TY - JOUR
TI - Involvement of small nerve fibres and autonomic nervous system in AL amyloidosis: comprehensive characteristics and clinical implications
AU - Kokotis, P.
AU - Manios, E.
AU - Schmelz, M.
AU - Fotiou, D.
AU - Dialoupi, I.
AU - Gavriatopoulou, M.
AU - Roussou, M.
AU - Lykka, A.
AU - Dimopoulos, M.A.
AU - Kastritis, E.
JO - Amyloid: The Journal of Protein Folding Disorders
PY - 2020
VL - 27
TODO - 2
SP - 103-110
PB - Taylor and Francis Ltd.
SN - 1350-6129, 1744-2818
TODO - 10.1080/13506129.2020.1713081
TODO - immunoglobulin light chain, adult;  aged;  AL amyloidosis;  Article;  autonomic dysfunction;  autonomic nervous system;  clinical article;  clinical evaluation;  controlled study;  disease severity;  epidermis;  female;  follow up;  heat pain threshold;  human;  human tissue;  innervation;  lower leg;  male;  middle aged;  nerve conduction;  nerve fiber;  nerve fiber degeneration;  peripheral nerve;  pressoreceptor reflex;  priority journal;  prognosis;  prospective study;  quantitative sensory testing;  skin biopsy;  small nerve fiber dysfunction;  survival;  very elderly;  AL amyloidosis;  autonomic nervous system;  biopsy;  nerve fiber;  pathology;  pathophysiology;  skin, Adult;  Aged;  Aged, 80 and over;  Autonomic Nervous System;  Biopsy;  Female;  Humans;  Immunoglobulin Light-chain Amyloidosis;  Male;  Middle Aged;  Nerve Fibers;  Prospective Studies;  Skin
TODO - Peripheral nerve involvement in immunoglobulin light chain (AL) amyloidosis is common, characterised by severe progressive mixed neuropathy with autonomic dysfunction but there is limited data on the implications and the characteristics of small nerve fibres dysfunction (SNFD). The aim of our prospective study was to evaluate SNFD and its clinical implications in newly diagnosed AL patients. Twenty-three consecutive patients (10 male, mean age 61.78 years) and 21 age- and gender-matched healthy controls (8 male, mean age 61.28 years) underwent clinical evaluation and standard nerve conduction studies (NCS), baroreflex sensitivity (BRS) test, quantitative sensory testing (QST) and skin biopsy at the lower leg for measuring the density of the nerve fibres innervating the epidermis (IENFD). Axonal degeneration of the large nerve fibres was revealed in 15 out of 23 patients while SNFD was indicated by QST and skin biopsy in 56% and 61% of the patients respectively. BRS index significantly correlated with the IENFD and the QST results while low IENFD was associated with significantly poorer survival. Our study provides new insights and also an initial evaluation of new tools for assessment of the involvement of autonomic and small nerve fibres in AL amyloidosis. These findings also appear to have prognostic implications. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
ER -