Distal symmetric polyneuropathy: A definition for clinical research - Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation
Distal symmetric polyneuropathy: A definition for clinical research - Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation
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DOI：
10.1212/01.wnl.0000149522.32823.ea
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发表时间：
2005-01-25
期刊：
影响因子：
9.9
通讯作者：
Sumner, AJ
中科院分区：
文献类型：
--
作者：
England, JD;Gronseth, GS;Sumner, AJ
本报告的目的是制定远端对称性多发性神经病的病例定义，以标准化和促进临床研究和流行病学研究。在对文献证据进行系统审查和分类后，采用正式的共识流程达成一致。文献表明，仅凭症状来预测多发性神经病的诊断准确性相对较差；体征比症状更能预测多发性神经病；在预测多发性神经病的存在方面，检查中的单一异常不如多个异常敏感。神经病症状、体征和电诊断结果的结合提供了远端对称性多发性神经病最准确的诊断。一组病例定义按照疾病的可能性进行排序。多发性神经病（对临床试验有用）的可能性最高发生在多种症状、多种体征和异常电诊断研究的组合中。当无法获得电诊断研究结果时，多发性神经病（对现场或流行病学研究有用）的可能性较小，同时存在多种症状和体征。当电诊断研究和体征不一致时，发生多发性神经病的可能性较低。出于研究目的，定义远端对称性多发性神经病的最佳方法是一组按疾病估计可能性排序的病例定义。将这种正式的病例定义纳入临床和流行病学研究将确保病例选择的更大一致性。
The objective of this report was to develop a case definition of distal symmetric polyneuropathy to standardize and facilitate clinical research and epidemiologic studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetric polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy ( useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy ( useful for field or epidemiologic studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach to defining distal symmetric polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiologic research studies will ensure greater consistency of case selection.