TY - JOUR
T1 - Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy
AU - Dyck, Peter James
AU - Karnes, Jeannine L.
AU - Daube, Jasper
AU - O'brien, Peter
AU - Service, F. John
N1 - Funding Information:
This investigation was supported in part by a Peripheral Neuropathy Clinical Center Grant from NTNCDS (NS14304), a Center Grant from MDA, a grant from Pfizer, Inc., and Mayo, Borchard, Upton and Herrick Funds.
PY - 1985/12
Y1 - 1985/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0022401992&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0022401992&partnerID=8YFLogxK
U2 - 10.1093/brain/108.4.861
DO - 10.1093/brain/108.4.861
M3 - Article
C2 - 4075076
AN - SCOPUS:0022401992
SN - 0006-8950
VL - 108
SP - 861
EP - 880
JO - Brain
JF - Brain
IS - 4
ER -