Less is More in Diabetic Neuropathy Diagnosis: Comparison of Quantitative Sudomotor Axon Reflex and Skin Biopsy. Issue 1 (September 2017)

• Record Type: Journal Article
• Authors: Abuzinadah, Ahmad R.; Kluding, Patricia; Wright, Douglas; D'Silva, Linda; Ryals, Janelle; Hendry, Bill; Jawdat, Omar; Herbelin, Laura; McVey, April L.; Barohn, Richard J.; Dimachkie, Mazen M.; Pasnoor, Mamatha
• Is Part Of: Journal of clinical neuromuscular disease. Volume 19:Issue 1(2017:Sep.)
• Publication Date: 2017-09
• Subjects: ENFD -- QSART -- diabetes -- neuropathy; Neuromuscular diseases -- Periodicals; 616.744005
• DOI: 10.1097/CND.0000000000000150
• Languages: English
• ISSNs: 1522-0443

Abstract

Abstract: Objectives: To compare the frequency of abnormalities in epidermal nerve fiber density (ENFD) and quantitative sudomotor axon reflex (QSART) in patients with diabetic distal symmetric polyneuropathy (DSPN). Methods: Nerve conduction studies, ENFD, and QSART data were obtained pre- and postexercise, in patients enrolled in a prospective diabetic neuropathy study. McNemar's test was applied to compare the yield of ENFD and QSART. Results: Eighteen patients (58 ± 4 years) were enrolled, with 36 data collection points. In diabetic DSPN and diabetic large fiber DSPN (DSPN-L), abnormal ENFD (77% and 100% respectively) is more frequent than abnormal QSART (39% and 35%, respectively) ( P value = 0.001 in diabetic DSPN and P value = 0.0002 in diabetic DSPN-L), whereas in diabetic small fiber DSPN (DSPN-S), both tests have similar yields (47%). Conclusions: ENFD has a high diagnostic yield in diabetic DSPN and DSPN-L. Including QSART data adds little to the sensitivity of EFND in DSPN-S.