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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 160-166. doi: 10.19723/j.issn.1671-167X.2023.01.025

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Diagnostic value of F wave changes in patients with Charcot-Marie-Tooth1A and chronic inflammatory demyelinating polyneuropathy

Xiao-xuan LIU,Shuo ZHANG,Yan MA,A-ping SUN,Ying-shuang ZHANG,Dong-sheng FAN*()   

  1. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-06-01 Online:2023-02-18 Published:2023-01-31
  • Contact: Dong-sheng FAN E-mail:dsfan@sina.com
  • Supported by:
    the Joint Project Fund of Peking University Health Science Centre and Ulm University(PKU2017ZC001-2)

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Abstract:

Objective: To analyze and compare the characteristics and causes of F wave changes in patients with Charcot-Marie-Tooth1A (CMT1A) and chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: Thirty patients with CMT1A and 30 patients with CIDP were enrolled in Peking University Third Hospital from January 2012 to December 2018. Their clinical data, electrophysiological data(nerve conduction velocity, F wave and H reflex) and neurological function scores were recorded. Some patients underwent magnetic resonance imaging of brachial plexus and lumbar plexus, and the results were analyzed and compared. Results: The average motor conduction velocity (MCV) of median nerve was (21.10±10.60) m/s in CMT1A and (31.52±12.46) m/s in CIDP. There was a significant difference between the two groups (t=-6.75, P < 0.001). About 43.3% (13/30) of the patients with CMT1A did not elicit F wave in ulnar nerve, which was significantly higher than that of the patients with CIDP (4/30, 13.3%), χ2=6.65, P=0.010. Among the patients who could elicit F wave, the latency of F wave in CMT1A group was (52.40±17.56) ms and that in CIDP group was (42.20±12.73) ms. There was a significant difference between the two groups (t=2.96, P=0.006). The occurrence rate of F wave in CMT1A group was 34.6%±39%, and that in CIDP group was 70.7%±15.2%. There was a significant difference between the two groups (t=-5.13, P < 0.001). The MCV of median nerve in a patient with anti neurofascin 155 (NF155) was 23.22 m/s, the latency of F wave was 62.9-70.7 ms, and the occurrence rate was 85%-95%. The proportion of brachial plexus and lumbar plexus thickening in CMT1A was 83.3% (5/6) and 85.7% (6/7), respectively. The proportion of brachial plexus and lumbar plexus thickening in the CIDP patients was only 25.0% (1/4, 2/8). The nerve roots of brachial plexus and lumbar plexus were significantly thickened in a patient with anti NF155 antibody. Conclusion: The prolonged latency of F wave in patients with CMT1A reflects the homogenous changes in both proximal and distal peripheral nerves, which can be used as a method to differentiate the CIDP patients characterized by focal demyelinating pathology. Moreover, attention should be paid to differentiate it from the peripheral neuropathy caused by anti NF155 CIDP. Although F wave is often used as an indicator of proximal nerve injury, motor neuron excitability, anterior horn cells, and motor nerve myelin sheath lesions can affect its latency and occurrence rate. F wave abnormalities need to be comprehensively analyzed in combination with the etiology, other electrophysiological results, and MRI imaging.

Key words: Charcot-Marie-Tooth, Chronic inflammatory demyelinating polyneuropathy, Electromyography

CLC Number: 

  • R745.4

Table 1

Comparison of epidemiological data between two groups"

Items CMT1A (n=30) CIDP (n=30) t/χ2 P
Age of onset/years, $\bar x \pm s$ 22.19±15.79 45.17±17.78 4.27 < 0.001*
Male/female, n 17/13 16/14 0.07 0.795
Disease duration/months, $\bar x \pm s$ 90.77±82.90 37.71±25.63 4.36 < 0.001*
Muscle weakness
  Upper limb, n 15 16 0.07 0.796
  Lower limb, n 28 19 7.95 0.005*
Foot drop, n 25 10 15.43 < 0.001*
Pain sensation loss, n 10 22 9.64 0.002*
Vibration sensation loss, n 13 19 2.41 0.121

Table 2

Comparison of electrophysiological results between 2 groups"

Items CMT1A (n=30) CIDP (n=30) t/χ2 P
Median nerve
  MCV/(m/s) 21.10±10.60 31.52±12.46 -6.75 < 0.001*
  CMAP amplitude/mV 3.16(0, 9.40) 3.55 (0, 10.10) 0.94 0.351
  F wave absent, n 12 3 7.20 0.007*
  F wave occurrence rate/% 41.37±41.98 62.82±13.50 -2.35 0.023*
  F wave latency /ms 47.78±17.21 41.30±9.80 2.64 0.013*
  F wave latency < 50 ms, n 9 20 8.08 0.004*
Ulnar nerve
  MCV/(m/s) 19.31±10.60 36.24±10.76 -7.61 < 0.001*
  CMAP amplitude/mV 3.08±2.40 3.28±2.56 1.29 0.201
  F wave absent, n 13 4 6.65 0.010
  F wave occurrence rate/% 34.60±39.00 70.70±15.20 -5.13 < 0.001*
  F wave latency/ms 52.40±17.56 42.20±12.73 2.96 0.006*
  F wave latency < 50 ms, n 6 20 13.30 < 0.001*

Table 3

Comparison of F wave latency variability between 2 groups"

Items CMT1A (n=30) CIDP (n=30) χ2 P
Median nerve, n
   < 30 ms 1 5 0.195
  30-40 ms 3 8 2.78 0.095
  41-50 ms 5 7 0.42 0.519
  51-60 ms 5 6 0.11 0.739
  >60 ms 4 1 0.353
  Absent 12 3 7.20 0.007*
Ulnar nerve, n
   < 30 ms 0 6 0.024*
  30-40 ms 3 7 1.92 0.166
  41-50 ms 3 7 1.92 0.166
  51-60 ms 5 5 0 1
  >60 ms 6 1 0.103
  Absent 13 4 6.65 0.010*

Figure 1

MRI images of brachial plexus and lumbar plexus roots in CMT1A, classical CIDP and NF155 positive CIDP A, B, nerve roots of brachial plexus and lumbar plexus were significantly thickened in a patient with CMT1A; C, D, nerve roots of brachial plexus and lumbar plexus were normal in a patient with classical CIDP; E, F, nerve roots of brachial plexus and lumbar plexus were significantly thickened in a patient with anti NF155 antibody CIDP. CMT1A, Charcot-Marie-Tooth1A; CIDP, chronic inflammatory demyelinating polyneuropathy; NF155, neurofascin 155."

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