Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review) Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation
John D. England,John D. England,Gary S. Gronseth,Gary M. Franklin,Gregory T. Carter,Laurence J. Kinsella,Jeffrey A. Cohen,Arthur K. Asbury,Kinga Szigeti,James R. Lupski,Norman Latov,Richard A. Lewis,Phillip A. Low,Morris A. Fisher,David N. Herrmann,James F. Howard,Giuseppe Lauria,Robert G. Miller,Michael Polydefkis,Austin J. Sumner +19 more
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TLDR
There is a need for additional prospective studies to define more exact guidelines regarding the role of autonomic testing, nerve biopsy, and skin biopsy for the assessment of polyneuropathy.Abstract:
Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, nerve biopsy, and skin biopsy for the assessment of polyneuropathy. Methods: A literature review using MEDLINE, EMBASE, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based upon the level of evidence. Results and Recommendations: 1) Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). 2) Nerve biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a nerve biopsy may be useful in the evaluation of DSP (Level U). 3) Skin biopsy is a validated technique for determining intraepidermal nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. AAN = American Academy of Neurology; AANEM = American Academy of Neuromuscular and Electrodiagnostic Medicine; AAPMR ART = autonomic reflex testing; BRSI = baroreflex sensitivity index; CASS = composite autonomic scoring scale; CIDP = chronic inflammatory demyelinating polyneuropathy; DSFN = distal small fiber neuropathy; DSP = distal symmetric polyneuropathy; EDx = electrodiagnosis; EFNS = European Federation of Neurological Societies; HRV = heart rate variability; IAN = idiopathic autonomic neuropathy; IENF = intraepidermal nerve fibers; MSNA = muscle sympathetic nerve activity; NCSs = nerve conduction studies; PGP 9.5 = protein-gene-product 9.5; PN = peripheral neuropathy; PRT = blood pressure recovery time; QAE = quantitative autonomic examination; QSART = quantitative sudomotor axon reflex test; QSS = Quality Standards Subcommittee; QST = quantitative sensory testing; SFSN = small fiber sensory polyneuropathy; TST = thermoregulatory sweat testing.read more
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Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments
Solomon Tesfaye,Andrew J.M. Boulton,Peter J. Dyck,Roy Freeman,Michael Horowitz,Péter Kempler,Giuseppe Lauria,Rayaz A. Malik,Vincenza Spallone,Aaron I. Vinik,Luciano Bernardi,Paul Valensi +11 more
TL;DR: A joint meeting of the 19th annual Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes (NEURODIAB) and the 8th International Symposium on Diabetes in Toronto, Canada, 13-18 October 2009, expert panels were convened to provide updates on classification, definitions, diagnostic criteria, and treatments of diabetic peripheral neuropathies as mentioned in this paper.
Journal ArticleDOI
Whole-Genome Sequencing in a Patient with Charcot–Marie–Tooth Neuropathy
James R. Lupski,Jeffrey G. Reid,Claudia Gonzaga-Jauregui,David Rio Deiros,David C.Y. Chen,Lynne V. Nazareth,Matthew N. Bainbridge,Huyen Dinh,Chyn Jing,David A. Wheeler,Amy L. McGuire,Feng Zhang,Pawel Stankiewicz,John J. Halperin,Chengyong Yang,Curtis Gehman,Danwei Guo,Rola K. Irikat,Warren Tom,Nick J. Fantin,Donna M. Muzny,Richard A. Gibbs +21 more
TL;DR: As shown in this study of a family with Charcot-Marie-Tooth disease, whole-genome sequencing can identify clinically relevant variants and provide diagnostic information to inform the care of patients.
