[Therapeutic options in patients with neuralgic amyotrophy]

To evaluate the outcomes of patients with neuralgic amyotrophy (NA) depending on the type of treatment received - surgical or glucocorticosteroid administration.

The outcome of 101 patients with verified NA was analyzed. The mean age of NA patients was 38.21±16.09 years (8 to 76 years), of which 69.3% were males (n=70) and 30.7% were females (n=31). The diagnosis was confirmed by electromyography, cervical spine MRI, and clinical data evaluation: pain according to VAS, duration of pain, timing of diagnosis from the disease onset, and severity of muscle weakness using the MRC scale. Most patients had a classic form (50.5%, n=51), followed by a distal form (39.6%, n=40), and nerve damage above the elbow joint or cranial nerves (9.9%, n=10). Most patients were examined during the phase of pain and muscle weakness (59.4%, n=60) and in the recovery phase (40.6%, n=41). 48.5% (n=49) of patients received steroids. Surgical treatment was performed in 15.8% of cases (n=16). The median follow-up of all patients was 12 months (Q₁-Q₃ 6.00-20.00).

Patients who received GCS recovered better - 67.7% had a complete recovery compared to patients who did not receive pathogenetic therapy. Regardless of the GCS use, the outcome also depended on the NA form and the initial severity of muscle weakness (p<0.001 and p=0.001, respectively). Comparing the outcomes in the groups with and without surgery showed no statistically significant differences. However, in the non-surgery group, a higher percentage of non-recovery was found (71.4%) compared to the group receiving surgical treatment (28.6%). In 97.4% (n=38) of cases of distal NA, ultrasound revealed focal changes in the nerves, which initially indicated a poor prognosis for recovery.

Steroid therapy affects muscle strength recovery in patients with NA. The NA form and the initial severity of motor deficit also affect the outcome. Surgical treatment is indicated for patients with distal NA.