Distal symmetric polyneuropathy: A definition for clinical research - Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation

J. D. England, G. S. Gronseth, G. Franklin, R. G. Miller, A. K. Asbury, G. T. Carter, J. A. Cohen, M. A. Fisher, J. F. Howard, L. J. Kinsella, N. Latov, R. A. Lewis, Phillip Anson Low, A. J. Sumner

Research output: Contribution to journalArticle

448 Citations (Scopus)

Abstract

The objective of this report was to develop a case definition of distal symmetric polyneuropathy to standardize and facilitate clinical research and epidemiologic studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetric polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiologic studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach to defining distal symmetric polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiologic research studies will ensure greater consistency of case selection.

Original languageEnglish (US)
Pages (from-to)199-207
Number of pages9
JournalNeurology
Volume64
Issue number2
StatePublished - Jan 25 2005
Externally publishedYes

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Physical and Rehabilitation Medicine
Polyneuropathies
Medicine
Signs and Symptoms
Epidemiologic Studies
Research
Multiple Abnormalities
Clinical Trials

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Distal symmetric polyneuropathy : A definition for clinical research - Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. / England, J. D.; Gronseth, G. S.; Franklin, G.; Miller, R. G.; Asbury, A. K.; Carter, G. T.; Cohen, J. A.; Fisher, M. A.; Howard, J. F.; Kinsella, L. J.; Latov, N.; Lewis, R. A.; Low, Phillip Anson; Sumner, A. J.

In: Neurology, Vol. 64, No. 2, 25.01.2005, p. 199-207.

Research output: Contribution to journalArticle

England, JD, Gronseth, GS, Franklin, G, Miller, RG, Asbury, AK, Carter, GT, Cohen, JA, Fisher, MA, Howard, JF, Kinsella, LJ, Latov, N, Lewis, RA, Low, PA & Sumner, AJ 2005, 'Distal symmetric polyneuropathy: A definition for clinical research - Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation', Neurology, vol. 64, no. 2, pp. 199-207.
England, J. D. ; Gronseth, G. S. ; Franklin, G. ; Miller, R. G. ; Asbury, A. K. ; Carter, G. T. ; Cohen, J. A. ; Fisher, M. A. ; Howard, J. F. ; Kinsella, L. J. ; Latov, N. ; Lewis, R. A. ; Low, Phillip Anson ; Sumner, A. J. / Distal symmetric polyneuropathy : A definition for clinical research - Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. In: Neurology. 2005 ; Vol. 64, No. 2. pp. 199-207.
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