Nerve Conduction Study in the Diagnosis of Vasculitic Neuropathy: A Systematic Review

Abstract

Vasculitic Neuropathy (VN) requires early diagnosis to prevent permanent nerve damage. While Nerve Conduction Studies (NCS) are essential non-invasive diagnostic tools, the specific electrophysiological patterns associated with VN vary, and their effectiveness in guiding clinical decisions remains a subject of study.

Objective: This systematic review aims to synthesize current evidence regarding the utility of NCS in the diagnosis of VN and to identify characteristic electrophysiological patterns in biopsy-confirmed cases. A systematic literature search was conducted on PubMed and Scopus databases using the keywords "nerve conduction study" and "vasculitic neuropathy". The review included four eligible articles involving 296 patients comprising Systemic Vasculitis (SV), Non-Systemic Vasculitis (NSV), and Peripheral Vasculitic Neuropathy (VNP). The analysis reveals that VN is consistently dominated by axonal neuropathy. While mononeuritis multiplex is the classic presentation, asymmetric polyneuropathy and diffuse polyneuropathy are frequently observed, likely due to delayed clinical evaluation. Asymmetry in NCS findings serves as a feature that may increase clinical suspicion for VN. Conversely, normal NCS results, primary demyelination patterns, or pure motor presentations are findings that may reduce clinical suspicion, making a VN diagnosis highly unlikely. The review found no significant differences in NCS patterns between Systemic Vasculitis Neuropathy (SVN) and Non-Systemic Vasculitis Neuropathy (NSVN). NCS is a vital diagnostic tool for VN. Clinicians should look for asymmetric axonal neuropathy as a key indicator. While NCS helps support the diagnosis and rule out other conditions, it cannot distinguish between systemic and non-systemic etiology.