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Evidence- and Consensus-Based Definition of Distal Symmetric Polyneuropathy

The range of definitions provided is incomplete, but still useful.

Despite neurologists' familiarity with the diagnosis of distal symmetric polyneuropathy, reaching agreement on a consistent clinical definition for this disorder remains remarkably challenging. To facilitate research into polyneuropathy, a task force of experts in the field, including such notables as John England, Norman Latov, Arthur Asbury, Phillip Low, and Austin Sumner, developed a consensus statement for the definition of distal symmetric polyneuropathy. They reviewed 61 articles and ultimately integrated information from the 12 with the best class of evidence.

Through a thoughtful consensus process, the authors developed a group of working definitions ranked by likelihood of disease. These definitions took into account neuropathic symptoms, clinical signs (including absent ankle reflexes, decreased distal sensation, and distal muscle weakness and atrophy), and nerve conduction study results. The more abnormalities present, the higher the diagnostic certainty of distal symmetric polyneuropathy. The authors recommend using the strictest definitions (i.e., those requiring positive symptoms, signs, and electrodiagnostic findings) for clinical research studies and looser ones (i.e., those not requiring electrodiagnostic studies) for epidemiologic work. Whereas they consider nerve conduction studies critical for establishing strict definitions, the authors do not recommend quantitative sensory testing because of its relatively poor reproducibility.

Comment: "I know it when I see it," is truly an apropos saying for the diagnosis of polyneuropathy, but this article highlights the complexities and limitations of developing any working definition for this common disorder. Underscoring this point, the authors even avoided including isolated painful small-fiber polyneuropathy in their definitions. Nonetheless, for investigators working in this field and practicing clinicians alike, this classification scheme provides a much-needed common standard and will likely lead to improved care for individuals afflicted with this group of disorders.

— Seward B. Rutkove, MD

Dr. Rutkove is Director of the Neuromuscular Division in the Department of Neurology at Beth Israel Deaconess Medical Center, and Associate Professor of Neurology, Harvard Medical School, Boston.

Published in Journal Watch Neurology March 11, 2005

Citation(s):

England JD et al. Distal symmetric polyneuropathy: A definition for clinical research: Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005 Jan 25; 64:199-207.

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