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Comment & Response
January 2015

Peripheral Nerve Involvement in Adult and Pediatric Patients With Central Nervous System Inflammatory Disease

Author Affiliations
  • 1C. Mondino National Neurological Institute, Pavia, Italy
JAMA Neurol. 2015;72(1):123. doi:10.1001/jamaneurol.2014.3524

To the Editor We read with interest the study by DeSena et al1 concerning 3 cases of myelitis and 2 cases of encephalomyelitis associated with concomitant peripheral nerve involvement (PNI) in a pediatric setting. We previously published a prospective study2 on 176 patients with encephalitis, myelitis, or encephalomyelitis following an infectious event. Concomitant PNI was found in 36% of patients. Similarly to the study by DeSena et al,1 our patients with PNI had higher residual disability compared with pure central nervous system patients. However, our study presented important differences: (1) in our work, patients were defined as having PNI only if they had evidence of electromyogram/nerve conduction study alteration not related to other causes of polyneuropathy; (2) in the study by DeSena et al,1 all patients with altered nerve conduction study results had exclusively motor and axonal features and our experience was different because axonal and demyelinating features were equally distributed (45.3% and 48.4%, respectively); and (3) only 46% of our patients with PNI were symptomatic of peripheral damage, showing sock and glove paresthesias, perineal anesthesia, and muscle atrophy outside the usual sites of entrapment.

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