Is electrodiagnosic testing for polyneuropathy overutilized?

Bodofsky, Elliot; Carter, Gregory T.; England, John D.

doi:10.1002/mus.25464

Cited by 24 publications

(33 citation statements)

References 25 publications

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“…However, the magnitude of these effects is relatively small, and does not clearly identify any subgroups with poor test usage. This is somewhat surprising, because some experts have suggested that EDX for PN may have low utility in patients with impaired glucose tolerance . Our data suggest that EDX may still yield important information in these patients, who are at risk for other neuromuscular diagnoses in addition to PN.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, EDX and magnetic resonance imaging tests often are the major driver of expenditures in assessment of neuropathy in the elderly . Expert opinion is somewhat divided on the value and utility of EDX for PN, and some have suggested using EDX only in the setting of suspected polyneuropathy with certain atypical features, such as asymmetry, acute or subacute onset, proximal symptoms, or prominent weakness . However, the exact role of EDX in evaluation of polyneuropathy remains unresolved and may be suboptimally addressed by existing practice parameters …”

Section: Introductionmentioning

confidence: 99%

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Utility of electrodiagnostic studies in patients referred with a diagnosis of polyneuropathy

Ginsberg

Morren

2019

Muscle and Nerve

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Background Peripheral polyneuropathies (PN) are common neuromuscular conditions. The role of electrodiagnostic study (EDX) in diagnosis of PN is not well‐defined. Methods We performed a retrospective chart review of patients referred for EDX evaluation of PN. Results Of 162 patients analyzed, 23 had pure peripheral neuropathy (pPN; 14.2%), 29 had peripheral neuropathy and another diagnosis (PN+; 17.9%), 51 had an alternative diagnosis (nonPN; 31.5%), and 59 had normal studies (36.4%). In univariable analysis, age (P < .001) and gender (P = .004) were weakly associated with final diagnosis. In multinomial logistic regression analysis, significant predictors included age (odds ratio [OR] for nonPN/PN+:1.07 per year; 95% confidence interval [CI], 1.03–1.11), gender (OR for PN+:0.2, 95% CI, 0.07–0.61), and diabetes/prediabetes (OR for pPN:3.29; 95% CI, 1.17–9.27). Conclusions These data suggest that EDX commonly yields additional or nonPNs in patients referred with a diagnosis of PN, and although some variables predict electrodiagnosis, none have a large enough effect to suggest poor utility in any subpopulation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utility of electrodiagnostic studies in patients referred with a diagnosis of polyneuropathy

Ginsberg

Morren

2019

Muscle and Nerve

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“…42154 Most neuromuscular experts advocate for the use of electrodiagnostic studies in distal symmetric polyneuropathy if the diagnosis is known or unknown 155. Several studies have shown that electrodiagnostic studies in this population can often change the diagnosis and management 156157158.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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“…In the correct clinical context, NCS on a second lower extremity may not add diagnostic value. Electrodiagnostic testing is one of the most frequently used tests when evaluating for suspected DSP . Conversely, DSP is among the most common reasons for referral for electrodiagnostic testing .…”

Section: Discussionmentioning

confidence: 99%

“…In combination with clinical history and physical examination, electrodiagnostic testing may help confirm or refute the diagnosis of polyneuropathy. It also can guide management by providing information about the category, severity, and prognosis of polyneuropathy …”

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confidence: 99%

Bilateral nerve conduction studies in the evaluation of distal symmetric polyneuropathy

Dupuis

Callaghan

et al. 2019

Muscle and Nerve

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Introduction Nerve conduction studies are used to aid in the diagnosis of distal symmetric polyneuropathy (DSP). It is unclear whether bilateral lower extremity nerve conduction studies (NCS) are needed when evaluating for suspected DSP. Methods We retrospectively analyzed NCS from patients who presented to the University of Michigan electromyography laboratory between July 1, 2016 and December 31, 2017 with symptoms of DSP to assess agreement and correlation between left and right lower extremity NCS parameters. Results We found significant agreement between abnormalities in individual nerve parameters of the left and right lower extremities of 105 patients, most notably in the sural nerve. In the 53 patients with bilateral sural, peroneal, and tibial studies, there was also significant agreement between whether the left and right met electrodiagnostic criteria for DSP (κ = 0.77). Discussion Bilateral lower extremity NCS may have limited utility in the evaluation of suspected DSP. Muscle Nerve, 2019

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Is electrodiagnosic testing for polyneuropathy overutilized?

Cited by 24 publications

References 25 publications

Utility of electrodiagnostic studies in patients referred with a diagnosis of polyneuropathy

Utility of electrodiagnostic studies in patients referred with a diagnosis of polyneuropathy

Diagnosis and management of sensory polyneuropathy

Bilateral nerve conduction studies in the evaluation of distal symmetric polyneuropathy

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