Epidermal nerve fibers: Confidence intervals and continuous measures with nerve conduction

JaNean K. Engelstad, Sean W. Taylor, Lawrence V. Witt, Belinda J. Hoebing, David N. Herrmann, P. James B Dyck, Christopher Jon Klein, David M. Johnson, Jenny L. Davies, Rickey E. Carter, Peter J Dyck

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives: Our first objective was to explore the value of estimating 95% confidence intervals (CIs) of epidermal nerve fibers (ENFs)/mm for number of sections to be evaluated and for confidently judging normality or abnormality. Our second objective was to introduce a new continuous measure combining nerve conduction and ENFs/mm. Methods: The 95%CI studieswere performed on 1, 1-2, 1-3 - - - 1-10 serial skip sections of 3-mm punch biopsies of leg and thigh of 67 healthy subjects and 23 patients with diabetes mellitus. Results: Variability of differences of ENFs/mm counts (and 95% CIs) from evaluation of 1, 1-2, 1-3 - - - 1-9 comparedwith1-10 serial skip sections decreased progressively without a break point with increasing numbers of sections evaluated. Estimating 95% CIs as sections are evaluated can be used to judge how many sections are needed for adequate evaluation, i.e., only a fewwhen counts and 95% CIs are well within the range of normality or abnormality and more when values are borderline. Also provided is a methodology to combine results of nerve conduction and ENFs/mm as continuous measures of normality or abnormality. Conclusion: Estimating 95% CIs of ENFs/mm is useful to judge how many sections should be evaluated to confidently declare counts to be normal or abnormal. Also introduced is a continuous measure of both large-fiber (nerve conduction) and small-fiber (ENFs/mm) normal structures/functions spanning the range of normality and abnormality for use in therapeutic trials.

Original languageEnglish (US)
Pages (from-to)2187-2193
Number of pages7
JournalNeurology
Volume79
Issue number22
DOIs
StatePublished - Nov 27 2012

Fingerprint

Neural Conduction
Nerve Fibers
Confidence Intervals
Therapeutic Uses
Thigh
Nerve
Fiber
Confidence Interval
Leg
Diabetes Mellitus
Healthy Volunteers
Biopsy
Normality

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Epidermal nerve fibers : Confidence intervals and continuous measures with nerve conduction. / Engelstad, JaNean K.; Taylor, Sean W.; Witt, Lawrence V.; Hoebing, Belinda J.; Herrmann, David N.; Dyck, P. James B; Klein, Christopher Jon; Johnson, David M.; Davies, Jenny L.; Carter, Rickey E.; Dyck, Peter J.

In: Neurology, Vol. 79, No. 22, 27.11.2012, p. 2187-2193.

Research output: Contribution to journalArticle

Engelstad, JK, Taylor, SW, Witt, LV, Hoebing, BJ, Herrmann, DN, Dyck, PJB, Klein, CJ, Johnson, DM, Davies, JL, Carter, RE & Dyck, PJ 2012, 'Epidermal nerve fibers: Confidence intervals and continuous measures with nerve conduction', Neurology, vol. 79, no. 22, pp. 2187-2193. https://doi.org/10.1212/WNL.0b013e3182759608
Engelstad, JaNean K. ; Taylor, Sean W. ; Witt, Lawrence V. ; Hoebing, Belinda J. ; Herrmann, David N. ; Dyck, P. James B ; Klein, Christopher Jon ; Johnson, David M. ; Davies, Jenny L. ; Carter, Rickey E. ; Dyck, Peter J. / Epidermal nerve fibers : Confidence intervals and continuous measures with nerve conduction. In: Neurology. 2012 ; Vol. 79, No. 22. pp. 2187-2193.
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