PM&R
Volume 1, Issue 1 , Pages 14-22 , January 2009

Practice Parameter: The Evaluation of Distal Symmetric Polyneuropathy: The Role of Autonomic Testing, Nerve Biopsy, and Skin Biopsy (An Evidence-Based Review) Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation

  • J.D. England, MD

      Affiliations

    • Louisiana State University Health Sciences Center, New Orleans; holds financial interests in Pfizer
    • ,
  • G.S. Gronseth, MD

      Affiliations

    • University of Kansas, Kansas City; holds financial interests in Pfizer and GlaxoSmithKline and Boeheringer Ingelheim for speaker honoraria and Ortho-McNeil for serving on the IDMC Committee
    • ,
  • G. Franklin, MD

      Affiliations

    • University of Washington, Seattle; has nothing to disclose
    • ,
  • G.T. Carter, MD

      Affiliations

    • Providence Health System, Southwest Washington; has nothing to disclose
    • ,
  • L.J. Kinsella, MD

      Affiliations

    • St. Louis University School of Medicine, St. Louis, MO; has received royalties from the American Medical Resources, Enduring Medical Materials (CD/DVD), has received honorarium from Medical Education Resources, CME LLC, Expert Witness testimony and record review, Peters Marketing Research, Delve Marketing Research, Cross Country Education and American Medical Seminars. Dr. Kinsella holds corporate appointments with Cross Country Education and Forest Park Hospital
    • ,
  • J.A. Cohen, MD

      Affiliations

    • Dartmouth Hitchcock Medical Center, Lebanon, NH; has nothing to disclose
    • ,
  • A.K. Asbury, MD

      Affiliations

    • University of Pennsylvania School of Medicine, Philadelphia; receives residual royalties from Elsevier for editorial work done prior to 2005. He receives honoraria from Dana Foundation, NY and the International Society for Neuroimmunology. His wife is a consultant for the Dana Foundation
    • ,
  • K. Szigeti, MD, PhD

      Affiliations

    • Baylor College of Medicine, Houston, TX; has nothing to disclose
    • ,
  • J.R. Lupski, MD, PhD

      Affiliations

    • Baylor College of Medicine, Houston, TX; holds financial interests in Athena Diagnostics and has received research funding from NIH/NEI, NIH/NIDCR, Charcot-Marie-Tooth Association and the March of Dimes
    • ,
  • N. Latov, MD

      Affiliations

    • Weill Medical College of Cornell, New York, NY; serves on as a Scientific Advisor for Quest Diagnostics and is a member of a Steering Committee, Talecris Biotherapeutics. Dr. Latov receives royalties from Demos publications and has received research support from the NIH and Talecris Biotherapeutics. He holds stock options in Therapath LLC and is the beneficiary of license fee payments from Athena Diagnostics to Columbia University. He has given expert testimony in legal proceedings related to neuropathy and has prepared an affidavit with regarding to the legal proceeding related to neuropathy
    • ,
  • R.A. Lewis, MD

      Affiliations

    • Wayne State University School of Medicine, Detroit, MI; holds financial interests in Talecris and has received research funding from MDA and CMTA. He estimates that approximately 33% of his clinical effort is spent on electromyography. He has received payment for expert testimony regarding the use of IVIg in CIDP; neuropathic pain after breast reduction
    • ,
  • P.A. Low, MD

      Affiliations

    • Mayo Clinic, Rochester, MN; has served as a consultant for WR Medical, Viatris, Eli Lilly and Company, Chelsea Therapeutics and Quigley Corporation
    • ,
  • M.A. Fisher, MD

      Affiliations

    • Loyola University Chicago Stritch School of Medicine and the Hines VAH, IL; holds financial interests in Astrazeneca, Photothera, Wyeth, Jalmarjone Sahron, Inarx, Boehringer-Ingelheim, Dullehi-Arubio, Axaron, U-Servicer; and PAION
    • ,
  • D. Herrmann

      Affiliations

    • University of Rochester Medical Center, NY; estimates that approximately 15-20% of his clinical effort is spent on skin biopsies
    • ,
  • J.F. Howard, MD

