.

22. Pant I., Jha K., Singh R. Peripheral neuropathy and the role of nerve biopsy: A revisit. Indian J. Pathol Microbiol. 2018; 61 (3): 339–344.

23. Lawrence A., Nagappa M., Mahadevan A., Taly A.B. Vasculitic neuropathy in elderly: A study from a tertiary care university hospital in South India. Ann Indian Acad Neurol. 2016; 19: 323–326.

24. Khalili-Shirazi A., Gregson N.A., Londei M. The distribution of CD1 molecules in inflammatory neuropathy. J. Neurol. Sci. 1998; 158: 154–163.

25. Prayson R.A., Sedlock D.J. Clinicopathologic study of 43 patients with sural nerve vasculitis. Hum. Pathol. 2003; 34: 484–490.

26. Супонева Н.А., Пирадов М.А., Гришина Д.А. Хронические дисиммунные полиневропатии. В кн.: Гусев Е.И., Гехт А.Б., ред. Болезни нервной системы: механизмы развития, диагностика и лечение. М.: ООО «Буки-Веди»; 2017: 171–190.

27. Rajabally Y.A., Stettner M., Kieseier B.C. CIDP and other inflammatory neuropathies in diabetes – diagnosis and management. Nat Rev Neurol. 2017; 13: 599–611.

28. Van den Bergh P.Y.K., Hadden R.D., Bouche P. Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society – first revision. Eur J. Neurol. 2010; 17 (3): 356–363.

29. Супонева Н.А., Наумова Е.С., Гнедовская Е.В. Хроническая воспалительная демиелинизирующая полинейропатия у взрослых: принципы диагностики и терапия первой линии. Нервно-мышечные болезни. 2016; 6 (1): 44–53.

30. Rajabally Y.A., Adams D., Latour P. Hereditary and inflammatory neuropathies: A review of reported associations, mimics and misdiagnoses. J. Neurol Neurosurg Psychiatry. 2016; 87: 1051–1060.

31. Пирадов М.А., Супонева Н.А., Гинзберг М.А. POEMS-синдром: обзор литературы и описание клинических наблюдений. Журнал неврологии и психиатрии им. С.С. Корсакова. 2014; 114 (4): 4–10.

32. Hashimoto R., Koike H., Takahashi M. Uncompacted Myelin Lamellae and Nodal Ion Channel Disruption in POEMS Syndrome. J. Neuropathol Exp Neurol. 2015; 74 (12): 1127–1136.

33. Igarashi M., Thompson E.I., Rivera G.K. Vincristine neuropathy in type I and type II Charcot–Marie–Tooth disease (hereditary motor sensory neuropathy). Med. Pediatr. Oncol. 1995; 25: 113–116.

34. Ferner R.E., Hughes R.A.C., Hall S.M. Neurofibromatous neuropathy in neurofibromatosis 1 (NF1). J. Med. Genet. 2004; 41: 837–841.

35. Максимова М.Ю. Нейросаркоидоз. Анналы клинической и экспериментальной неврологии. 2009; 3 (1): 35–42.

36. Tavee J.O., Stern B.J. Neurosarcoidosis. Clinics in Chest Medicine. 2015; 36 (4): 643–656.

 

 

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DOI 10.23648/UMBJ.2018.32.22690

 

BIOPSY OF PERIPHERAL NERVES IN DIAGNOSTICS OF POLYNEUROPATHY

 

D.A. Semikova1, N.A. Suponeva1, D.A. Grishina1, R.V. Ureneva2, N.V. Belova1, A.M. Maksimov1, E.V. Slesareva2, V.V. Mashin2

1 Research Centre of Neurology, Moscow, Russia;

2 Ulyanovsk State University, Ulyanovsk, Russia

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Peter Dick and colleagues developed nerve isolation technique more than half a century ago in the laboratory of nerve pathomorphism, Mayo Clinic (Minnesota). Despite a large number of available research methods nerve biopsy has retained its diagnostic value. It is used in such cases when it is impossible to establish the cause of neuropathy using routine examination techniques.

