Axonal loss in patients with inflammatory demyelinating polyneuropathy as determined by motor unit number estimation and MUNIX

Objective: This study quantifies functioning axons and reinnervation by applying two methods multiple point stimulation (MPS) MUNE, and motor unit number index (MUNIX), in patients with acute- and chronic inflammatory demyelinating polyneuropathy (AIDP, CIDP). Methods: Nineteen patients with inflammatory demyelinating polyneuropathy (eleven AIDP and eight CIDP) were prospectively included. MPS MUNE and MUNIX examinations on the thenar muscle group by stimulating the median nerve were applied on all patients. Motor unit size was calculated as single motor unit potential (sMUP) and motor unit size index (MUSIX). The results were compared with twenty healthy subjects. Results: In AIDP patients mean MPS MUNE (106) and MUNIX (80) were lower than control MPS MUNE (329) and MUNIX (215) (p < 0.001). In CIDP patients both MPS MUNE (88) and MUNIX (67) were lower than controls (p < 0.001). In CIDP patients sMUP (63) and MUSIX (90) were higher than control sMUP (35) and MUSIX (58) (p < 0.05 and p < 0.01). When AIDP and CIDP groups were combined the sensitivity for MPS MUNE and MUNIX were 89.5% and 68.4%, respectively. Conclusions: Decreased MPS MUNE and MUNIX suggest presence of axonal loss or loss of functioning axons in AIDP and CIDP. Increased motor unit size in CIDP patients indicates compensatory reinnervation. Moreover, both MPS MUNE and MUNIX can discriminate between disease versus non-disease. Significance: Estimation of the number and the average size of motor units may have clinical value for the assessment of axonal loss or loss of functioning axons in patients with AIDP and CIDP. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.