      Affiliations

    • University of North Carolina, Chapel Hill; serves on a myasthenia gravis medical scientific board, has served as an Associate Editor, Journal of Clinical Neuromuscular Disease (1998-2006), receives honoraria from Duke University Medical Center, and Medical Educational Resources. He is the director of MEG laboratories and estimates that 75% of his time is spent there. He also holds stock options in GE, Pfizer and Johnson & Johnson. In addition, he has provided an affidavit on two cases regarding myasthenia gravis
    • ,
  • G. Lauria

      Affiliations

    • Fondazione IRCCS National Neurological Institute “Carlo Besta”, Milan, Italy; holds financial interests in GlaxoSmithKline and Formenti-Grunenthal. In addition he has received research funding from Pfitzer, Formenti-Grunenthal, Foramenti-Grunenthal, Italian Ministry of Health and Regione Lombardia
    • ,
  • R.G. Miller, MD

      Affiliations

    • California Pacific Medical Center, San Francisco; holds financial interests in Celgene and Pathologica
    • ,
  • M. Polydefkis

      Affiliations

    • Johns Hopkins Medical Institutions, Baltimore, MD; holds financial interests in DSMB, Pfizer, Johnson & Johnson, Mitsubishi Pharma, Merck, Xenoport and GSK. He has received research funding from JDRF, NIH, Astellas Pharma, Mitsubishi Pharma and Sanofi-Aventis. He estimates that 10% of his clinical effort is devoted to EMG, 5% to skin biopsy and <1% on lumbar puncture
    • ,
  • A.J. Sumner, MD

      Affiliations

    • Louisiana State University Health Sciences Center, New Orleans; has received payment for expert testimony in the possible neurotoxic injury of the peripheral nerve
    • Corresponding Author InformationSend correspondence to: American Academy of Physical Medicine and Rehabilitation

References 

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  2. Martyn CN, Hughes RAC. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1997;62:310–318
  3. England JD, Asbury AK. Peripheral neuropathy. Lancet. 2004;363:2151–2161
  4. Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve. 2003;27:646–661
  5. Singer W, Spies JM, McArthur , et al. Prospective evaluation of somatic and autonomic small fibers in selected neuropathies. Neurology. 2004;62:612–618(Class III)
  6. Dyck PJ, Karnes JL, O'Brien PC, Litchy WJ, Low PA, Melton LJ. The Rochester Diabetic Neuropathy Study: Reassessment of tests and criteria for diagnosis and staged severity. Neurology. 1992;42:1164–1170(Class II)
  7. Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O'Brien PC, Slezak JM. Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve. 1997;20:1561–1568(Class II)
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  10. Ebert TJ, Morgan BJ, Barney JA, Denahan T, Smith JJ. Effects of aging on baroreflex regulation of sympathetic activity in humans. Am J Physiol. 1992;263:798–803
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  14. Low PA, Walsh JC, Huang C, McLeod JG. The sympathetic nervous system in diabetic neuropathy: A clinical and pathological study. Brain. 1975;98:341–356
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  20. Low PA, Zimmerman BR, Dyck PJ. Comparison of distal sympathetic with vagal function in diabetic neuropathy. Muscle Nerve. 1986;9:592–596
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  23. Argov Z, Steiner , et al. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989;79:243–245
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  35. Lauria G, Cornblath DR, Johansson O, et al. EFNS Guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy. Eur J Neurol. 2005;12:1–12
  36. McArthur JC, Stocks EA, Hauer P, Cornblath DR, Griffin JW. Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol. 1998;55:1513–1520(Class III)
  37. Goranson LG, Mellgren SI, Lindal S, Omdal R. The effect of age and gender on epidermal nerve fiber density. Neurology. 2004;62:774–777
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 Published simultaneously in Neurology and Muscle & Nerve. Approved by the AAPM&R Board of Governors April 7, 2008; by the AANEM Board of Directors May 1, 2008; and the AAN Board of Governors August 20, 2008.

 Author affiliations and disclosures are provided at the end of the article. Supplemental data available at www.pmrjournal.org

 With regards to conflicts of interest, the authors disclose the following:

PII: S1934-1482(08)00037-3

doi: 10.1016/j.pmrj.2008.11.011

PM&R
Volume 1, Issue 1 , Pages 14-22 , January 2009

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