Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline
N R Rosenberg, P Portegies, M de Visser, M Vermeulen
Department of
Neurology, Academic Medical Centre, University of Amsterdam, PO Box
22700, 1100 DE Amsterdam, The Netherlands
Correspondence to: Dr N R Rosenberg
Received 12 July 2000 and in revised form 8 November 2000;
Accepted 24 January
2001
OBJECTIVE
(1) To
evaluate a clinical guideline for the diagnostic investigation of
patients presenting with signs and symptoms (present for longer than 6 weeks) suggesting a chronic polyneuropathy. (2) To investigate the
contribution of electrophysiological studies to a focused search for
aetiology in these patients.
METHODSA chart review
was carried out of a consecutive group of outpatients in 1993-7 at a
university department of neurology, with signs and symptoms suggesting
a polyneuropathy in whom the diagnostic investigation had been carried
out according to a recently introduced guideline. Diagnostic tests were
performed and final diagnoses were made.
RESULTSUnnecessary
investigations were carried out in 108 (51%) of 213 patients and too
few tests in 23 (11%) of these patients. In 82 (48%) of the 172 patients who fulfilled the inclusion criteria neurophysiological tests
did not contribute to the final diagnosis. Neurophysiological criteria
for demyelination were fulfilled in only 13 (8%) of the 172 patients.
CONCLUSIONIn patients
presenting with signs and symptoms of chronic polyneuropathy the number
of tests in the diagnostic investigation can be considerably reduced.
In patients with signs and symptoms of polyneuropathy, providing the
clinical phenotype is typical, in the presence of diabetes mellitus,
renal failure, HIV infection, alcoholism, or use of potentially
neurotoxic drugs further investigations are non-contributory. The
significance of electrophysiological studies in the investigation of
patients with polyneuropathy is rather to separate sensorimotor
neuropathies from pure sensory neuropathies than to distinguish between
demyelinating and axonal neuropathies.
Keywords: chronic polyneuropathy; diagnostic investigation; electrophysiological studies
© 2001 by Journal of Neurology, Neurosurgery, and Psychiatry
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