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The clinical, electrophysiological and morphological peculiarities of atypical chronic inflammatory demyelinating polyneuropathies


Author: Gavriliuc Eugeniu
Degree:doctor of medicine
Speciality: 14.00.13 - Neurology
Year:2019
Scientific adviser: Vitalie Lisnic
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 12 September, 2018
Approved by NCAA on the 25 January, 2019

Abstract

Adobe PDF document – 1.97 Mb / in romanian

Thesis

CZU 616.833-002.2 (043)

Adobe PDF document 10.47 Mb / in romanian
125 pages

Keywords

atypical chronical inflammatory demyelinating polyneuropathy, nerve biopsy, monoclonal gammopathy

Summary

Structure of the thesis: introduction, 4 chapters, general conclusions and recommendations, bibliography from 109 sources, 9 anexes, 135 pages as basic text, 33 figures, 30 tabels. The scientific results were published in 14 scientific papers.

The research domain: neurology, neurophysiology.

Study aim: highliting the clinical, electrophysiological and morphological pecularities in patients with atypical chronic inflammatory demyelinating polyneuropathy (CIDP).

Objectives of the research: highlighting the clinical and electrophysiological particularities of atypical forms of CIDP; comparative analysis of the degree of disability in patients with atypical and typical CIDP evaluated by functional tests: the overall neuropathy limitations scale, the 9-holes peg test and the 10-meters distance test; studying nerve conduction in the proximal parts of the peripheral nervous system in all cases of atypical sensory CIDP to demonstrate preganglionic or post-ganglionic demyelination; evaluation of serum protein immunoelectrophoresis results for the analysis of the relationship between the presence of monoclonal gammopathies of uknown significance and the clinical evolution of CIDP; the role of laboratory tests: antimyelin and antiglycolipid antibodies, the role of superficial peroneal nerve biopsy in completing the diagnosis of CIDP; developing a diagnostic algorithm for patients with typical and atypical CIDP and establishing the degree of correlations between the results of the paraclinical examinations and the results of the functional tests in CIDP patients.

The novelty: Atypical forms of CIDP have a significant percentage, approximately 50% of all clinical cases of CIDP. Identification of a large number of atypical forms was possible through the application of additional diagnostic methods.

The scientific problem addressed in the study: consists in developing a diagnostic algorithm for typical and atypical forms of CIDP, which contributed to the identification of additional laboratory tests (lumbar puncture, evoked somatosensitive potentials and superficial peroneal nerve biopsy), which allowed the optimization of the diagnosis of the atypical clinical forms of CIDP.

Theoretical significance: the statistical analysis of the correlations between the functional assessments of disability in the CIDP patients and the results of the laboratory examinations, especially the results of the nervs conduction test, allowed us to create a prognostic model of the evolution of disability in both the group of patients with typical and atypical CIDP.

Practical value: the peculiarities of the clinical, electrophysiological and laboratory test results of atypical CIDP were highlighted; the technique of extracting the superficial peroneal nerve segment and biopsy staining methods have been developed; the need for electrophoresis and immunofixation of serum proteins was highlighted in all cases of CIDP in order to monitor the association of a possible monoclonal gammopathy with a myeloma or lymphoma and to change the treatment tactics.

Implementation of the results: the principles of those demonstrated in the study were implemented in the daily practice of the Institute of Neurology and Neurosurgery and International Hospital MEDPARK from Moldova.