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J Neurol Sci. 2014 Sep 15;344(1-2):121-8. doi: 10.1016/j.jns.2014.06.041. Epub 2014 Jun 27.

Retrospective study of a TTR FAP cohort to modify NIS+7 for therapeutic trials.

Author information

  • 1Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
  • 2Amyloidosis Center, Department of Neurology, Boston University School of Medicine, 72 East Concord Street, K504, Boston, MA 02118, USA.
  • 3Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN 46202, USA.
  • 4Alnylam Pharmaceuticals, 300 Third Street, Cambridge, MA 02142, USA.
  • 5Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: dyck.peter@mayo.edu.


Protein stabilization and oligonucleotide therapies are being tested in transthyretin amyloid polyneuropathy (TTR FAP) trials. From retrospective analysis of 97 untreated TTR FAP patients, we test the adequacy of Neuropathy Impairment Score+7 tests (NIS+7) and modifications to comprehensively score impairments for use in such therapeutic trials. Our data confirms that TTR FAP usually is a sensorimotor polyneuropathy with autonomic features which usually is symmetric, length dependent, lower limb predominant and progressive. NIS+7 adequately assesses weakness and muscle stretch reflexes without ceiling effects but not sensation loss, autonomic dysfunction or nerve conduction abnormalities. Three modifications of NIS+7 are suggested: 1) use of Smart Somatotopic Quantitative Sensation Testing (S ST QSTing); 2) choice of new autonomic assessments, e.g., sudomotor testing of distributed anatomical sites; and 3) use of only compound muscle action potential amplitudes (of ulnar, peroneal and tibial nerves) and sensory nerve action potentials of ulnar and sural nerve - than the previously recommended attributes suggested for the sensitive detection of diabetic sensorimotor polyneuropathy. These modifications of NIS+7 if used in therapeutic trials should improve characterization and quantification of sensation and autonomic impairment in TTR FAP and provide better nerve conduction tests.

Copyright © 2014 Elsevier B.V. All rights reserved.


Ceiling effects; Modified NIS+7; Neuropathy Impairment Score (NIS); Polyneuropathy signs and tests; Smart Somatotopic QSTing; Transthyretin amyloidosis polyneuropathy (TTR FAP)

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