Ultrasound evaluation in transthyretin-related amyloid neuropathy

Muscle Nerve. 2014 Sep;50(3):372-6. doi: 10.1002/mus.24168. Epub 2014 Jun 16.

Abstract

Introduction: Familial amyloid polyneuropathy is a rare condition caused by mutations of the transthyretin gene (TTR). We assessed the pattern of nerve ultrasound (US) abnormalities in patients with TTR-related neuropathy.

Methods: Seven patients with TTR-related neuropathy (TTR-N) and 5 asymptomatic TTR-mutation carriers (TTR-C) underwent neurological examination, nerve conduction studies, and US evaluation.

Results: Multifocal US abnormalities were identified in 6 of 7 TTR-N patients. A single patient with only a mild sensory polyneuropathy had normal nerves on US evaluation. In the TTR-C, we only detected an enlarged ulnar nerve at the elbow. Interestingly, disease severity correlated with number of nerves affected on US evaluation.

Conclusions: No specific pattern of US abnormalities was identified in this cohort. However, in TTR-related amyloid neuropathy, US may be a helpful tool in monitoring disease progression, and/or clinical response to pharmacological treatment.

Keywords: amyloid; neurophysiology; peripheral neuropathy; transthyretin (TTR); ultrasound.

MeSH terms

  • Action Potentials / physiology
  • Adult
  • Aged
  • Amyloid Neuropathies, Familial / diagnostic imaging*
  • Amyloid Neuropathies, Familial / genetics*
  • Cohort Studies
  • Electromyography
  • Female
  • Heterozygote
  • Humans
  • Lower Extremity / diagnostic imaging
  • Lower Extremity / innervation
  • Lower Extremity / physiopathology
  • Male
  • Median Nerve / diagnostic imaging
  • Median Nerve / pathology
  • Middle Aged
  • Mutation / genetics
  • Neural Conduction
  • Neurologic Examination
  • Peripheral Nervous System Diseases / diagnostic imaging
  • Peripheral Nervous System Diseases / genetics
  • Ulnar Nerve / diagnostic imaging
  • Ulnar Nerve / pathology
  • Ultrasonography

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related