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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Clinical Associate Professor Erisela Qerama Monvilas, Aarhus University, Denmark
- Second opponent: Senior Consultant Sondre Vatne Meling, Stavanger University Hospital
- Third member and chair of the evaluation committee: Professor Cecilie Røe, University of Oslo
Chair of the Defence
Professor Chistofer Lundqvist, University of Oslo
Principal Supervisor
Senior Consultant Neurophysiologist Kristian Bernhard Nilsen, Oslo University Hospital
Summary
Distal, symmetrical polyneuropathy (DSPN) is the most common disease in the peripheral nervous system, and one of the most important causes is diabetes. Accurate and timely diagnoses may reduce the risk of foot ulcers and falls, and improve pain management.
The aims of the thesis were to improve and help standardize diagnostics and assessment of DSPN and associated neuropathic pain.
The aims were addressed by evaluating the diagnostic accuracy of a common test for diabetic DSPN (5.07/10g monofilament test) and three tools for discriminating between neuropathic and non-neuropathic pain (painDETECT; the self-completed Leeds Assessment of Neurological Symptoms and Signs, S-LANSS; and Douleur Neuropathique 4, DN4). Lastly, we investigated how to combine different nerve conduction study (NCS) measures to best evaluate diabetic DSPN.
The monofilament test had poor diagnostic accuracy in diagnosing diabetic DSPN, classifying only 2 out of 3 patients correctly. The test performed even worse in female patients, giving cause for concern.
The predictive ability of the three tools in discriminating between neuropathic and non-neuropathic pain were poor to mediocre, with DN4 performing best. Applying any of the three tools had only a small effect on post-test probability of neuropathic pain; Better supportive tools are needed for this patient group.
Finally, Dunker et. al showed that one can reliably evaluate the nervous function of patients with diabetic DSPN by combining NCS measures of five specific nerves in the lower extremities of patients with diabetic polyneuropathy. Such a composite score may increase test sensitivity while also improving reliability and robustness.
The results of this thesis shed light on diagnostic practices that are in need of improvement and recommend an improved NCS method for evaluating diabetic polyneuropathy. Monofilament tests, painDETECT, S-LANSS and DN4 should be interpreted with caution in patients referred to polyneuropathy assessments.
Additional information
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