Advanced

Evaluation of clinical tools and their diagnostic use in distal symmetric polyneuropathy

Pourhamidi, Kaveh; Dahlin, Lars LU ; Englund, Elisabet LU and Rolandsson, Olov (2014) In Primary Care Diabetes 8(1). p.77-84
Abstract
Aims: To compare the diagnostic usefulness of tuning fork, monofilament, biothesiometer and skin biopsies in peripheral neuropathy in individuals with varying glucose metabolism. Methods: Normoglycaemic, impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) individuals were recruited. Nerve conduction studies (NCS) and thermal threshold tests were performed. Vibrotactile sense was tested with a biothesiometer and a 128-Hz tuning fork. Touch/pressure perception was examined with a 10-g monofilament. Skin biopsies were performed and intraepidermal nerve fibres were quantified. Distal symmetric polyneuropathy (DSPN) was defined as neuropathy disability score >= 2 and abnormal NCS. Thermal threshold tests were used to define small... (More)
Aims: To compare the diagnostic usefulness of tuning fork, monofilament, biothesiometer and skin biopsies in peripheral neuropathy in individuals with varying glucose metabolism. Methods: Normoglycaemic, impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) individuals were recruited. Nerve conduction studies (NCS) and thermal threshold tests were performed. Vibrotactile sense was tested with a biothesiometer and a 128-Hz tuning fork. Touch/pressure perception was examined with a 10-g monofilament. Skin biopsies were performed and intraepidermal nerve fibres were quantified. Distal symmetric polyneuropathy (DSPN) was defined as neuropathy disability score >= 2 and abnormal NCS. Thermal threshold tests were used to define small nerve fibre neuropathy (sDSPN) in cases where NCS (large nerve fibres) were normal. Results: The prevalence of DSPN and sDSPN in the whole group (n = 119) was 18% and 23%, respectively. For the biothesiometer, a cut-off of >= 24.5V had a sensitivity of 82% and specificity of 70% (AUC = 0.81, 95% CI 0.71-0.91) when evaluating DSPN. An intraepidermal nerve fibre density cut-off of <= 3.39 fibres/mm showed a sensitivity of 74% and specificity of 70% in the detection of sDSPN, whereas the sensitivity of the tuning fork and the biothesiometer were relatively low, 46% and 67%, respectively. When combining skin biopsies with the tuning fork, 10 more sDSPN cases were identified. Adding skin biopsy to the combination of the tuning fork and biothesiometer increased the sensitivity of finding sDSPN cases, but not DSPN, from 81% to 93%. Conclusion: Using a biothesiometer in clinical routine might be a sensitive method to detect large nerve fibre dysfunction in the lower extremity, whereas skin biopsies in combination with methods measuring vibrotactile sense could increase the diagnostic sensitivity of detecting peripheral neuropathy at an early stage. (C) 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Biothesiometer, Diabetes mellitus, Nerve fibres, Neuropathy, Skin biopsy
in
Primary Care Diabetes
volume
8
issue
1
pages
77 - 84
publisher
Elsevier
external identifiers
  • wos:000334086600011
  • scopus:84895792447
ISSN
1878-0210
DOI
10.1016/j.pcd.2013.04.004
language
English
LU publication?
yes
id
c6361743-fc8b-4695-bc77-a5a6aad6d270 (old id 4439752)
date added to LUP
2014-07-01 07:44:44
date last changed
2017-03-05 03:12:28
@article{c6361743-fc8b-4695-bc77-a5a6aad6d270,
  abstract     = {Aims: To compare the diagnostic usefulness of tuning fork, monofilament, biothesiometer and skin biopsies in peripheral neuropathy in individuals with varying glucose metabolism. Methods: Normoglycaemic, impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) individuals were recruited. Nerve conduction studies (NCS) and thermal threshold tests were performed. Vibrotactile sense was tested with a biothesiometer and a 128-Hz tuning fork. Touch/pressure perception was examined with a 10-g monofilament. Skin biopsies were performed and intraepidermal nerve fibres were quantified. Distal symmetric polyneuropathy (DSPN) was defined as neuropathy disability score &gt;= 2 and abnormal NCS. Thermal threshold tests were used to define small nerve fibre neuropathy (sDSPN) in cases where NCS (large nerve fibres) were normal. Results: The prevalence of DSPN and sDSPN in the whole group (n = 119) was 18% and 23%, respectively. For the biothesiometer, a cut-off of &gt;= 24.5V had a sensitivity of 82% and specificity of 70% (AUC = 0.81, 95% CI 0.71-0.91) when evaluating DSPN. An intraepidermal nerve fibre density cut-off of &lt;= 3.39 fibres/mm showed a sensitivity of 74% and specificity of 70% in the detection of sDSPN, whereas the sensitivity of the tuning fork and the biothesiometer were relatively low, 46% and 67%, respectively. When combining skin biopsies with the tuning fork, 10 more sDSPN cases were identified. Adding skin biopsy to the combination of the tuning fork and biothesiometer increased the sensitivity of finding sDSPN cases, but not DSPN, from 81% to 93%. Conclusion: Using a biothesiometer in clinical routine might be a sensitive method to detect large nerve fibre dysfunction in the lower extremity, whereas skin biopsies in combination with methods measuring vibrotactile sense could increase the diagnostic sensitivity of detecting peripheral neuropathy at an early stage. (C) 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.},
  author       = {Pourhamidi, Kaveh and Dahlin, Lars and Englund, Elisabet and Rolandsson, Olov},
  issn         = {1878-0210},
  keyword      = {Biothesiometer,Diabetes mellitus,Nerve fibres,Neuropathy,Skin biopsy},
  language     = {eng},
  number       = {1},
  pages        = {77--84},
  publisher    = {Elsevier},
  series       = {Primary Care Diabetes},
  title        = {Evaluation of clinical tools and their diagnostic use in distal symmetric polyneuropathy},
  url          = {http://dx.doi.org/10.1016/j.pcd.2013.04.004},
  volume       = {8},
  year         = {2014},
}