Specific Clinical Criteria Identifies Inflammatory Neuropathy

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Specific Clinical Criteria Identifies Inflammatory Neuropathy
Specific Clinical Criteria Identifies Inflammatory Neuropathy

When screening for neuropathy, specifically noting onset, distribution, and associated systemic features (ODS) accurately identifies patients with inflammatory neuropathy with a high degree of sensitivity and specificity.   

“Patients with inflammatory neuropathies need to be identified, investigated, and treated promptly to avoid irreversible nerve damage and possible death. Unfortunately, physicians are frequently booked for several weeks to months which makes it difficult to evaluate urgent patients quickly,” study author Chafic Karam, MD, of the ALS and Neuromuscular Disease Center at Oregon Health and Science University in Portland, told Neurology Advisor. “This tool can help the busy physician screen for patients with inflammatory neuropathy prior to their clinic visit, hopefully leading to quick evaluation and better patient care and outcomes.”

Dr Karam and co-author Louis A. Tramontozzi III, MD, note that large fiber peripheral neuropathy is secondary to inflammatory or autoimmune processes in 20% of patients. Further, timely workup and initiation of immunosuppressives may prevent further morbidity.

To better understand how these clinical characteristics might aid in diagnosis, the investigators reviewed the charts of patients with large fiber neuropathy as evidenced by nerve conduction studies. Data were obtained on symptom onset, distribution, and systemic features.Patients were then divided into ODS positive (ODS+) and ODS negative (ODS-) groups. Sensitivity and specificity analyses were conducted based on the presence or absence of inflammatory and autoimmune neuropathy.

The study included 206 patients, of which only 3 had inflammatory neuropathy without ODS+ status. When using ODS criteria, the specificity was 85% and the sensitivity was 96% for inflammatory neuropathy. Further, the ODS criteria demonstrated a positive predictive value of 0.8 and a negative predictive value of 0.97. The 3 patients that were ODS- were found to ultimately have demyelinating neuropathy distally on conduction studies. In total, 19 patients without inflammatory neuropathy were ODS+. These patients were found to have neuropathy associated with end-stage renal disease, diabetes, multiple myeloma, chemotherapy, lymphomatous neuropathy, inherited neuropathy, and/or idiopathic neuropathy.

While the ODS criteria allows for rapid screening of patients with treatable forms of neuropathy, “it is to be used as a screening tool and cannot replace clinical judgement,” Dr Karam said.  Notably, nerve conduction studies improve the sensitivity of ODS and may identify cases that were not found with the ODS criteria, he added.

Overall, the ODS criteria is simple and can help accelerate diagnostic evaluation while also saving ODS- patients from undergoing unnecessary testing.

Reference

Karam C,Tramontozzi LA. Rapid screening for inflammatory neuropathies by standardized clinical criteria. Neurol Clin Pract. 2016; doi:10.1212/CPJ.0000000000000271.

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