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

Peter James Dyck, Jeannine L. Karnes, Jasper Daube, Peter O'brien, F. John Service

Research output: Contribution to journalArticlepeer-review

293 Scopus citations

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
DOIs
StatePublished - Dec 1 1985

ASJC Scopus subject areas

  • Clinical Neurology

Fingerprint Dive into the research topics of 'Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy'. Together they form a unique fingerprint.

Cite this