Quantitative Sensory Test: Normal Range in Korean Adults and Application to Diabetic Polyneuropathy

정량적 감각 검사: 한국인에서의 연령별 정상 범위 및 당뇨병성 다발신경병증에서의 유용성 평가

  • Kim, Su-Hyun (Department of Neurology, Seoul National University College of Medicine) ;
  • Kim, Sung-Min (Department of Neurology, Seoul National University College of Medicine) ;
  • Ahn, Suk-Won (Department of Neurology, Seoul National University College of Medicine) ;
  • Hong, Yoon-Ho (Department of Neurology, Seoul Boramae Hospital) ;
  • Park, Kyung-Seok (Department of Neurology, Seoul National University College of Medicine) ;
  • Sung, Jung-Joon (Department of Neurology, Seoul National University College of Medicine) ;
  • Lee, Kwang-Woo (Department of Neurology, Seoul National University College of Medicine)
  • 김수현 (서울대학교 의과대학 신경과학교실) ;
  • 안석원 (서울대학교 의과대학 신경과학교실) ;
  • 김성민 (서울대학교 의과대학 신경과학교실) ;
  • 홍윤호 (서울보라매병원 신경과) ;
  • 박경석 (서울대학교 의과대학 신경과학교실) ;
  • 성정준 (서울대학교 의과대학 신경과학교실) ;
  • 이광우 (서울대학교 의과대학 신경과학교실)
  • Received : 2010.01.22
  • Accepted : 2010.06.08
  • Published : 2010.06.30

Abstract

Background: Although quantitative sensory test (QST) is being used with increasing frequency for measuring sensory thresholds in clinical practice and epidemiologic studies, there has been no age-matched normative data in Korean adults. The objective of this study is to evaluate the value of QST in diabetic polyneuropathy with normal range in Korean adults. Methods: The Computer Aided Sensory Examination IV 4,2 (WR Medical Electronics Co., Stillwater, Minnesota, U.S.A.), with 4,2,1 stepping algorithm was used to determine vibration and cold perception threshold in 70 normal controls and 19 patients with diabetic polyneuropathy aged from 21 to 79 years. The data were used to define age-matched upper and lower normal limits and normal range of side to side difference. We also evaluated the duration of diabetes, serum HbA1C level, and findings of nerve conduction study (NCS) and QST in patients with diabetic polyneuropathy. Results: In normal adults, sensory thresholds slightly increased with age, and a slight side-to-side difference was observed. The diagnostic sensitivity of QST was not higher than NCS in patients with diabetic polyneuropathy (36.8% vs. 42.1%, p=0.716), especially among elderly patients. Conclusions: QST might be used as a complementary test for NCS in the diagnosis of diabetic polyneuropathy. Although the QST is a simple method for the evaluation of peripheral nerve function, there are some limitations. Most of all, because the QST measuring is dependent on the subjective response of patients, the degree of concentration and cooperation of the patients can significantly affect the result. And thus, attention should be paid during the interpretation of QST results in patients with peripheral neuropathy.

Keywords

References

  1. Yarnitsky D. Quantitative sensory testing. Muscle Nerve 1997;20: 198-204. https://doi.org/10.1002/(SICI)1097-4598(199702)20:2<198::AID-MUS10>3.0.CO;2-#
  2. Gruener G, Dyck PJ. Quantitative sensory testing: methodology, applications, and future directions. J Clin Neurophysiol 1994;11: 568-583. https://doi.org/10.1097/00004691-199411000-00004
  3. Lee SM, Kim BJ. Diagnostic usefulness of quantitative sensory test in diabetic polyneuropathy: comparison with nerve conduction study. J Korean Neurol Assoc 1999;17:106-111.
  4. Dyck PJ, O'Brien PC, Kosanke JL, Gillen DA, Karnes JL. A 4, 2, and 1 stepping algorithm for quick and accurate estimation of cutaneous sensation threshold. Neurology 1993;43:1508-1512. https://doi.org/10.1212/WNL.43.8.1508
  5. Dyck PJ, Zimmerman I, Gillen DA, Johnson D, Karnes JL, O' Brien PC. Cool, warm, and heat-pain detection thresholds: testing methods and inferences about anatomic distribution of receptors. Neurology 1993;43:1500-1508. https://doi.org/10.1212/WNL.43.8.1500
  6. Dyck PJ. Detection, characterization and staging of polyneuropathy: assessed in diabetics. Muscle Nerve 1988;11:21-32. https://doi.org/10.1002/mus.880110106
  7. Wolfe GI. Quentitative sensory testing: basic principles and clinical applications. In: Dumitru D, Amato AA, Zwarts M. Electrodiagnostic Medicine. 2nd ed. Philadelphia: Hanley & Belfus. 2001429-437.
  8. Meh D. Denislic M. Quantitative assessment of thermal and pain sensitivity. J Neurol Sci 1994;127:164-169. https://doi.org/10.1016/0022-510X(94)90069-8
  9. Yarnitsky D, Sprecher E, Zaslansky R, Hemli JA. Heat pain threshold: normative data and repeatability. Pain 1995;60:329-332. https://doi.org/10.1016/0304-3959(94)00132-X
  10. Redmond JM, McKenna MJ, Feingold M, Ahmad BK. Sensory testing versus conduction velocity in diabetic polyneuropathy. Muscle Nerve 1992;15:1334-1339. https://doi.org/10.1002/mus.880151207
  11. Horowitz SH. Correlation of near-nerve sural conduction and quantified sensory testing in patients with diabetic neuropathy. Muscle Nerve 1995;18:1202-1204. https://doi.org/10.1002/mus.880181018
  12. Dyck PJ, Bushek W, Spring EM, Karnes JL, Litchy WJ, O'Brien PC, et al. Vibratory and cooling detection thresholds compared with other tests in diagnosing and staging diabetic neuropathy. Diabetes Care 1987;10:432-440. https://doi.org/10.2337/diacare.10.4.432