American Society for Peripheral Nerve
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Correlation of lower extremity neuropathy sensibility tests and electrodiagnostic studies in patients with diabetes mellitus
Tirzah M. Fakkel, MD MSc; Nadine Boers, MD MSc; Willem D. Rinkel, MD, PhD; J Henk Coert, MD, PhD
Utrecht University Medical Center, Utrecht, Netherlands

Introduction Early diagnosis and treatment of diabetic sensorimotor polyneuropathy (DSP) is important in counseling patients and prevention of complications. Anamnesis and physical examination can be combined with electrodiagnostic studies (EDX) to diagnose DSP. The 39-item Rotterdam Diabetic Foot (RDF) Test Battery is our standard tool for evaluating sensation in the feet. The aim of this study is to compare this battery to EDX in order to assess its clinical value.
Materials & Methods Baseline data from the DeCompression (DECO) trial, a multicenter trial evaluating the (cost-) effectiveness of lower extremity nerve decompression surgery in diabetic patients, was used. Foot examinations were performed with the 39-item RDF Test Battery, consisting of 39 dichotomized items testing incremental sensory loss in the main nerve territories. Neuropathy symptoms were assessed with the Michigan Neuropathy Screening Instrument (MNSI). EDX studies were performed on the sural nerve (sensory) and the peroneal nerve (motor function). Spearman correlation coefficients were calculated to investigate the relationship between EDX data, the RDF Test Battery score, MNSI scores, HbA1c, age and duration of DM.
Results Data from 46 participants, with a mean age (SD) of 62.7 years (10.0) and a mean duration of diabetes (SD) of 17.3 years (13.2) were studied. A significant correlation between the RDF Test Battery score and right sural amplitudes was found (r -0.39, p=0.04), and between the RDF score and peroneal amplitudes at the ankle (r -0.38, p=0.01). No significant correlation was found between EDX studies and baseline MNSI scores, between EDX studies and baseline HbA1c values or between EDX studies and duration of DM. A significant correlation was found between age and peroneal amplitudes below fibula head (r -0.44, p=0.02), above fibular head (r -0.57,p=0.04) and right sural conduction velocity (r -0.40, p=0.04).
Conclusions Our study shows a moderate correlation between the RDF Test Battery score and EDX studies of the sural and peroneal nerve. Sensibility testing combined with EDX studies have shown to be clinically valuable to diagnose DSP.


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