Electrophysiological features of acute inflammatory demyelinating polyneuropathy associated with SARS-CoV-2 infection

Objective: To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. Methods: Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 con...

Full description

Bibliographic Details
Published in:Neurophysiologie Clinique
Main Authors: Uncini A., Foresti C., Frigeni B., Storti B., Servalli M. C., Gazzina S., Cosentino G., Bianchi F., Del Carro U., Alfonsi E., Piccinelli S. C., De Maria G., Padovani A., Filosto M., Ippoliti L.
Other Authors: Uncini, A., Foresti, C., Frigeni, B., Storti, B., Servalli, M. C., Gazzina, S., Cosentino, G., Bianchi, F., Del Carro, U., Alfonsi, E., Piccinelli, S. C., De Maria, G., Padovani, A., Filosto, M., Ippoliti, L.
Format: Article in Journal/Newspaper
Language:English
Published: 2021
Subjects:
DML
Online Access:http://hdl.handle.net/11564/767027
https://doi.org/10.1016/j.neucli.2021.02.001
Description
Summary:Objective: To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. Methods: Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared. Results: S-AIDP patients more frequently developed respiratory failure (83.3% vs. 25%, P = 0.000) and required intensive care unit (ICU) hospitalization (58.3% vs. 31.3%, P = 0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs. 26.2%, P = 0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs. 32.4%, P = 0.002) and F waves were more often absent (45.6% vs. 31.8%, P = 0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs. 2.8%, P = 0.000);11 S-AIDP patients showed this pattern in 2 nerves. Conclusion: Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.