Nodopathy: clinic, diagnosis, treatment. Clinical description
- Authors: Bulatov A.R.1, Litvinenko I.V.1, Tsygan N.V.1, Bardakov S.N.1, Boykova A.A.1, Kolesnik T.A.1, Onishchenko L.S.1
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Affiliations:
- Military Medical Academy
- Issue: Vol 42, No 4 (2023)
- Pages: 427-435
- Section: Case report
- URL: https://journal-vniispk.ru/RMMArep/article/view/264754
- DOI: https://doi.org/10.17816/rmmar611154
- ID: 264754
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Abstract
AIM: Evaluation of the significance and possibilities of laboratory-instrumental diagnostic methods in establishing the diagnosis and selection of targeted therapy in patients with nodopathies.
MATERIALS AND METHODS: System analysis of data from foreign and domestic literature with the presentation of a clinical case.
RESULTS: Polyneuropathies are classified as demyelinating or axonal based on electrophysiological studies. However, in 2015, in addition to axonal and demyelinating neuropathies, it was proposed to distinguish a separate pathophysiological group — nodopathies. The pathogenesis of nodopathies may differ depending on the type of ion channels involved in the process, but always leads to a loss of excitability of the axon membrane; in the nodal region the membrane becomes inexcitable. Such neuropathies are characterized by transient conduction blocks followed by the development of axonal degeneration. Typical examples of nodopathies are acute motor axonal neuropathy, as well as multifocal motor neuropathy. Current pathophysiological understanding of specialized nodal regions (nodes of Ranvier) and associated axoglial proteins is growing. Hypotheses have been put forward about their role in the pathogenesis of immune-mediated attack on the peripheral myelinated axon. Recently, high titers of antibodies directed against a number of key adhesion molecules have been identified in both acute and chronic inflammatory neuropathies. These facts add to the differences in differential diagnosis between axonal and demyelinating peripheral neuropathies. New disease classification schemes based on seropositivity, improved electrophysiological and ultrasound classification, and identification of putative underlying pathological targets and mechanisms are being rapidly developed.
CONCLUSION: Using our clinical example, we demonstrated the capabilities of laboratory and instrumental diagnostic methods in establishing a diagnosis in a patient with one of the forms of nodopathies — multifocal motor neuropathy.
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##article.viewOnOriginalSite##About the authors
Al'bert R. Bulatov
Military Medical Academy
Author for correspondence.
Email: albert_br@mail.ru
ORCID iD: 0000-0001-7180-4389
SPIN-code: 1626-8400
Lecturer of the Nervous Diseases Department
Russian Federation, Saint PetersburgIgor' V. Litvinenko
Military Medical Academy
Email: litvinenkoiv@rambler.ru
ORCID iD: 0000-0001-8988-3011
SPIN-code: 6112-2792
Scopus Author ID: 35734354000
ResearcherId: F-9120-2013
M.D., D.Sc. (Medicine), Professor the Head of the Department and Clinic of Nervous Diseases
Russian Federation, Saint PetersburgNikolay V. Tsygan
Military Medical Academy
Email: 1860n@mail.ru
ORCID iD: 0000-0002-5881-2242
SPIN-code: 1006-2845
Scopus Author ID: 37066611200
ResearcherId: H-9132-2016
M.D., D.Sc. (Medicine), Professor, Deputy Head of the Department and Clinic of Nervous Diseases
Russian Federation, Saint PetersburgSergey N. Bardakov
Military Medical Academy
Email: epistaxis@mail.ru
ORCID iD: 0000-0002-3804-6245
SPIN-code: 2351-4096
M.D., Ph.D. (Medicine), Lecturer of the Nervous Diseases Depart
Russian Federation, Saint PetersburgAleksandra A. Boykova
Military Medical Academy
Email: saboykova@yandex.ru
SPIN-code: 3191-4308
student of the 4th faculty, 5th year
Russian Federation, Saint PetersburgTatyana A. Kolesnik
Military Medical Academy
Email: taniakolesnik061@mail.ru
student of the 4th faculty, 5th year
Russian Federation, Saint PetersburgLyudmila S. Onishchenko
Military Medical Academy
Email: ludonis1947@yandex.ru
ORCID iD: 0000-0003-3562-1029
SPIN-code: 4985-7683
Scopus Author ID: 160612003492
ResearcherId: I-7566-2016
Ph. D. (Biology), Scientific Center
Russian Federation, Saint PetersburgReferences
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