Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy

Peter J Dyck, J. L. Karnes, J. Daube, P. O'Brien, F. J. Service

Research output: Contribution to journalArticle

284 Citations (Scopus)

Abstract

Scored symptoms, neurological deficits, detection threshold of cutaneous sensation and parameters of nerve conduction were compared with quantitated neuropathological abnormalities in the sural nerve in 47 healthy subjects and 36 diabetic patients, 32 with and 4 without neuropathy. The fifth percentile line of a new Index of Pathology, which combines loss of myelinated fibres and abnormality of the remaining fibres, was found to provide a sensitive and reliable minimum neuropathological criterion for the diagnosis of polyneuropathy. Abnormality, as assessed by two clinical evaluations, similarly separated healthy subjects and diabetic patients into those with and without neuropathy. For the detection of diabetic polyneuropathy, vibration sense was more sensitive than touch-pressure or thermal cooling. Abnormalities of nerve conduction were found to be both sensitive and reliable in the detection of polyneuropathy. Velocity was most frequently abnormal, but only slightly more often than F wave latency and amplitude. We conclude that abnormality, as judged independently from two different types of evaluation, provides a sensitive and reliable minimal criterion for the diagnosis of neuropathy. Although symptoms, neurological deficits and abnormalities of nerve conduction are statistically associated, they should be evaluated separately to provide adequate characterization.

Original languageEnglish (US)
Pages (from-to)861-880
Number of pages20
JournalBrain
Volume108
Issue number4
StatePublished - 1985

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diabetic neuropathy
Diabetic Neuropathies
Neural Conduction
Nerve
peripheral nervous system diseases
nerve tissue
Polyneuropathies
Conduction
Fibers
Healthy Volunteers
Pathology
signs and symptoms (animals and humans)
Sural Nerve
Touch
Fiber
Vibration
Cooling
Percentile
touch (sensation)
Evaluation

ASJC Scopus subject areas

  • Neuroscience(all)
  • Statistics, Probability and Uncertainty
  • Applied Mathematics
  • Mathematics(all)
  • Statistics and Probability
  • Agricultural and Biological Sciences (miscellaneous)
  • Clinical Neurology

Cite this

Dyck, P. J., Karnes, J. L., Daube, J., O'Brien, P., & Service, F. J. (1985). Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy. Brain, 108(4), 861-880.

Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy. / Dyck, Peter J; Karnes, J. L.; Daube, J.; O'Brien, P.; Service, F. J.

In: Brain, Vol. 108, No. 4, 1985, p. 861-880.

Research output: Contribution to journalArticle

Dyck, PJ, Karnes, JL, Daube, J, O'Brien, P & Service, FJ 1985, 'Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy', Brain, vol. 108, no. 4, pp. 861-880.
Dyck, Peter J ; Karnes, J. L. ; Daube, J. ; O'Brien, P. ; Service, F. J. / Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy. In: Brain. 1985 ; Vol. 108, No. 4. pp. 861-880.
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