Quality improvement in neurology

England, John D.; Franklin, Gary M.; Gjorvad, Gina; Swain-Eng, Rebecca J.; Brannagan, Thomas H.; David, William S.; Dubinsky, Richard; Smith, Benn E.

doi:10.1212/wnl.0000000000000397

Cited by 23 publications

(18 citation statements)

References 22 publications

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“…In population-based studies, the prevalence of DSP among patients with confirmed diabetes approaches 25% and is approximately 12% in those with impaired glucose tolerance [25]. Thus, routine screening for diabetes before the full clinical manifestations of the disease will help preventing or slowing the progression of related complications such as diabetic neuropathy [26]. Our findings of an association between increased albuminuria and polyneuropathy are similar to those from the study by Kong et al [27].…”

Section: Risk Factors For Polyneuropathysupporting

confidence: 86%

Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital

Kuate-Tegueu

Temfack

Ngankou

et al. 2015

Journal of the Neurological Sciences

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Section: Risk Factors For Polyneuropathysupporting

confidence: 86%

Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital

Kuate-Tegueu

Temfack

Ngankou

et al. 2015

Journal of the Neurological Sciences

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“…A peripheral neuropathy diagnosis was made after review of patient symptoms and neurological signs and found to be consistent with the accepted parameters to define peripheral neuropathy 10. All patients were seen by a Mayo Clinic neurologist.…”

Section: Methodsmentioning

confidence: 99%

Clinical, physiological and pathological characterisation of the sensory predominant peripheral neuropathy in copper deficiency

Taylor

Laughlin

Kumar

et al. 2017

J Neurol Neurosurg Psychiatry

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An axonal, length-dependent sensory predominant peripheral neuropathy causing sensory ataxia is characteristic of copper deficiency usually co-occurring with myelopathy. Neurophysiological testing confirms involvement of large, greater than small fibres. The pathological findings suggest axonal degeneration and repair. Inflammatory infiltrates are common but are small and of doubtful pathological significance.

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“…In agreement with this assessment, the American Academy of Neurology recently released quality measures for patients with distal symmetric polyneuropathy with 1 of the 6 measures pertaining to falls. 19 Falls should not only be an important outcome measure of future clinical trials, but also a focus of the clinical care of patients with neuropathy.…”

Section: Methodsmentioning

confidence: 99%

Longitudinal patient-oriented outcomes in neuropathy

et al. 2015

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Objective: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.Methods: The 1996The -2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients $65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.Results: We identified 953 peripheral neuropathy cases and 953 propensity-matched controls.The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p 5 0.008), 5.0 years for pain (36% vs 27%, p 5 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p , 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p 5 0.002), but no differences in pain (p 5 0.08) or self-rated health (p 5 0.9) were observed. Conclusions:In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patientoriented outcome. Neurology ® 2015;85:71-79 GLOSSARY ADL 5 activities of daily living; CI 5 confidence interval; GEE 5 generalized estimating equations; HRS 5 Health and Retirement Study; IADL 5 instrumental activities of daily living; ICD-9 5 International Classification of Diseases-9; OR 5 odds ratio.Peripheral neuropathy is a highly prevalent disease, particularly in older persons, with more than 15% of those over age 40 years affected.1 While improved glucose control decreases the incidence of neuropathy in type 1 diabetes, the effect is much smaller in type 2 diabetes.2 Similarly, no effective treatments exist for idiopathic peripheral neuropathy (20%-30% of cases).3-5 As new disease-modifying therapeutics are developed for the treatment and prevention of neuropathy, there is a need to better understand the natural history of how peripheral neuropathy affects patient-oriented outcomes over time.Previous cross-sectional studies have shown that neuropathy is associated with worse quality of life, more pain, and increased number of falls.6-11 However, limited longitudinal data are available to provide stronger epidemiologic support for neuropathy as the prime mediator of these outcomes. Of the longitudinal studies that have been performed, Ahroni...

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Quality improvement in neurology

Cited by 23 publications

References 22 publications

Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital

Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital

Clinical, physiological and pathological characterisation of the sensory predominant peripheral neuropathy in copper deficiency

Longitudinal patient-oriented outcomes in neuropathy

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