Diagnostic value of symptoms in chronic polyneuropathy: The Erasmus Polyneuropathy Symptom Score

Abstract

In this study, we evaluated the diagnostic value of symptoms of chronic polyneuropathy and to construct and validate a simple questionnaire that can help diagnose chronic polyneuropathy. In a multi‐step procedure, we initially compiled a 12‐item questionnaire concerning polyneuropathy symptoms. The questionnaire was completed by 117 polyneuropathy patients and 188 controls (headache, transient ischemic attack, multiple sclerosis). First, we calculated sensitivity, specificity and likelihood ratios of each symptom. Next, we used multi‐variable logistic regression to create a model that could discriminate patients from controls, using only the most informative symptoms and their frequency of occurrence. Based on the regression coefficients, we developed a simple scoring system (Erasmus Polyneuropathy Symptom Score, E‐PSS), which was externally validated in 140 cases with chronic idiopathic axonal polyneuropathy and 96 controls without polyneuropathy. We assessed performance with discrimination (area under the curve, AUC) and calibration analyses. Numb and tingling feet were most frequently reported by polyneuropathy patients and had the highest sensitivity. Walking on cotton wool and allodynia had the highest specificity. Logistic regression yielded a model that contained these four symptoms, complemented with balance problems and tingling hands. Based on this analysis, the E‐PSS was created, ranging from 0 to 14. The E‐PSS had a good performance (AUC = 0.92) in the derivation set and proved to be valid in the external population (AUC = 0.95). In conclusion, the Erasmus Polyneuropathy Symptom Score (E‐PSS) is a simple, validated six‐item score that takes the presence and frequency of six different symptoms into account and it may be a helpful tool to screen individuals for the presence of chronic polyneuropathy.

The complex association between pain and neuropathy

“…However, our cohort included patients with pre‐diabetes, which is generally accepted as a risk factor to polyneuropathy, 16 and, therefore, might be considered along the spectrum of diabetic polyneuropathy, although the association between prediabetes and polyneuropathy is somewhat controversial 17 . These results are in line with previous studies of patients with diabetic polyneuropathy, 2,3 suggesting considerable phenotypic overlap between diabetic and non‐diabetic polyneuropathies regarding neuropathic symptoms. As expected, we found in our cohort of patients, that the presence and the severity of negative neuropathic symptoms including numbness and mainly weakness, were associated with a more severe polyneuropathy as determined by electrophysiology and clinical scales.…”

“…Polyneuropathy is the most common neurologic disorder, with an overall prevalence of 14.8% in the adult population ≥ 40 y of age with and without diabetes 1 . The most common symptoms of polyneuropathy are sensory, occurring in approximately 90% of patients, 2 followed by pain and weakness in approximately half 3 . Pain represents one of the most problematic symptoms in most polyneuropathies, including polyneuropathy due to diabetes mellitus, 4 the most common etiology for polyneuropathy, 3 and is associated with lower quality of life, sleep interference, and symptoms of depression and anxiety 5 .…”

Prevalence and Risk Factor Profiles for Chronic Axonal Polyneuropathy in the General Population

“…Symptoms were, like in clinical practice, judged on the combination and frequency of symptoms compatible with polyneuropathy, supported by a screening tool. 5,14 Neurologic examination was deemed abnormal if multiple items were abnormal in a symmetrical pattern because chronic axonal polyneuropathy is considered a symmetrical disease. Sural sensory nerve action potential (SNAP) amplitude <4.0 μV was considered abnormal.…”

Acupuncture in chemotherapy-induced dysgeusia (AcuDysg): study protocol of a randomised controlled trial

“…Patients will complete a diary during the 8 weeks of acupuncture treatment. The diary contains 9items (xerostomia,17 polyneuropathy,18 dysgeusia,1 odynophagia,19 fatigue,20 nausea and appetite (based on the EORCT core quality of life questionnaire (QLQ-C30)) that are assessed on the NRS from 1 to 10, with higher values indicating more severe symptoms. Two additional items on chemotherapy and acupressure have yes or no as the response option.…”