Expenditures in the elderly with peripheral neuropathy

Callaghan, Brian C.; Burke, James F.; Rodgers, Ann; McCammon, Ryan J.; Langa, Kenneth M.; Feldman, Eva L.; Kerber, Kevin A.

doi:10.1212/cpj.0b013e3182a78fb1

Cited by 19 publications

(17 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Importantly, the neurologist’s clinical history and examination and a few simple blood tests provide the clues for identifying the underlying cause of most neuropathies. However, electrodiagnostic tests and MRIs, which account for the vast majority of the expenditures in the evaluation of DSP, 5–7 rarely lead to changes in etiology and management, and therefore the role of these tests requires further study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Role of Neurologists and Diagnostic Tests on the Management of Distal Symmetric Polyneuropathy

et al. 2014

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

“…2–4 Not surprisingly, the evaluation of peripheral neuropathy can be quite costly, with most of the cost driven by electrodiagnostic and MRI testing. 5–7 Given the high aggregate costs associated with this evaluation, determining the value of these diagnostic tests becomes of paramount importance.…”

Section: Introductionmentioning

confidence: 99%

Role of Neurologists and Diagnostic Tests on the Management of Distal Symmetric Polyneuropathy

et al. 2014

View full text Add to dashboard Cite

“…While NCS have demonstrated diagnostic value, they are often normal in patients with early or small fiber predominant neuropathy. Electrodiagnostic studies have been identified as one of the largest drivers of health care costs related to neuropathy evaluation(Callaghan et al, 2013). Numbness and sensory complaints are one of the most common symptoms practicing neurologists encounter.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic utility of Sudoscan for distal symmetric peripheral neuropathy

Smith

Lessard

Reyna

et al. 2014

Journal of Diabetes and its Complications

117

View full text Add to dashboard Cite

AIMS Diagnosis of early distal symmetric polyneuropathy (DSP) is challenging. Nerve conduction studies (NCS) are often normal. Skin biopsy for intraepidermal nerve fiber density (IENFD) has better sensitivity, but is invasive. Sudoscan is a novel technology that measures electrochemical skin conductance (ESC, microSimens – uS), which is thought to be proportionate to the number of functional sweat glands. This study evaluated Sudoscan’s diagnostic utility for DSP METHODS 55 patients with suspected DSP (22 with diabetes, 2 prediabetes, 31 idiopathic) and 42 controls underwent the Utah Early Neuropathy Scale (UENS) and Sudoscan. Each was offered skin biopsy. DSP participants underwent quantitative sudomotor axon reflex testing (QSART) and NCS. RESULTS Feet and hands ESC were reduced among DSP participants compared to controls (64 +/− 22 vs. 76 +/− 14 uS p<0.005, and 58 +/− 19 vs. 66 +/− 18 uS p<0.04). There was no difference between diabetic and idiopathic DSP. Receiver operating characteristic curve analysis revealed feet ESC and IENFD had similar areas under the curve (0.761 and 0.752). ESC correlated with Sural amplitude (0.337, p<0.02), UENS (−0.388, p<0.004), and MNSI (−0.398, p<0.005). CONCLUSIONS Sudoscan is a promising diagnostic test for diabetic and idiopathic DSP, with diagnostic performance similar to IENFD.

show abstract

“…19 In contrast, electrodiagnostic tests and MRI of the brain and/or spine rarely change management of these patients despite being frequently performed and contributing to most of the cost associated with the evaluation of DSP. 32 Electrodiagnostic tests led to a change in management in only 2 of 458 DSP patients seen by community neurologists despite being ordered in 80% of the population. 19 Electrodiagnostic tests clearly have a role in the evaluation of some DSP patients, but the precise subgroup of patients that benefits has not been well defined.…”

Section: Methodsmentioning

confidence: 99%

Distal Symmetric Polyneuropathy

Callaghan

Price

Feldman

2015

JAMA

228

163

View full text Add to dashboard Cite

Importance Peripheral neuropathy is a highly prevalent and morbid condition affecting 2–7% of the population. Patients frequently suffer from pain and are at risk of falls, ulcerations, and amputations. We aimed to review recent diagnostic and therapeutic advances in peripheral neuropathy in distal symmetric polyneuropathy, the most common subtype of peripheral neuropathy. Observations and Advances Current evidence supports limited routine laboratory testing in patients with distal symmetric polyneuropathy. Patients without a known cause should have a complete blood count, comprehensive metabolic panel, B12, serum protein electrophoresis with immunofixation, fasting glucose, and a glucose tolerance test. The presence of atypical features such as asymmetry, non-length-dependence, motor predominance, acute or subacute onset, and/or prominent autonomic involvement should prompt a consultation with a neurologist or neuromuscular specialist. Electrodiagnostic tests and magnetic resonance imaging of the neuroaxis are the main drivers of the cost of the diagnostic evaluation, but evidence supporting their use is lacking. Strong evidence supports the use of tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, and voltage-gated calcium channel ligands in the treatment of neuropathic pain. More intensive glucose control substantially reduces the incidence of distal symmetric polyneuropathy in patients with type 1 diabetes, but does not in type 2 diabetes. Conclusions and Relevance The opportunity exists to improve guideline concordant testing in distal symmetric polyneuropathy patients. Moreover, the role of electrodiagnostic tests needs to be further defined, and interventions to reduce magnetic resonance imaging use in this population are needed. Even though several efficacious medications exist for neuropathic pain treatment, pain is still under-recognized and undertreated. New disease modifying medications are needed to prevent and treat peripheral neuropathy, particularly in type 2 diabetes.

show abstract

Expenditures in the elderly with peripheral neuropathy

Cited by 19 publications

References 13 publications

Role of Neurologists and Diagnostic Tests on the Management of Distal Symmetric Polyneuropathy

Role of Neurologists and Diagnostic Tests on the Management of Distal Symmetric Polyneuropathy

The diagnostic utility of Sudoscan for distal symmetric peripheral neuropathy

Distal Symmetric Polyneuropathy

Contact Info

Product

Resources

About