Dor neuropática no aprisionamento do nervo fibular na cabeça da fíbula

Öztürk, İlker; Fidanci, Halit; Arlier, Zülfikar

doi:10.1055/s-0042-1758644

Brasil

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Original Article • Arq. Neuro-Psiquiatr. 80 (11) • 2022 • https://doi.org/10.1055/s-0042-1758644 linkcopiar

Dor neuropática no aprisionamento do nervo fibular na cabeça da fíbula

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Antecedentes A neuropatia fibular na cabeça da fíbula (PNFH) é uma mononeuropatia que normalmente se apresenta com pé caído e anormalidades sensoriais sobre a área da pele inervada pelo nervo fibular.

Objetivo O objetivo do presente estudo foi avaliar a dor neuropática em pacientes com PNFH.

Métodos Pacientes com características clínicas e eletrodiagnósticas consistentes com PNFH associada a perda de peso, postura das pernas ou sono prolongado foram incluídos neste estudo de coorte retrospectivo. Estudos de condução nervosa foram realizados nas extremidades inferiores bilaterais de todos os pacientes. A escala de avaliação de sintomas e sinais neuropáticos de Leeds (LANSS) foi aplicada a todos os pacientes.

Resultados Trinta e dois pacientes com PNFH (78%) foram incluídos no estudo. A pontuação LANSS em outros pacientes foi menor que 12. Houve 1 paciente com pontuação LANSS de 12. As características eletrodiagnósticas de 16 pacientes foram compatíveis com degeneração axonal. Os escores médios do LANSS de pacientes com PNFH com e sem degeneração axonal foram 4,3 ± 3,7 e 5,2 ± 2,9, respectivamente (p = 0,255).

Conclusão O presente estudo mostrou que a dor neuropática é um sintoma raro em pacientes com PNFH associada à perda de peso, postura das pernas ou sono prolongado.

Palavras-chave Eletrodiagnóstico; Condução Nervosa; Neuralgia; Nervo Fibular

Clinical feature		Number of patients (%)
Male		25 (78.1)
Right-sided PNFH		20 (62.5)
Medical condition	Crossing legs	14 (43.8)
	Squatting	7 (21.9)
	Prolonged sleep	5 (15.6)
	Weight loss	5 (15.6)
	Both crossing legs and weight loss	6 (18.8)
	Prolonged sleep	5 (15.6)
Neurological examination - weakness	Dorsiflexion of foot	31 (96.9)
	Eversion of foot	26 (81.3)
	None	1 (3.1)
Neurological examination - sensory abnormality	Dorsum of foot	10 (31.3)
	Lateral of leg	1 (3.1)
	Both foot dorsum and leg lateral	15 (46.9)
	None	6 (18.8)

Electrodiagnostic parameter	Mean ± SD (min-max) (number)
Terminal CMAP amplitude (mV) EDB / TA	6.2 ± 2.8 (0–11.9) (n = 32) / 7.5 ± 3.3 (2.1–14.5) (n = 32)
Motor NCV across BFH-PF segment (m/s) EDB^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included. /TA^‡ ‡ Since peroneal nerve CMAP (TA) could not be obtained in one patient by peroneal nerve stimulation at the popliteal fossa, this patient was not included.	36.7 ± 7.5 (22–53) (n = 31) / 39.2 ± 11.7 (20–65) (n = 31)
CMAP amplitude reduction in percentage across BFH-PF segment (%) EDB^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included. / TA	58.7 ± 32.1 (0–98.1) (n = 31) / 53.1 ± 26.6 (0–100) (n = 32)
Motor NCV difference between ankle-BFH and BFH-PF segments EDB (m/s)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	11.1 ± 6.9 (2–27) (n = 31)
Reduction of motor NCV across the BFH-PF segment compared with that across the ankle-below fibular head segment (%)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	23.1 ± 13.8 (4.2–51.1) (n = 31)
Superficial peroneal CNAP amplitude (μV)	12.6 ± 8.4 (0–27.7) (n = 32)
Superficial peroneal sensory NCV (m/s) ^§ § Since superficial peroneal nerve CNAP could not be obtained in three patients, these patients were not included.	48.4 ± 5.8 (37.0–57.5) (n = 28)
The severity of active denervation – TA	2.5 ± 0.8 (1–4)
The severity of active denervation – PL	1.3 ± 0.5 (0–3)

Electrodiagnostic parameters	Number of patients (%)
CMAP amplitude (mV) < 3.7 mV (EDB)	13 (40.6)
CMAP amplitude (mV) < 3.9 mV (TA)	9 (28.1)
Motor NCV across BFH-PF segment < 40.1 m/s (EDB)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	20 (64.5)
Motor NCV across BFH-PF segment < 41.0 m/s (TA)^‡ ‡ Since peroneal nerve CMAP (TA) could not be obtained in one patient by peroneal nerve stimulation at the popliteal fossa, this patient was not included.	19 (61.3)
Motor NCV across BFH-PF segment < 40.1 m/s (EDB) or < 41 m/s (TA)	32 (75.0)
CMAP amplitude reduction in percentage across BFH-PF segment > 25% (EDB)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	24 (77.4)
CMAP amplitude reduction in percentage across BFH-PF segment > 25% (TA)	29 (90.6)
CMAP amplitude reduction in percentage across BFH-PF segment > 25% (EDB or TA)	31 (96.9)
Motor NCV difference between ankle-below fibular head and BFH-PF segments > 6 m/s (EDB)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	20 (64.5)
Reduction of motor NCV across the BFH-PF segment compared with that across the ankle-BFH segment > 12% (EDB)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	22 (71.0)
Superficial peroneal CNAP amplitude < 5.3 μV	8 (25)
Superficial peroneal sensory NCV < 37.0 m/s^§ § Since superficial peroneal nerve CNAP could not be obtained in three patients, these patients were not included.	1 (3.6)
PSW or fibrillation potentials – TA	32 (100)
PSW or fibrillation potentials – PL	23 (71.9)
Neurogenic MUAP – TA	1 (3.1)

Clinical and electrodiagnostic parameter	LANSS score
Clinical and electrodiagnostic parameter	P	R
Age	0.576	0.103
Duration	0.997	0.001
MRC score of DF	0.330	-0.178
MRC score of eversion	0.305	−0.187
Peroneal nerve CMAP amplitude (EDB)	0.203	0.231
Peroneal nerve CMAP amplitude (TA)	0.846	0.036
Motor NCV across BFH-PF segment (EDB)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	0.090	−0.310
Motor NCV across BFH-PF segment (TA)^‡ ‡ Since peroneal nerve CMAP (TA) could not be obtained in one patient by peroneal nerve stimulation at the popliteal fossa, this patient was not included.	0.991	0.002
CMAP amplitude reduction in percentage across BFH-PF segment (EDB)^† † Since peroneal nerve CMAP (EDB) could not be obtained in one patient, this patient was not included.	0.465	0.136
CMAP amplitude reduction in percentage across BFH-PF segment (TA)	0.991	0.002
Superficial peroneal CNAP amplitude	0.621	−0.091
Superficial peroneal sensory NCV^§ § Since superficial peroneal nerve CNAP could not be obtained in three patients, these patients were not included. Spearman's correlation test was used.	0.663	−0.086
The severity of active denervation – TA	0.888	0.026
The severity of active denervation – PL	0.398	0.155

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[TFN1] Abbreviation: PNFH, peroneal neuropathy at the fibular head.