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

Authors
  • Hanewinckel, Rens1, 2
  • van Oijen, Marieke1
  • Taams, Noor E1, 2
  • Merkies, Ingemar S J3
  • Notermans, Nicolette C4
  • Vrancken, Alexander F J E4
  • Ikram, M Arfan2
  • van Doorn, Pieter A1
  • 1 Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands. , (Netherlands)
  • 2 Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. , (Netherlands)
  • 3 Department of Neurology, St. Elisabeth Hospital, Willemstad, Curacao.
  • 4 Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Journal of the peripheral nervous system : JPNS
Publication Date
Sep 01, 2019
Volume
24
Issue
3
Pages
235–241
Identifiers
DOI: 10.1111/jns.12328
PMID: 31172622
Source
Medline
Keywords
Language
English
License
Unknown

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. © 2019 Peripheral Nerve Society.

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