Abstract Details

Title The Recovery of Severe Foot Drop in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in relation to Electrodiagnostic Findings of the Affected Tibialis Anterior (TA) Muscle

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-029

Objective To study the treatment response of severe foot drop in CIDP with reference to the distal compound muscle action potential (CMAP) amplitude of the affected tibialis anterior (TA) muscle.

Background Foot drop is common in CIDP causing gait difficulty and falls, but its long-term prognosis is unclear.

Design/Methods Using standard EFNS/PNS criteria for diagnosis, consecutive CIDP patients with less than anti-gravity strength in one or both legs (< 3/5 ankle dorsiflexion on MRC manual muscle testing (ADF MMT)) were identified by retrospective review of our EMG Database from 2007-2015. All patients received standard immunosuppressive treatment. The outcome of foot drop over the treatment period was determined by serially tabulating ADF MMT, and the amplitude of the affected distal TA CMAP evoked by supramaximal stimulation of the fibular nerve below the fibular head.

Results Of the 21 CIDP patients identified (7 females, mean age: 42, range: 13-68), ADF MMT was <3/5 in 38/42 legs. At baseline, mean ADF MMT in this group was 1/5 (range: 0-2.5). Over the treatment period, ADF MMT improved slowly to above 3/5 power in 23 legs (61%), plateauing to a peak MMT of 4.5 (mean), range (3-5) over 15 months (mean), range (5-49 months). When baseline distal TA CMAP amplitude was > 0.4 mV (lower limit of normal: 4 mV), anti-gravity strength was achieved in 5/6 legs whereas for baseline amplitudes of </= 0.4, only 2/10 legs achieved antigravity strength.

Conclusions The majority of CIDP patients with severe foot drop regain anti-gravity strength in the TA with treatment, but this occurs slowly over a period of many months to years. The baseline distal TA CMAP amplitude is one factor among several that may help predict recovery of foot drop in CIDP.

Authors/Disclosures
Dinushi Weerasinghe, MBBS PRESENTER	No disclosure on file
Aravindhan Veerapandiyan, MD (Arkansas Childrens Hospital/UAMS)	Dr. Veerapandiyan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen, Novartis,Edgewise Therapeutics, Pfizer, PTC Therapeutics, Sarepta Therapeutics, Inc., UCB Pharma, Catalyst, Entrada, Lupin, Percheron, ITF. Dr. Veerapandiyan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Veerapandiyan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Muscle and Nerve. The institution of Dr. Veerapandiyan has received research support from AMO Pharma, Capricor Therapeutics, Edgewise Therapeutics, FibroGen, Muscular Dystrophy Association, Novartis, Parent Project Muscular Dystrophy, Pfizer, RegenxBio, SolodBio and Sarepta Therapeutics. Dr. Veerapandiyan has received personal compensation in the range of $5,000-$9,999 for serving as a MD with PPMD, MDA.
Michael Stanton, MD, FAAN (University of Rochester Medical Center)	Dr. Stanton has nothing to disclose.
David N. Herrmann, MD, FAAN (University of Rochester Medical Center)	Dr. Herrmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acceleron. Dr. Herrmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint global. Dr. Herrmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Herrmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurogene. Dr. Herrmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sarepta. Dr. Herrmann has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Regenacy. Dr. Herrmann has received intellectual property interests from a discovery or technology relating to health care.
Eric L. Logigian, MD, FAAN (University of Rochester Medical Center)	Dr. Logigian has nothing to disclose.

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