Knowledge gaps in diagnosing chronic polyneuropathy: Review of national guidelines.

IF 3.9 3区 医学 Q1 CLINICAL NEUROLOGY Journal of the Peripheral Nervous System Pub Date : 2024-10-29 DOI:10.1111/jns.12667
M Wiersma, G M van der Star, N C Notermans, P A van Doorn, A F J E Vrancken
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Abstract

The prevalence of chronic polyneuropathy will increase due to the aging population, and therefore, it becomes ever so important to optimize the diagnostic process. However, it is uncertain which blood tests are required and when nerve conduction studies (NCS) should be done in the workup of chronic polyneuropathy. We aimed to investigate the methodology used to develop national polyneuropathy guidelines and to provide an overview and strength of evidence of the recommendations. We searched PubMed and websites of national neurological associations as listed on the website of the World Federation of Neurology to identify national guidelines pertaining to the workup of chronic polyneuropathy by neurologists in an outpatient clinic setting. We identified three national guidelines in the United States and seven national guidelines in Denmark, France, Germany, the Netherlands, Norway, Spain, and Turkey. The methodology used to develop the guidelines differed greatly. All guidelines recommend a series of blood tests. Some guidelines advise to conduct NCS in all patients, while other guidelines advise to conduct NCS when certain symptoms are present. There is variation in recommendations about the extensiveness of NCS, but all mention measuring the sural nerve and the motor peroneal nerve. The evidence for the recommendations is graded as low. Despite some overlap, there are disparities between guidelines regarding the workup that is advised to do in patients with chronic polyneuropathy. It remains unclear which combination of blood tests are to be strongly recommended. Furthermore, it is undetermined whether NCS are always necessary.

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诊断慢性多发性神经病的知识差距:国家指南回顾。
由于人口老龄化,慢性多发性神经病的发病率将会增加,因此优化诊断过程变得越来越重要。然而,目前还不确定在慢性多发性神经病的诊断过程中需要进行哪些血液检查,以及何时应该进行神经传导检查(NCS)。我们旨在研究制定国家多发性神经病指南所使用的方法,并提供建议的概述和证据强度。我们搜索了 PubMed 和世界神经病学联合会网站上列出的各国神经病学协会的网站,以确定与神经病学家在门诊环境中检查慢性多发性神经病相关的国家指南。我们在美国找到了三份国家指南,在丹麦、法国、德国、荷兰、挪威、西班牙和土耳其找到了七份国家指南。这些指南的制定方法大相径庭。所有指南都建议进行一系列血液检测。一些指南建议对所有患者进行 NCS,而另一些指南则建议在出现某些症状时进行 NCS。关于 NCS 的范围的建议也不尽相同,但都提到要测量腓肠神经和运动腓肠神经。这些建议的证据等级为低。尽管存在一些重叠,但各指南在建议慢性多发性神经病患者进行的检查方面仍存在差异。目前仍不清楚应强烈推荐哪种血液检测组合。此外,NCS 是否总是必要的也未确定。
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来源期刊
CiteScore
6.10
自引率
7.90%
发文量
45
审稿时长
>12 weeks
期刊介绍: The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.
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