Fuzzy classification of patient state with application to electrodiagnosis of peripheral polyneuropathy

Duckstein, Lucien; Blinowska, A.; Verroust, J

doi:10.1109/10.398639

Cited by 26 publications

(21 citation statements)

References 12 publications

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“…Duckstein et al [16] have proposed a classification of this neurological disorder using fuzzy logic, but the input parameters they used were extracted from nerve conduction studies. Although it was an interesting approach, it relied on an invasive assessment method with accessibility limitations, and the sensitivity test was performed by comparing the fuzzy system’s output with the authors’ own classification criteria, leading to a possible bias.…”

Section: Introductionmentioning

confidence: 99%

Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait

Watari

Sartor

Picon

et al. 2014

J NeuroEngineering Rehabil

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BackgroundElectromyography (EMG) alterations during gait, supposedly caused by diabetic sensorimotor polyneuropathy, are subtle and still inconsistent, due to difficulties in defining homogeneous experimental groups with a clear definition of disease stages. Since evaluating these patients involve many uncertainties, the use of a fuzzy model could enable a better discrimination among different stages of diabetic polyneuropathy and lead to a clarification of when changes in muscle activation start occurring. The aim of this study was to investigate EMG patterns during gait in diabetic individuals with different stages of DSP severity, classified by a fuzzy system.Methods147 subjects were divided into a control group (n = 30) and four diabetic groups: absent (n = 43), mild (n = 30), moderate (n = 16), and severe (n = 28) neuropathy, classified by a fuzzy model. The EMG activity of the vastus lateralis, tibialis anterior, and gastrocnemius medialis were measured during gait. Temporal and relative magnitude variables were compared among groups using ANOVA tests.ResultsMuscle activity changes are present even before an established neural involvement, with delay in vastus lateralis peak and lower tibialis anterior relative magnitude. These alterations suggest an impaired ankle shock absorption mechanism, with compensation at the knee. This condition seems to be more pronounced in higher degrees of neuropathy, as there is an increased vastus lateralis activity in the mild and severe neuropathy groups. Tibialis anterior onset at terminal stance was anticipated in all diabetic groups; at higher degrees of neuropathy, the gastrocnemius medialis exhibited activity reduction and peak delay.ConclusionEMG alterations in the vastus lateralis and tibialis anterior occur even in the absence of diabetic neuropathy and in mild neuropathic subjects, seemingly causing changes in the shock absorption mechanisms at the heel strike. These changes increase with the onset of neural impairments, and the gastrocnemius medialis starts presenting altered activity in the later stages of the disease (moderate and severe neuropathy). The degree of severity of diabetic neuropathy must be taken into account when analyzing diabetic patients’ biomechanical patterns of locomotion; we recommend the use of a fuzzy model for classification of disease stages.

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Section: Introductionmentioning

confidence: 99%

Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait

Watari

Sartor

Picon

et al. 2014

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

show abstract

“…Duckstein et al used fuzzy set structure to classify diabetic neuropathy based on an invasive electrophysiological test (27). However, this equipment requires specific knowledge and appropriate professional training, and it is thus not widely used in public health systems, especially in poorer countries.…”

Section: Discussionmentioning

confidence: 99%

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

Picon¹,

Ortega²,

Watari³

et al. 2012

Clinics

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OBJECTIVE:This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy.METHODS:A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard.RESULTS:According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy.CONCLUSION:The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.

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“…Followup. Neuropathy was evaluatcd using the Neuropathy Disability Score (11) and an electrophysiologic score, thc Diagnostica Index (12). The platelet count, CRP, I~G K , and IgAh levels were evaluated serially.…”

Section: Case Reportmentioning

confidence: 99%

All‐trans‐retinoic acid in poems syndrome. Therapeutic effect associated with decreased circulating levels of proinflammatory cytokines

Authier¹,

Bélec²,

Lévy³

et al. 1996

Arthritis & Rheumatism

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Chronically elevated serum levels of proinflammatory cytokines is a feature of the syndrome known as POEMS (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal [MI protein, skin changes). A patient had a POEMS syndrome with thrombocytosis and biclonal gammopathy and was treated as follows: all-trans-retinoic acid (tretinoin) at 90 mg/day for 50 days, no treatment for 70 days, readministration of tretinoin at 75 mg/day for 180 days. Focal bone lesion irradiation was performed from day 26 to day 50. Serum levels of interleukin-6 (IL-6), tumor necrosis factor a (TNFa), and IL-lP normalized within 7 days after the first administration of tretinoin, transiently increased at the time of radiotherapy, increased again after withdrawal of the tretinoin, and decreased again after its reintroduction. The platelet count and gammopathy paralleled the changes in the cytokine levels. This study documents in vivo the ability of all-trans-retinoic acid to down-regulate the release of IL-6, IL-lP, and TNFa, and illustrates its potential as a therapeutic agent in conditions associated with chronic overproduction of proinflammatory cytokines.~.

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Fuzzy classification of patient state with application to electrodiagnosis of peripheral polyneuropathy

Cited by 26 publications

References 12 publications

Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait

Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

All‐trans‐retinoic acid in poems syndrome. Therapeutic effect associated with decreased circulating levels of proinflammatory cytokines

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