AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy

Abstract

Electrodiagnostic (EDX) studies are often very helpful in the diagnosis and management of patients who have or are suspected to have Distal Symmetric Polyneuropathy (DSP). However, EDX studies may not be appropriate in every situation. There are five common scenarios in which EDX studies are likely to be beneficial: (1) determining primary and alternative diagnoses; (2) determining severity, duration and prognosis of disease; (3) evaluating risk of associated problems; (4) determining the effect of medications; and (5) evaluating the effect of toxic exposures. Muscle Nerve 57: 337-339, 2018.

Modified collision study to isolate and study small fibre neuropathy in patients with Type 2 diabetes

“…Even though small fibre neuropathy is the most prevalent, unfortunately it is usually not recognized by routine electrophysiologic studies which are limited to the study of large nerves. [ 4 ] This can lead to excessive investigation, which can cause a strain on resources and finances. In this study, we intend to examine the slow velocity small fibres responsible for small fibre DSPN, by isolating them using collision technique principle in routine electrophysiologic studies, in patients with T2D which would help provide a novel tool to identify this common neuropathy in clinical practice.…”

Patients who meet electrodiagnostic criteria for CIDP rarely present with a sensory predominant DSP phenotype

“…Distal symmetric polyneuropathy (DSP) is one of the most common reasons for electrodiagnostic testing (EDX) referrals. [1][2][3] The value those results carry in the management of patients is controversial. 3,4…”

“…unsuspected diagnoses for which effective disease-modifying therapy exists. 2 This policy statement specifically alludes to the importance of identifying chronic inflammatory demyelinating polyneuropathy (CIDP), a disabling and potentially treatable condition for which EDX is foundational to the diagnosis. 5 Other studies have shown that the prevalence of demyelinating neuropathies among patients referred for peripheral neuropathy is low.…”

“…Considering the low prevalence of atypical CIDP in the general population,7 the low prevalence of atypical CIDP among DSP patients, and the lack of evidence to support disease-modifying treatment of atypical CIDP such as DADS, EDX has a low yield for identifying treatable acquired demyelinating neuropathies in patients with a sensory predominant DSP phenotype. EDX may still provide value in the workup of DSP when other clinical circumstances are considered, but this is beyond the scope of this study 2. T A B L E 1 Baseline characteristics of patients with CIDP and MMN…”

Aspectos epidemiológicos dos pacientes com polineuropatia no Distrito Federal

“…10 Os estudos eletrodiagnósticos são sensíveis, específicos e apresentam medidas validadas para detecção de polineuropatia. 11 Avaliações eletrodiagnósticas incluem estudo de condução nervosa (ECN) e eletromiografia por agulha (EMG). No diagnóstico de polineuropatia, o ECN é a parte mais informativa da avaliação eletrodiagnóstica, pois fornece uma medida do estado funcional das fibras sensitivas e motoras.…”