The purpose of this review is to discuss the informativeness of biopsy in various peripheral nerve disorders. Patients undergoing the procedure should clearly understand what questions it can answer. The described morphological methods for nerve biopsy and the results obtained will allow a neurologist to assess the need for such a diagnostic technique. The nosology spectrum, given in this review, shows the possibilities of morphological diagnostics for idiopathetic polyneuropathies.

Keywords: polyneuropathy, neuropathy, sural nerve, nerve biopsy, microscopy.

 

Reference

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2.      Mathis S., Magy L., Le Masson G. Value of nerve biopsy in the management of peripheral neuropathies. Expert Review of Neurotherapeutics. 2018; 18 (7): 589–602.

3.      Grinberg M.S. Neyrokhirurgiya [Neurosurgery]. Moscow: MED pressinform; 2010. 667 (in Russian).

4.      Dyck P.J., Dyck P.J.B., Englestad J. Pathologic alterations of nerves. In: Dyck P.J., Thomas P.K., eds. Peripheral Neuropathy. Philadelphia: Elsevier Saunders; 2005: 733–741.

5.      Weis J., Brandner S., Lammens M. Processing of nerve biopsies: A practical guide for neuropathologists. Clinical Neuropathology. 2012; 31 (1): 7–23.

6.      Mellgren S.I., Lindal S. Nerve biopsy – some comments on procedures and indications. Acta Neurol Scand. 2011; 124 (suppl. 191): 64–70.

7.      Grant I.A. Differential diagnosis of diabetic neuropathies. In: Dyck P.J., Thomas P.K., eds. Diabetic Neuropathy. Ed. 2. Philadelphia: WB Saunders; 1999: 415–444.

8.      King R., Ginsberg L. The nerve biopsy: indications, technical aspects, and contribution. In: Said G., Krarup C., eds. Handbook of Clinical Neurology. Vol. 115 (3-rd series): Peripheral Nerve Disorders. The Netherlands: Elsevier BV; 2013: 155–170.

9.      Mathis S., Goizet C., Tazir M. Charcot-Marie-Tooth diseases: An update and some new proposals for the classification. J. Med. Genet. 2015; 52: 681–690.

10.    Illarioshkin S.N., Dadali E.L., Fedotov V.P. Novaya forma nasledstvennoy nevropatii: bolezn' Sharko–Mari–Tuta tipa 2F [A new form of hereditary neuropathy: Charcot-Marie-Tut disease, type 2F]. Nervnye bolezni. 2005; 2: 42–46 (in Russian).

11.    Vallat J.M., Mathis S., Funalot B. The various Charcot-Marie-Tooth diseases. Curr. Opin. Neurol. 2013; 26: 473–480.

12.    Lewis R.A., Sumner A.J., Shy M.E. Electrophysiological features of inherited demyelinating neuropathies: a reappraisal in the era of molecular diagnosis. Muscle nerve. 2000; 23: 1472–1487.

13.    Duchesne M., Mathis S., Richard L. Nerve Biopsy Is Still Useful in Some Inherited Neuropathies. Journal of Neuropathology & Experimental Neurology. 2018; 77 (2): 88–99.

14.    Ericson U., Ansved T., Borg K. Charcot-Marie-Tooth disease: muscle biopsy findings in relation to neurophysiology. Neuromuscul. Disord. 1998; 8: 175–181.

15.    Said G. Indications and usefulness of nerve biopsy. Archives of neurology. 2002; 59 (10): 1532–1535.

16.    Conceição I., González-Duarte A., Obici L. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J. Peripher. Nerv. Syst. 2016; 21: 5–9.

17.    Mathis S., Magy L., Vallat J.M. Neuromuscular disorders in tropical areas. In: Preux P.M., Dumas M., eds. Neuroepidemiology in tropical health. 1-st ed. Elsevier-Academic Press (AP); 2018: 195–211.

18.    Hui M., Uppin M.S., Challa S. Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India. Ann. Indian Acad. Neurol. 2015; 18: 292–297.

19.    Kulshreshtha D., Malhotra K.P., Malhotra H.S. Mandating nerve biopsy: A step towards personalizing therapy in pure neuritic leprosy. Journal of the Peripheral Nervous System. 2018. DOI: 10.1111/jns.12283.

