Expert consensus on the combined investigation of polyneuropathies with electrodiagnostic tests and neuromuscular ultrasound

Luciana Pelosi¹, Zsuzsanna Arányi², Daniele Coraci³, Alexander Grimm⁴, Ingrid Herraets⁵, Lisa D Hobson-Webb⁶, Antonios Kerasnoudis⁷, Ruth Leadbetter⁸, Simon Podnar⁹, Neil Simon¹⁰, Johan Telleman¹¹, Nens van Alfen¹², Leo Visser¹³, Francis O Walker¹⁴, Natalie Winter⁴, Eppie M Yiu¹⁵, Craig Zaidman¹⁶, Michael S Cartwright¹⁴

Affiliations

¹ Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand. Electronic address: pelosiluciana@gmail.com.
² Department of Neurology, Semmelweis University, Budapest, Hungary.
³ Department of Neuroscience, University of Padova, Padua, Italy.
⁴ Department of Neurology and Epileptology, University Tuebingen, Germany.
⁵ Elisabeth-Tweesteden Hospital Tilburg, Department of Neurology and Clinical Neurophysiology, Hilvarenbeekseweg 60, 5022 GC, the Netherlands.
⁶ Neuromuscular Division/Department of Neurology, Duke University, Durham, NC, USA.
⁷ St Josef Hospital, Ruhr University, Bochum, Germany.
⁸ Department of Neurology, Wellington Hospital, Wellington, NZ, New Zealand.
⁹ Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
¹⁰ Northern Beaches Clinical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
¹¹ Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands.
¹² Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands.
¹³ Department of Neurology and Clinical Neurophysiology , Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands.
¹⁴ Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹⁵ Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia; Neuroscience Research Group, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia.
¹⁶ Divisions of Child Neurology and Neuromuscle, Washington University in St. Louis School of Medicine, St. Louis, United States.

PMID: 40411981
DOI: 10.1016/j.clinph.2025.2110749

Expert consensus on the combined investigation of polyneuropathies with electrodiagnostic tests and neuromuscular ultrasound

Luciana Pelosi et al. Clin Neurophysiol. 2025 Jul.

. 2025 Jul:175:2110749.

doi: 10.1016/j.clinph.2025.2110749. Epub 2025 May 19.

Authors

Affiliations

¹ Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand. Electronic address: pelosiluciana@gmail.com.
² Department of Neurology, Semmelweis University, Budapest, Hungary.
³ Department of Neuroscience, University of Padova, Padua, Italy.
⁴ Department of Neurology and Epileptology, University Tuebingen, Germany.
⁵ Elisabeth-Tweesteden Hospital Tilburg, Department of Neurology and Clinical Neurophysiology, Hilvarenbeekseweg 60, 5022 GC, the Netherlands.
⁶ Neuromuscular Division/Department of Neurology, Duke University, Durham, NC, USA.
⁷ St Josef Hospital, Ruhr University, Bochum, Germany.
⁸ Department of Neurology, Wellington Hospital, Wellington, NZ, New Zealand.
⁹ Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
¹⁰ Northern Beaches Clinical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
¹¹ Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands.
¹² Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands.
¹³ Department of Neurology and Clinical Neurophysiology , Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands.
¹⁴ Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹⁵ Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia; Neuroscience Research Group, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia.
¹⁶ Divisions of Child Neurology and Neuromuscle, Washington University in St. Louis School of Medicine, St. Louis, United States.

PMID: 40411981
DOI: 10.1016/j.clinph.2025.2110749

Abstract

Consensus was sought from 17 nominated global expert leaders to provide guidance on the combined use of neuromuscular ultrasound (NMUS) and electrodiagnostic tests (EDX) in the investigation of peripheral neuropathy (PN) in clinical practice. Consensus was based on an initial systematic review of the literature by the experts themselves, followed by three anonymised surveys, using the Delphi method. No consensus was defined as < 60 % rating frequency. The panel agreed that NMUS should be used if EDX cannot differentiate an axonal from a demyelinating process or an acquired from a hereditary process, and in the investigation of vasculitic neuropathy; NMUS of the brachial plexus should be used in Guillain-Barre' syndrome if EDX is negative; when NMUS is used, at least two nerves of the upper limbs should be scanned; NMUS should be used for screening or repeat testing for carpal tunnel syndrome in children with mucopolysaccharidoses. Areas of disagreement exposed gaps in current knowledge and informed the direction of future research, which should aim to identify situations in which NMUS can stand alone as a diagnostic test, particularly for screening or repeat testing and especially in vulnerable individuals and paediatric populations.

Keywords: Delphi method; Electrodiagnostic testing; Expert consensus; Neuromuscular ultrasound; Polyneuropathy.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nens van Alfen works as an ultrasound instructor for Sonoskills and performs editorial duties for Wiley Publishing; all payments go to their employer.

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Expert consensus on the combined investigation of polyneuropathies with electrodiagnostic tests and neuromuscular ultrasound

Affiliations

Expert consensus on the combined investigation of polyneuropathies with electrodiagnostic tests and neuromuscular ultrasound

Authors

Affiliations

Abstract

Conflict of interest statement

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