The Realistic Yield of Lower Leg SNAP Amplitudes and SRAR in the Routine Evaluation of Chronic Axonal Polyneuropathies

Overview

Journal J Neurol

Specialty Neurology

Date 2008 Aug 23

PMID 18719962

Citations 7

Authors

A F J E Vrancken

N C Notermans

J H J Wokke

H Franssen

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the realistic yield of lower leg sensory nerve action potential amplitudes (SNAP) and the sural/radial nerve amplitude ratio (SRAR) in the routine evaluation of suspected distal axonal polyneuropathy.

Methods: Investigated were 721 people. In 393 referents without and 328 patients with chronic distal symmetrical polyneuropathy the SRAR, sural, superficial peroneal and dorsal sural SNAP were determined.

Results: The dorsal sural SNAP could not be elicited in 26 % of referents. Axonal polyneuropathy was confirmed by an abnormally low value of the sural or superficial peroneal SNAP or SRAR in 70 % of patients, and most often (68 %) by an absent sural or superficial peroneal SNAP. In 9 % of patients there was a normal sural but abnormal superficial peroneal SNAP, and 11 % had an abnormal sural but normal superficial peroneal SNAP. ROC curve analysis demonstrated equal accuracy of the sural and superficial peroneal SNAP.

Conclusions: To confirm distal axonal polyneuropathy in routine clinical practice the sural and superficial peroneal SNAP had equal and complementary yield, whereas the SRAR and dorsal sural SNAP had limited additional yield.

Citing Articles

The additional diagnostic value of motor nerve excitability testing in chronic axonal neuropathy.

Kroigard T, Sodemann U, Gaist L, Sindrup S, Tankisi H Clin Neurophysiol Pract. 2022; 7:27-33.

PMID: 35128215 PMC: 8803553. DOI: 10.1016/j.cnp.2021.12.001.

Normative reference values for the dorsal sural nerve derived from a large multicenter cohort.

Kroigard T, Gylfadottir S, Itani M, Khan K, Andersen H, Sindrup S Clin Neurophysiol Pract. 2021; 6:239-243.

PMID: 34604609 PMC: 8473014. DOI: 10.1016/j.cnp.2021.08.001.

Sural Radial Amplitude Ratio: A Study in Healthy Indian Subjects.

Mansukhani K, Dhonde M, Sreenivasan A, Sharma A, Balakrishnan L, Chavan P Ann Indian Acad Neurol. 2020; 23(3):255-260.

PMID: 32606508 PMC: 7313579. DOI: 10.4103/aian.AIAN_321_20.

[Polyneuropathy in older individuals].

Loscher W, Iglseder B Internist (Berl). 2020; 61(3):254-260.

PMID: 32030437 DOI: 10.1007/s00108-020-00748-6.

Dorsal Sural Sensory Nerve Action Potential: A Study for Reference Values.

Chaudhari S, Mansukhani K, Sharma A, Balakrishnan L, Sreenivasan A Ann Indian Acad Neurol. 2017; 20(2):127-131.

PMID: 28615897 PMC: 5470164. DOI: 10.4103/0972-2327.194313.

References

Pastore C, Izura V, Geijo-Barrientos E, Dominguez J . A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy. Muscle Nerve. 1999; 22(12):1667-73. DOI: 10.1002/(sici)1097-4598(199912)22:12<1667::aid-mus8>3.0.co;2-w. View

Killian J, Foreman P . Clinical utility of dorsal sural nerve conduction studies. Muscle Nerve. 2001; 24(6):817-20. DOI: 10.1002/mus.1074. View

Buschbacher R . Sural and saphenous 14-cm antidromic sensory nerve conduction studies. Am J Phys Med Rehabil. 2003; 82(6):421-6. View

Wilbourn A . Sensory nerve conduction studies. J Clin Neurophysiol. 1994; 11(6):584-601. DOI: 10.1097/00004691-199411000-00005. View

Mesrati F, Vecchierini M . F-waves: neurophysiology and clinical value. Neurophysiol Clin. 2005; 34(5):217-43. DOI: 10.1016/j.neucli.2004.09.005. View

