title: Optimizing temperature threshold testing in small-fiber neuropathy.
abstract: BACKGROUND
  We examined optimization of a temperature threshold testing (TTT) protocol for patients with suspected small-fiber neuropathy (SFN) to lessen the burden for both patients and technicians, without sacrificing accuracy.
  
  
  METHODS
  Data from 81 patients with SFN (skin biopsy and TTT abnormal) and 81 without SFN (skin biopsy and TTT normal) were used. Warm, cold, and heat pain sensation thresholds were determined bilaterally on the thenar eminence and foot dorsum by methods of limits and levels. Diagnostic accuracy was determined for various sensory modality combinations through comparative corresponding area under the receiver-operator characteristic curves.
  
  
  RESULTS
  Assessment of warm and cold thresholds in all extremities by the method of levels showed the best discriminatory ability (area under the curve 0.95, sensitivity 84.2%, specificity 93.8%).
  
  
  CONCLUSIONS
  These assessments are suggested for TTT examination in possible SFN patients. By applying this combination, the time needed for TTT can be reduced, maintaining diagnostic accuracy.
authors.affiliation: Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Mayienne
authors.initials: M
authors.lastname: Bakkers
authors.affiliation: Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Catharina G
authors.initials: CG
authors.lastname: Faber
authors.affiliation: Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jos P H
authors.initials: JP
authors.lastname: Reulen
authors.affiliation: Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Janneke G J
authors.initials: JG
authors.lastname: Hoeijmakers
authors.affiliation: Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Els K
authors.initials: EK
authors.lastname: Vanhoutte
authors.affiliation: Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Ingemar S J
authors.initials: IS
authors.lastname: Merkies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004916:Erythromelalgia / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000294:innervation; D006225:Hand / Q000294:innervation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012684:Sensory Thresholds / Q000502:physiology*; D012867:Skin / Q000473:pathology; D013696:Temperature; D055815:Young Adult
keywords: method of levels; polyneuropathy; quantitative sensory testing; small-fiber neuropathy; temperature threshold testing