20.    Sommer C., Geber C., Young P. Polyneuropathies – etiology, diagnosis, and treatment options. Dtsch Arztebl Int. 2018; 115: 83–90.

21.    Collins M.P., Hadden R.D. The nonsystemic vasculitic neuropathies. Nat. Rev. Neurol. 2017; 13: 302–316.

22.    Pant I., Jha K., Singh R. Peripheral neuropathy and the role of nerve biopsy: A revisit. Indian J. Pathol Microbiol. 2018; 61 (3): 339–344.

23.    Lawrence A., Nagappa M., Mahadevan A., Taly A.B. Vasculitic neuropathy in elderly: A study from a tertiary care university hospital in South India. Ann. Indian Acad. Neurol. 2016; 19: 323–326.

24.    Khalili-Shirazi A., Gregson N.A., Londei M. The distribution of CD1 molecules in inflammatory neuropathy. J. Neurol. Sci. 1998; 158: 154–163.

25.    Prayson R.A., Sedlock D.J. Clinicopathologic study of 43 patients with sural nerve vasculitis. Hum. Pathol. 2003; 34: 484–490.

26.    Suponeva N. A., Piradov M.A., Grishina D.A. Khronicheskie disimmunnye polinevropatii [Chronic disimmune polyneuropathy]. Gusev E.I., Gekht A.B. Bolezni nervnoy sistemy: mekhanizmy razvitiya, diagnostika i lechenie [Diseases of the nervous system: Mechanisms of development, diagnosis and treatment]. Moscow: OOO «Buki-Vedi»; 2017: 171–190 (in Russian).

27.    Rajabally Y.A., Stettner M., Kieseier B.C. CIDP and other inflammatory neuropathies in diabetes – diagnosis and management. Nat. Rev. Neurol. 2017; 13: 599–611.

28.    Van den Bergh P.Y.K., Hadden R.D., Bouche P. Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society – first revision. Eur. J. Neurol. 2010; 17 (3): 356–363.

29.    Suponeva N.A., Naumova E.S., Gnedovskaya E.V. Khronicheskaya vospalitel'naya demieliniziruyushchaya polineyropatiya u vzroslykh: printsipy diagnostiki i terapiya pervoy linii [Chronic inflammatory demyelinating polyneuropathy in adults: Principles of diagnosis and first-line therapy]. Nervno-myshechnye bolezni. 2016; 6 (1): 44–53 (in Russian).

30.    Rajabally Y.A., Adams D., Latour P. Hereditary and inflammatory neuropathies: A review of reported associations, mimics and misdiagnoses. J. Neurol Neurosurg Psychiatry. 2016; 87: 1051–1060.

31.    Piradov M.A., Suponeva N.A., Ginzberg M.A. POEMS-sindrom: obzor literatury i opisanie klinicheskikh nablyudeniy [POEMS-syndrome: Literature review and clinical observations]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2014; 114 (4): 4–10 (in Russian).

32.    Hashimoto R., Koike H., Takahashi M. Uncompacted Myelin Lamellae and Nodal Ion Channel Disruption in POEMS Syndrome. J. Neuropathol Exp Neurol. 2015; 74 (12): 1127–1136.

33.    Igarashi M., Thompson E.I., Rivera G.K. Vincristine neuropathy in type I and type II Charcot–Marie–Tooth disease (hereditary motor sensory neuropathy). Med. Pediatr. Oncol. 1995; 25: 113–116.

34.    Ferner R.E., Hughes R.A.C., Hall S.M. Neurofibromatous neuropathy in neurofibromatosis 1 (NF1). J. Med. Genet. 2004; 41: 837–841.

35.    Maksimova M.Yu. Neyrosarkoidoz [Neurosarcoidosis]. Annaly klinicheskoy i eksperimental'noy nevrologii. 2009; 3 (1): 35–42 (in Russian).

36.    Tavee J.O., Stern B.J. Neurosarcoidosis. Clinics in Chest Medicine. 2015; 36 (4): 643–656.