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Updated: Apr 18, 2026
Nerve Ultrasound Protocol to Detect Dysimmune Neuropathies
Published on: October 7, 2021
Triple-stimulation technique improves the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy
Shahram Attarian1, Jérôme Franques, Jouve Elisabeth
1Reference Centre for Neuromuscular Diseases and ALS, Department of Neurology and Neuromuscular Diseases, Centre Hospitalier Universitaire La Timone, 264 rue Saint-Pierre, 13385, Marseille, France; Inserm UMR_S 910 Medical Genetics and Functional Genomics, Aix-Marseille University, Marseilles, France.
Introduction:
A difficult clinical situation occurs when a chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patient does not fulfill any of the diagnostic criteria. Moreover, nerve conduction studies (NCS) can be consistent with axonal neuropathy and lead to misdiagnosis.
Methods:
We aimed to assess the usefulness of the triple-stimulation technique (TST) for detection of proximal conduction blocks (CBs) in patients with axonal-like CIDP. Four patients with axonal-like CIDP were studied and compared with 10 typical CIDP patients. In the axonal-like group, NCS showed a decrease in compound muscle action potential amplitude without features of demyelination, but nerve biopsy showed features of demyelination in all 4.
Results:
Twelve nerves were tested with TST, and 8 CBs were detected between the root emergence and the Erb point in the 4 patients, all of whom improved after treatment with intravenous immunoglobulin.
Conclusion:
TST can identify very proximal CBs in CIDP. The sensitivity of nerve conduction studies may be improved by TST in CIDP.
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