당뇨병성 다발신경병증의 조기 진단에서 신경전도검사의 유용성에 관한 논란: 긍정적인 관점에서
Controversies on the Usefulness of Nerve Conduction Study in the Early Diagnosis of Diabetic Polyneuropathy: Pros
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Although various criteria on the diagnosis of diabetic neuropathy are applied from trial to trial, being tailored in concert with its purpose, the utmost evidences of the diagnosis are subjective symptoms and objective signs of neurologic deficit. The application and interpretation of auxiliary electrophysiological test including nerve conduction study (NCS) should be made on the context of clinical pictures. The evaluation of the functions of small, thinly myelinated or unmyelinated nerve fibers has been increasingly stressed recently with the advent of newer techniques, e.g., measurement of intraepidermal fiber density, quantitative sensory testing, and autonomic function test. And the studies with those techniques have shed light to the nature of the evolution of diabetic neuropathy. The practical application of these techniques to the diagnosis of diabetic neuropathy in the individual patients, however, should be made cautiously due to several shortcomings: limited accessibility, wide overlapping zone between norm and abnormality with resultant unsatisfactory sensitivity and specificity, difficulty in performing subsequent tests, unproven quantitative correlation with clinical deficit, and invasiveness of some technique. NCS, as an extension of clinical examination, is still the most reliable electrophysiological test in evaluating neuropathy and gives the invaluable information about the nature of neuropathy, whereas the newer techniques need more refinement of the procedure and interpretation, and the accumulation of large scaled data of application to be considered as established diagnostic tools of peripheral neuropathy.
Abstract
Although various criteria on the diagnosis of diabetic neuropathy are applied from trial to trial, being tailored in concert with its purpose, the utmost evidences of the diagnosis are subjective symptoms and objective signs of neurologic deficit. The application and interpretation of auxiliary electrophysiological test including nerve conduction study (NCS) should be made on the context of clinical pictures. The evaluation of the functions of small, thinly myelinated or unmyelinated nerve fibers has been increasingly stressed recently with the advent of newer techniques, e.g., measurement of intraepidermal fiber density, quantitative sensory testing, and autonomic function test. And the studies with those techniques have shed light to the nature of the evolution of diabetic neuropathy. The practical application of these techniques to the diagnosis of diabetic neuropathy in the individual patients, however, should be made cautiously due to several shortcomings: limited accessibility, wide overlapping zone between norm and abnormality with resultant unsatisfactory sensitivity and specificity, difficulty in performing subsequent tests, unproven quantitative correlation with clinical deficit, and invasiveness of some technique. NCS, as an extension of clinical examination, is still the most reliable electrophysiological test in evaluating neuropathy and gives the invaluable information about the nature of neuropathy, whereas the newer techniques need more refinement of the procedure and interpretation, and the accumulation of large scaled data of application to be considered as established diagnostic tools of peripheral neuropathy.
참고문헌 (14)
- "Report and recommendations of the San Antonio conferenceon diabetic neuropathy", Neurology, 38, pp.1161~1165 (1988)
- Maser RE, "Epidemiological correlates of diabetic neuropathy.Report from Pittsburgh Epidemiology of Diabetes ComplicationsStudy", Diabetes, 38, pp.1456~1461 (1989)
- Dyck PJ, "The prevalence by staged severity of various types ofdiabetic neuropathy, retinopathy, and nephropathy in apopulation-based cohort: the Rochester Diabetic NeuropathyStudy", Neurology, 43, pp.817~824 (1993)
- Sumner CJ, "The spectrum of neuropathy in diabetes and impaired glucosetolerance", Neurology, 60, pp.108~111 (2003)
- Singleton JR, "Increased prevalenceof impaired glucose tolerance in patients with painful sensoryneuropathy", Diabetes Care, 24, pp.1448~1453 (2001)
- Dyck PJ, "Longitudinalassessment of diabetic polyneuropathy using a composite scorein the Rochester Diabetic Neuropathy Study cohort", Neurology, 49, pp.229~239 (1997)
- Shy ME, "Quantitative sensory testing: report of theTherapeutics and Technology Assessment Subcommittee of theAmerican Academy of Neurology", Neurology, 60, pp.898~904 (2003)
- Ravits JM, "AAEM minimonograph #48: autonomic nervoussystem testing", Muscle Nerve, 20, pp.919~937 (1997)
- Sommer C, "Skin biopsy in the management ofperipheral neuropathy", Lancet Neurol, 6, pp.632~642 (2007)
- Devigili G, "The diagnostic criteria for small fibre neuropathy:from symptoms to neuropathology. Brain 2008 June 4.[Epub ahead of print11. Herrmann DN, McDermott MP", Sowden JE
- Messing S, "Is skin biopsy a predictor oftransition to symptomatic HIV neuropathy? A longitudinalstudy", Neurology, 66, pp.857~861 (2006)
- Sorensen L, "The relationship amongpain, sensory loss, and small nerve fibers in diabetes", DiabetesCare, 29, pp.883~887 (2006)
- Shun CT, "Skin denervation in type 2 diabetes: correlations withdiabetic duration and functional impairments", Brain, 127, pp.1593~1605 (2004)
- Bae JS, "Subclinical diabetic neuropathy with normalconventional electrophysiological study", Neurol, 254, pp.53~59 (2007)