A comparison of the Neuropen against standard quantitative sensory-threshold measures for assessing peripheral nerve function.
OBJECTIVE
To investigate the efficacy of the Neuropen, a new clinical device that assesses both pain and pressure perception, to evaluate peripheral nerve function in diabetic patients compared with standard clinical testing methods.


METHODS
Peripheral nerve function was assessed in 124 diabetic patients attending a multidisciplinary diabetes clinic, using (i) the modified Neuropathy Disability Score (NDS), derived from assessment of vibration, pinprick (pain), temperature sensation plus ankle reflexes, and (ii) vibration perception threshold (VPT) measured at the hallux. Patients were stratified into various neuropathic groups according to their NDS score. In addition, nerve function was assessed using the Neuropen, a device combining a 10-g monofilament and a weighted Neurotip. Inability to feel sensation on either or both feet for each test of the Neuropen (i.e. the monofilament or the Neurotip) was defined as an abnormal response.


RESULTS
The sensitivity of the Neuropen to detect neuropathy compared with the NDS (score > or = 6/10) was high using either an abnormal monofilament response (87.8%), an abnormal Neurotip response (91.8%) or a combination of the two (82.0%). Neuropen specificity improved, however, when the combination of abnormal monofilament and abnormal Neurotip responses was used (68%), rather than the individual tests (57% and 41%, respectively).


CONCLUSIONS
The Neuropen is a sensitive device for assessing nerve function and may provide an inexpensive alternative screening method to identify patients with moderate to severe neuropathy.
Paisley
A  N
A
Diabetic Foot Clinic, Disablement Services Centre, Withington Hospital, Manchester, UK.
Abbott
C  A
C
van Schie
C  H  M
C
Boulton
A  J  M
A
D017668:Age of Onset; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D004594:Electrophysiology / Q000295:instrumentation; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010525:Peripheral Nerves / Q000503:physiopathology*; D010812:Physical Stimulation / Q000379:methods; D012684:Sensory Thresholds / Q000502:physiology*; D014732:Vibration
D006442:Glycated Hemoglobin