Selecting a prospective test for early detection of diabetic polyneuropathy

Microneurolysis of entrapped peripheral nerve has the best chance of success when compression has not created significant axonal loss. The purpose of this study is to learn the best way to identify potential surgical candidates at the earliest time for intervention, by examining patients in a clinical setting using objective, electrodiagnostic nerve conduction studies (NCS), and subjective touch threshold studies, Semmes-Weinstein monofilaments (SWM) and Pressure-Specified Sensory Device™ (PSSD). Fifty-five patients with diabetic polyneuropathy over the age of 30 years were included. Neuropathy symptom score was the gold standard for statistical calculation, with a prevalence of 70%. In the symptomatic population, prevalence was 64% for NCS (n = 25), 59% for SWM (n = 43), and 88% for PSSD (n = 51). In the asymptomatic population, prevalence was 70% for NCS, 27% for SWM, and 92% for PSSD. It is concluded that the PSSD is the most sensitive device of those tested for identifying peripheral neuropathy in an at risk population of patients.