Dr Lunn and his team will test a non-invasive magnetic resonance imaging (MRI) method for its ability to be used as a diagnostic tool for people with inflammatory neuropathy.
What are the aims of the project?
This project aims to improve the diagnosis and measurement of progression of inflammatory neuropathy by using MRI to image nerves. It is hoped the work will lead to an alternative to the invasive and potentially painful assessments that some people currently need to undergo.
Why is this research important?
The immune response exists to protect the body from infection, but occasionally it can be misdirected, causing auto-immune conditions such as the inflammatory neuropathies. These occur when the immune response is directed at the nerves that carry information between the brain and spinal cord, and the muscles and skin. These ‘peripheral nerves’ can be responsible for sensation, movement or motor coordination.
Multifocal motor neuropathy with conduction block (MMNCB) is a type of inflammatory neuropathy that causes muscle weakness and wasting, but does not have any of the sensory symptoms, such as tingling or burning, that neuropathies can cause.
Accurate diagnosis of MMNCB is crucial to distinguish it from progressive muscular atrophy (PMA; a type of motor neuron disease). A prompt diagnosis is also important, so that treatment can start as soon as possible; the condition responds well to immunoglobulin therapy, which can delay nerve damage.
Currently, diagnosis is a challenging process involving clinical assessments and testing to measure the electrical activity of the nerves (neurophysiological tests). These tests are not entirely accurate and for some people it is also necessary to take a nerve biopsy, which is invasive and can be painful.
Evidence suggests that MRI, a widely used, non-invasive imaging tool, could aid diagnosis by giving useful structural information about the nerves. Advances in magnetic resonance neurography (MRN, where MRI is used to scan and gain images of nerves) mean that peripheral nerves can be visualized. The extent of its usefulness in MMNCB has not been fully examined; this is what Dr Lunn and his team will investigate.
What will the researchers do?
Two studies will be carried out to assess the usefulness of MRN in the diagnosis and measurement of progression of MMNCB.
Firstly, Dr Lunn and his team will perform MRN on ten people with MMNCB and ten healthy individuals. All participants will also undergo the standard diagnostic tests for MMNCB; clinical assessments and nerve conduction tests. The results will be compared against each other and with those from another group of individuals, with chronic inflammatory demyelinating polyneuropathy (CIDP), to see whether MRN can be an accurate predictor of MMNCB.
Secondly, the team will assess how much structural detail can be obtained using MRN. To do this, 20 people with suspected inflammatory neuropathy who are due to have nerve biopsy as part of their diagnostic process will be scanned with MRN. They will then have a biopsy taken and this tissue will be examined by microscopy to look for structural changes (a standard part of the diagnostic process). The results from the MRN and the biopsy will be compared, to see how accurately MRN is able to show the structural changes in the nerve.
How will the outcomes of this research benefit people with inflammatory neuropathy?
This research will indicate whether MRN could be a useful diagnostic tool for inflammatory neuropathies.
If MRN can accurately predict nerve damage, it could offer a non-invasive, pain free alternative for people who need nerve biopsies as part of their diagnosis. Additionally, if it is shown to be a sensitive measure (i.e. able to recognize even small changes in the nerves), it could lead to earlier diagnosis and provide a way of testing the effectiveness of potential new treatments in clinical trials.
Project leader: Dr Michael Lunn
Institute: University College London
Condition: inflammatory and autoimmue neuropathy
Duration: One year
Total cost (£): 29,686
Official title: Exploring the role of advanced magnetic resonance imaging in investigation and management of inflammatory neuropathies
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