Benatar M . Distal symmetric polyneuropathy: limitations of the proposed case definition. Muscle Nerve. 2006; 34(2):131-4. DOI: 10.1002/mus.20573. View

Falco F, Hennessey W, Goldberg G, Braddom R . Standardized nerve conduction studies in the lower limb of the healthy elderly. Am J Phys Med Rehabil. 1994; 73(3):168-74. DOI: 10.1097/00002060-199406000-00005. View

Turgut N, Guldiken S, Balci K, Tugrul A, Berberoglu U, Altun B . Comparative neurophysiological study for the diagnosis of mild polyneuropathy in patients with diabetes mellitus and glucose intolerance. Int J Neurosci. 2006; 116(6):745-59. DOI: 10.1080/00207450600675340. View

Guiloff R, Sherratt R . Sensory conduction in medial plantar nerve: normal values, clinical applications, and a comparison with the sural and upper limb sensory nerve action potentials in peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1977; 40(12):1168-81. PMC: 492940. DOI: 10.1136/jnnp.40.12.1168. View

10.

Singer P, Kennedy R . Correlation of electrophysiologic and physical examination parameters of neuropathy. Electromyogr Clin Neurophysiol. 1983; 23(4):287-95. View

11.

Lehtinen J, Niskanen L, Hyvonen K, Siitonen O, Uusitupa M . Nerve function and its determinants in patients with newly-diagnosed type 2 (non-insulin-dependent) diabetes mellitus and in control subjects--a 5-year follow-up. Diabetologia. 1993; 36(1):68-72. DOI: 10.1007/BF00399096. View

12.

Kushnir M, Klein C, Kimiagar Y, Pollak L, Rabey J . Medial dorsal superficial peroneal nerve studies in patients with polyneuropathy and normal sural responses. Muscle Nerve. 2004; 31(3):386-9. DOI: 10.1002/mus.20183. View

13.

England J, Gronseth G, Franklin G, Miller R, Asbury A, Carter G . 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; 64(2):199-207. DOI: 10.1212/01.WNL.0000149522.32823.EA. View

14.

Overbeek B, van Alfen N, Bor J, Zwarts M . Sural/radial nerve amplitude ratio: reference values in healthy subjects. Muscle Nerve. 2005; 32(5):613-8. DOI: 10.1002/mus.20421. View

15.

Shin J, Seong Y, Lee H, Kim S, Suk H, Lee Y . The usefulness of minimal F-wave latency and sural/radial amplitude ratio in diabetic polyneuropathy. Yonsei Med J. 2000; 41(3):393-7. DOI: 10.3349/ymj.2000.41.3.393. View

16.

Dyck P, Litchy W, Daube J, Harper C, Dyck P, Davies J . Individual attributes versus composite scores of nerve conduction abnormality: sensitivity, reproducibility, and concordance with impairment. Muscle Nerve. 2003; 27(2):202-10. DOI: 10.1002/mus.10320. View

17.

Karsidag S, Morali S, Sargin M, Salman S, Karsidag K, Us O . The electrophysiological findings of subclinical neuropathy in patients with recently diagnosed type 1 diabetes mellitus. Diabetes Res Clin Pract. 2005; 67(3):211-9. DOI: 10.1016/j.diabres.2004.07.017. View

18.

Falco F, Hennessey W, Braddom R, Goldberg G . Standardized nerve conduction studies in the upper limb of the healthy elderly. Am J Phys Med Rehabil. 1992; 71(5):263-71. DOI: 10.1097/00002060-199210000-00003. View

19.

Oh S, Demirci M, DAJANI B, Melo A, Claussen G . Distal sensory nerve conduction of the superficial peroneal nerve: new method and its clinical application. Muscle Nerve. 2001; 24(5):689-94. DOI: 10.1002/mus.1056. View

20.

Levin K, Stevens J, Daube J . Superficial peroneal nerve conduction studies for electromyographic diagnosis. Muscle Nerve. 1986; 9(4):322-6. DOI: 10.1002/mus.880090407. View