EMLA-induced skin wrinkling for the detection of diabetic neuropathy
ObjectiveTo determine the usefulness of Eutectic Mixture of Local Anesthetic (EMLA)-induced stimulated skin wrinkling (SSW) to detect diabetic sensorimotor polyneuropathy (DSPN).Research Design and Methods 210 diabetics were prospectively recruited (mean age 58.5±12.7 years) from a large te...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2013-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fneur.2013.00126/full |
| _version_ | 1819049415273349120 |
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| author | Wei Ping eNg Kok Onn eLee Liang eShen Jonathan eOng Thaw Dar eNyein Nyein Einar Patrick Wilder-Smith |
| author_facet | Wei Ping eNg Kok Onn eLee Liang eShen Jonathan eOng Thaw Dar eNyein Nyein Einar Patrick Wilder-Smith |
| author_sort | Wei Ping eNg |
| collection | DOAJ |
| description | ObjectiveTo determine the usefulness of Eutectic Mixture of Local Anesthetic (EMLA)-induced stimulated skin wrinkling (SSW) to detect diabetic sensorimotor polyneuropathy (DSPN).Research Design and Methods 210 diabetics were prospectively recruited (mean age 58.5±12.7 years) from a large tertiary center from 2009 to 2011. EMLA was applied to the tips of digits 2, 3 and 4 and the degree of wrinkling graded. Diabetic Neuropathy Symptom (DNS) score, nerve conduction studies (NCS), Semmes-Weinstein monofilament (SWMF) tests, and vibratory perception thresholds (VPT) testing were chosen as comparative clinical standards to diagnose length-dependent DSPN.ResultsInter-rater agreement for 2 examiners of SSW was high, with Cohen’s weighted Κ of 0.912 for the right hand, and 0.823 for the left. K measure of agreement of SSW with the NCS, DNS scores, SWMF testing and VPT testing was 0.486, 0.243, 0.289 and 0.395 respectively. SSW was able to distinguish between normal and abnormal NCS and DNS results, with median scores of 3.333 vs 1.667 (p<0.0005); and 3.167 vs 2.000 (p<0.0005) respectively. Following ROC analysis, at a cut-off point of < 3 for an abnormal SSW test, sensitivity of SSW test for diagnosing DSPN using NCS as a reference standard was 81.3%, and specificity was 67.0%, on par with other testing methods. Conclusions Stimulated skin wrinkling shows comparable sensitivity to other methods for detecting DSPN. Given its low cost and easy administration, SSW can be considered a useful alternative screening method for diagnosing diabetic neuropathy. |
| first_indexed | 2024-12-21T11:31:47Z |
| format | Article |
| id | doaj.art-67b9c4138b9648839183b21e9907da16 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T11:31:47Z |
| publishDate | 2013-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-67b9c4138b9648839183b21e9907da162022-12-21T19:05:32ZengFrontiers Media S.A.Frontiers in Neurology1664-22952013-09-01410.3389/fneur.2013.0012659117EMLA-induced skin wrinkling for the detection of diabetic neuropathyWei Ping eNg0Kok Onn eLee1Liang eShen2Jonathan eOng3Thaw Dar eNyein Nyein4Einar Patrick Wilder-Smith5National University HospitalYong Loo Lin School of medicine, National University SingaporeYong Loo Lin School of Medicine, National University of SingaporeNational University HospitalNational University HospitalYong Loo Lin School of medicine, National University SingaporeObjectiveTo determine the usefulness of Eutectic Mixture of Local Anesthetic (EMLA)-induced stimulated skin wrinkling (SSW) to detect diabetic sensorimotor polyneuropathy (DSPN).Research Design and Methods 210 diabetics were prospectively recruited (mean age 58.5±12.7 years) from a large tertiary center from 2009 to 2011. EMLA was applied to the tips of digits 2, 3 and 4 and the degree of wrinkling graded. Diabetic Neuropathy Symptom (DNS) score, nerve conduction studies (NCS), Semmes-Weinstein monofilament (SWMF) tests, and vibratory perception thresholds (VPT) testing were chosen as comparative clinical standards to diagnose length-dependent DSPN.ResultsInter-rater agreement for 2 examiners of SSW was high, with Cohen’s weighted Κ of 0.912 for the right hand, and 0.823 for the left. K measure of agreement of SSW with the NCS, DNS scores, SWMF testing and VPT testing was 0.486, 0.243, 0.289 and 0.395 respectively. SSW was able to distinguish between normal and abnormal NCS and DNS results, with median scores of 3.333 vs 1.667 (p<0.0005); and 3.167 vs 2.000 (p<0.0005) respectively. Following ROC analysis, at a cut-off point of < 3 for an abnormal SSW test, sensitivity of SSW test for diagnosing DSPN using NCS as a reference standard was 81.3%, and specificity was 67.0%, on par with other testing methods. Conclusions Stimulated skin wrinkling shows comparable sensitivity to other methods for detecting DSPN. Given its low cost and easy administration, SSW can be considered a useful alternative screening method for diagnosing diabetic neuropathy.http://journal.frontiersin.org/Journal/10.3389/fneur.2013.00126/fullDiabetic neuropathyscreening testsnerve conductionstimulated skin wrinklingvibration thresholdmonofilament |
| spellingShingle | Wei Ping eNg Kok Onn eLee Liang eShen Jonathan eOng Thaw Dar eNyein Nyein Einar Patrick Wilder-Smith EMLA-induced skin wrinkling for the detection of diabetic neuropathy Frontiers in Neurology Diabetic neuropathy screening tests nerve conduction stimulated skin wrinkling vibration threshold monofilament |
| title | EMLA-induced skin wrinkling for the detection of diabetic neuropathy |
| title_full | EMLA-induced skin wrinkling for the detection of diabetic neuropathy |
| title_fullStr | EMLA-induced skin wrinkling for the detection of diabetic neuropathy |
| title_full_unstemmed | EMLA-induced skin wrinkling for the detection of diabetic neuropathy |
| title_short | EMLA-induced skin wrinkling for the detection of diabetic neuropathy |
| title_sort | emla induced skin wrinkling for the detection of diabetic neuropathy |
| topic | Diabetic neuropathy screening tests nerve conduction stimulated skin wrinkling vibration threshold monofilament |
| url | http://journal.frontiersin.org/Journal/10.3389/fneur.2013.00126/full |
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