title: The sensitivity and specificity of the neurological examination in polyneuropathy patients with clinical and electrophysiological correlations.
abstract: BACKGROUND
  Polyneuropathy is one of the most prevalent neurologic disorders. Although several studies explored the role of the neurological examination in polyneuropathy, they were mostly restricted to specific subgroups of patients and have not correlated examination findings with symptoms and electrophysiological results.
  
  
  OBJECTIVE
  To explore the sensitivity and specificity of different neurological examination components in patients with diverse etiologies for polyneuropathy, find the most sensitive combination of examination components for polyneuropathy detection, and correlate examination findings with symptoms and electrophysiological results.
  
  
  METHODS
  Patients with polyneuropathy attending the neuromuscular clinic from 01/2013 to 09/2015 were evaluated. Inclusion criteria included symptomatic polyneuropathy, which was confirmed by electrophysiological studies. 47 subjects with no symptoms or electrophysiological findings suggestive for polyneuropathy, served as controls.
  
  
  RESULTS
  The total cohort included 312 polyneuropathy patients, with a mean age of 60±14 years. Abnormal examination was found in 95%, most commonly sensory findings (86%). The most common abnormal examination components were impaired ankle reflexes (74%), vibration (73%), and pinprick (72%) sensation. Combining ankle reflex examination with vibration or pinprick perception had the highest sensitivity, of 88%. The specificities of individual examination component were generally high, excluding ankle reflexes (62%), and vibration perception (77%). Abnormal examination findings were correlated with symptomatic weakness and worse electrophysiological parameters.
  
  
  CONCLUSIONS
  The neurological examination is a valid, sensitive and specific tool for diagnosing polyneuropathy, and findings correlate with polyneuropathy severity. Ankle reflex examination combined with either vibration or pinprick sensory testing is the most sensitive combination for diagnosing polyneuropathy, and should be considered minimal essential components of the physical examination in patients with suspected polyneuropathy.
authors.affiliation: Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Alon
authors.identifier: http://orcid.org/0000-0002-9020-2399
authors.initials: A
authors.lastname: Abraham
authors.affiliation: Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Majed
authors.initials: M
authors.lastname: Alabdali
authors.affiliation: Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Abdulla
authors.initials: A
authors.lastname: Alsulaiman
authors.affiliation: Department of Neurology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Hana
authors.initials: H
authors.lastname: Albulaihe
authors.affiliation: Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Ari
authors.initials: A
authors.lastname: Breiner
authors.affiliation: Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Hans D
authors.initials: HD
authors.lastname: Katzberg
authors.affiliation: Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Danah
authors.initials: D
authors.lastname: Aljaafari
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai, Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada.
authors.forename: Leif E
authors.initials: LE
authors.lastname: Lovblom
authors.affiliation: Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
mesh_terms: D000368:Aged; D055724:Electrophysiological Phenomena; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000175:diagnosis* / Q000503:physiopathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity