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. 2023 Sep;81(9):785-794.
doi: 10.1055/s-0043-1772599. Epub 2023 Oct 4.

F-waves persistence in peripheral sensory syndromes

Fabricio Diniz de Lima  1   2 , Alberto Rolim Muro Martinez  1 , Gabriel da Silva Schmitt  1 , Andrea Fernandes Eloy da Costa França  3 , Paulo Eduardo Neves Ferreira Velho  3 , Juliana Akita  4 , José Antônio Garbino  4 , Anamarli Nucci  1 , Marcondes Cavalcante França Jr  1
Affiliations

F-waves persistence in peripheral sensory syndromes

Fabricio Diniz de Lima et al. Arq Neuropsiquiatr. 2023 Sep.

Abstract
in English, Portuguese

Background: The distinction between sensory neuronopathies (SN), which is by definition purely sensory, and sensory polyneuropathies (SP) and sensory multineuropathies (SM) is important for etiologic investigation and prognosis estimation. However, this task is often challenging in clinical practice. We hypothesize that F-wave assessment might be helpful, since it is able to detect subtle signs of motor involvement, which are found in SP and SM, but not in SN.

Objective: The aim of the present study was to determine whether F-waves are useful to distinguish SN from SP and SM.

Methods: We selected 21 patients with SP (12 diabetes mellitus, 4 transthyretin familial amyloid polyneuropathy, 4 others), 22 with SM (22 leprosy), and 26 with SN (13 immune-mediated, 10 idiopathic, 3 others) according to clinical-electrophysiological-etiological criteria. For every subject, we collected data on height and performed 20 supramaximal distal stimuli in median, ulnar, peroneal, and tibial nerves, bilaterally, to record F-waves. Latencies (minimum and mean) and persistences were compared across groups using the Kruskal-Wallis and Bonferroni tests. P-values < 0.05 were considered significant.

Results: All groups were age, gender, and height-matched. Overall, there were no significant between-group differences regarding F-wave latencies. In contrast, F-wave persistence was able to stratify the groups. Peroneal F-wave persistence was higher, bilaterally, in the SN group compared to SM and SP (p < 0.05). In addition, F-waves persistence of the ulnar and tibial nerves was also helpful to separate SN from SP (p < 0.05).

Conclusion: F-wave persistence of the peroneal nerves might be an additional and useful diagnostic tool to differentiate peripheral sensory syndromes.

Antecedentes: A distinção entre neuronopatias sensitivas (SN) e polineuropatias sensitivas (SP) e multineuropatias sensitivas (SM) é importante para a investigação etiológica e para o prognóstico. Contudo, esta tarefa é desafiadora na prática clínica. Hipotetizou-se que a avaliação das ondas-F pode ser útil, por ser capaz de detectar envolvimento motor nas SP e SM, mas não nas SN.

Objetivo: Determinar se as ondas-F podem ajudar a distinguir entre SN, SP e SM. MéTODOS: Selecionou-se 21 pacientes com SP (12 diabetes mellitus, 4 ATTR-FAP e 4 com outras neuropatias), 22 com SM (22 hanseníases) e 26 com SN (13 imunomediadas, 10 idiopáticas e 3 com outras neuronopatias), de acordo com critérios clínicos, etiológicos e eletrofisiológicos. Para cada indivíduo, foi aferida a altura e foram aplicados 20 estímulos distais supramáximos nos nervos mediano, ulnar, fibular e tibial, bilateralmente, para registrar as ondas-F. Uma comparação foi feita, por grupo, das latências (mínimas e médias) e persistências pelos testes Kruskal-Wallis e Bonferroni. Valores de p < 0.05 foram considerados estatisticamente significativos.

Resultados: Todos os grupos foram pareados por idade, sexo e altura. Não houve diferença estatística significativa entre os grupos quanto às latências das ondas-F. A persistência da onda-F foi capaz de estratificar os grupos, sendo as dos nervos fibulares bilateralmente maiores no grupo SN que nos grupos SM e SP (p < 0.05). Adicionalmente, a persistência das ondas-F dos nervos ulnares e tibiais também foi útil para distinguir SN de SP (p < 0.05). CONCLUSãO: A persistência das ondas-F dos nervos fibulares pode ser uma ferramenta adicional e útil para diferenciar síndromes sensitivas periféricas.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flowchart summarizing the design of the study and the etiological profile of patients in each group that underwent F-wave evaluation. NCS/EMG: nerve conduction study and electromyography.
Figure 2
Figure 2
Boxplots showing the distribution of F-wave persistence for the median ( A ), ulnar ( B ), peroneal ( C ) and tibial ( D ) nerves in left (blue boxes) and right (red boxes) sides stratified for the three groups.
Figure 3
Figure 3
Receiver operator characteristics curves showing the diagnostic accuracy of peroneal nerve F-wave persistence to differentiate sensory neuronopathies from non-sensory neuronopathies ( A ) and sensory neuronopathies from sensory polyneuropathies ( B ).
See this image and copyright information in PMC

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