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Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities.
Eur J Pain. 2009 Aug; 13(7):711-8.EJ

Abstract

Dysesthesias of the lower limbs are a common complaint of patients and may be indicative of peripheral neuropathy. Here we investigated the prevalence and type of neuropathy in patients presenting with this complaint and compared the diagnostic performance of different diagnostic modalities. Forty-two patients were recruited prospectively and underwent a clinical examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsy at the dorsum of the foot. All patients had a correlate for their dysesthesias in at least one diagnostic modality. Most patients (>90%) had signs of small fiber loss or dysfunction. In about half of all patients large fibers were also affected. Nerve conduction studies were abnormal in 23/42 patients (54.8%). Cold or warm detection thresholds in QST were abnormal in 15/42 (35.7%) patients. Decreased intraepidermal nerve fiber density (IENFD) was found in 37 patients (88.1%), including some patients with normal QST findings. Nearly all patients with pathological QST had a reduced IENFD, indicating a high positive predictive value (93%) of QST in screening for reduced IENFD as correlate for neuropathy. Therefore in all patients with lower limb dysesthesias of unknown origin, the non-invasive methods of NCS and QST should be used and potentially complemented by skin biopsy.

Authors+Show Affiliations

Department of Pain Therapy, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bochum, Germany. andrea.scherens@ruhr-uni-bochum.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18789872

Citation

Scherens, Andrea, et al. "Painful or Painless Lower Limb Dysesthesias Are Highly Predictive of Peripheral Neuropathy: Comparison of Different Diagnostic Modalities." European Journal of Pain (London, England), vol. 13, no. 7, 2009, pp. 711-8.
Scherens A, Maier C, Haussleiter IS, et al. Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities. Eur J Pain. 2009;13(7):711-8.
Scherens, A., Maier, C., Haussleiter, I. S., Schwenkreis, P., Vlckova-Moravcova, E., Baron, R., & Sommer, C. (2009). Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities. European Journal of Pain (London, England), 13(7), 711-8. https://doi.org/10.1016/j.ejpain.2008.07.014
Scherens A, et al. Painful or Painless Lower Limb Dysesthesias Are Highly Predictive of Peripheral Neuropathy: Comparison of Different Diagnostic Modalities. Eur J Pain. 2009;13(7):711-8. PubMed PMID: 18789872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities. AU - Scherens,Andrea, AU - Maier,Christoph, AU - Haussleiter,Ida Sybille, AU - Schwenkreis,Peter, AU - Vlckova-Moravcova,Eva, AU - Baron,Ralf, AU - Sommer,Claudia, Y1 - 2008/09/12/ PY - 2008/04/21/received PY - 2008/06/19/revised PY - 2008/07/29/accepted PY - 2008/9/16/pubmed PY - 2009/9/12/medline PY - 2008/9/16/entrez SP - 711 EP - 8 JF - European journal of pain (London, England) JO - Eur J Pain VL - 13 IS - 7 N2 - Dysesthesias of the lower limbs are a common complaint of patients and may be indicative of peripheral neuropathy. Here we investigated the prevalence and type of neuropathy in patients presenting with this complaint and compared the diagnostic performance of different diagnostic modalities. Forty-two patients were recruited prospectively and underwent a clinical examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsy at the dorsum of the foot. All patients had a correlate for their dysesthesias in at least one diagnostic modality. Most patients (>90%) had signs of small fiber loss or dysfunction. In about half of all patients large fibers were also affected. Nerve conduction studies were abnormal in 23/42 patients (54.8%). Cold or warm detection thresholds in QST were abnormal in 15/42 (35.7%) patients. Decreased intraepidermal nerve fiber density (IENFD) was found in 37 patients (88.1%), including some patients with normal QST findings. Nearly all patients with pathological QST had a reduced IENFD, indicating a high positive predictive value (93%) of QST in screening for reduced IENFD as correlate for neuropathy. Therefore in all patients with lower limb dysesthesias of unknown origin, the non-invasive methods of NCS and QST should be used and potentially complemented by skin biopsy. SN - 1532-2149 UR - https://www.unboundmedicine.com/medline/citation/18789872/Painful_or_painless_lower_limb_dysesthesias_are_highly_predictive_of_peripheral_neuropathy:_comparison_of_different_diagnostic_modalities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1090-3801(08)00176-6 DB - PRIME DP - Unbound Medicine ER -