Journal ArticleDOI
European federation of neurological societies/peripheral nerve society guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. report of a joint task force of the european fe-deration of neurological societies and the peripheral nerve society
Giuseppe Lauria,Sung-Tsieh Hsieh,Olle Johansson,William R. Kennedy,Jean-Marc Léger,Svein Ivar Mellgren,Maria Nolano,Ingemar S. J. Merkies,Michael Polydefkis,A. G. Smith,Cornelia Sommer,J. Valls-Solé +11 more
TL;DR: Revision of the guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy, published in 2005, has become appropriate owing to publication of more relevant articles and most of the new studies focused on small fiber neuropathy (SFN).
Journal ArticleDOI
Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management
Vincenza Spallone,Dan Ziegler,Roy Freeman,Luciano Bernardi,Simona Frontoni,Rodica Pop-Busui,Martin J. Stevens,Péter Kempler,Jannik Hilsted,Solomon Tesfaye,Phillip A. Low,Paul Valensi +11 more
TL;DR: The Cardiovascular Autonomic Neuropathy (CAN) Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy worked to update CAN guidelines, with regard to epidemiology, clinical impact, diagnosis, usefulness of CAN testing, and management.
Journal ArticleDOI
American association of clinical endocrinologists and american college of endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015.
Yehuda Handelsman,Zachary T. Bloomgarden,George Grunberger,Guillermo E. Umpierrez,Robert S. Zimmerman,Timothy S. Bailey,Lawrence Blonde,George A. Bray,A. Jay Cohen,Samuel Dagogo-Jack,Jaime A. Davidson,Daniel Einhorn,Om P. Ganda,Alan J. Garber,W. Timothy Garvey,Robert R. Henry,Irl B. Hirsch,Edward S. Horton,Daniel L. Hurley,Paul S. Jellinger,Lois Jovanovič,Harold E. Lebovitz,Derek LeRoith,Philip T. Levy,Janet B. McGill,Jeffrey I. Mechanick,Jorge H. Mestman,Etie S. Moghissi,Eric A. Orzeck,Rachel Pessah-Pollack,Paul D. Rosenblit,Aaron I. Vinik,Kathleen Wyne,Farhad Zangeneh +33 more
TL;DR: These guidelines are a working document that reflects the state of the field at the time of publication and any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances.
References
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Journal ArticleDOI
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
John D. England,Gary S. Gronseth,Gary M. Franklin,Robert G. Miller,Arthur K. Asbury,Gregory T. Carter,Jeffrey A. Cohen,Morris A. Fisher,James F. Howard,Laurence J. Kinsella,Norman Latov,Richard A. Lewis,Phillip A. Low,Austin J. Sumner +13 more
TL;DR: A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature that indicated symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy.
Journal ArticleDOI
Epidermal Nerve Fiber Density Normative Reference Range and Diagnostic Efficiency
TL;DR: A reference range for intraepidermal nerve fiber density in normal humans is established by means of a simple quantitation method based on enumeration of individual intraepidersmal nerve fibers on vertical sections of punch skin biopsy specimens stained with the sensitive panaxonal marker anti-protein gene product 9.5.
Journal ArticleDOI
Epidemiology of peripheral neuropathy.
TL;DR: The commoner forms of peripheral neuropathy, single and multiple mononeuropathy, and radiculopathy are considered separately because they may be rather commoner than is usually thought.
Journal ArticleDOI
Quantitative sudomotor axon reflex test in normal and neuropathic subjects
TL;DR: Postganglionic sweat output in human subjects resulting from axon reflex stimulation using acetylcholine electrophoresis is quantified using an acrylic plastic chamber placed over a defined area of skin.
Journal ArticleDOI
Composite Autonomic Scoring Scale for Laboratory Quantification of Generalized Autonomic Failure
TL;DR: An autonomic reflex screen, which consisted of a quantitative sudomotor axon reflex test, orthostatic blood pressure and heart rate response to tilt, heart rateresponse to deep breathing, and beat-to-beat blood pressure measurements during phases II and IV of the Valsalva maneuver, tilt, and deep breathe, was used to develop a 10-point composite autonomic scoring scale of autonomic function.