Diagnosis and management of chronic polyneuropathy
Chronic polyneuropathy is a common neurological disorder in which there is a generalized affection of peripheral nerves. It can be caused by diseases such as diabetes, and toxic substances such as alcohol and certain drugs. However, quite often the cause cannot be determined. In clinical practice the evaluation of patients with polyneuropathy is a complicated two stage procedure, which first determines the presence and pattern of peripheral nerve affection, and then seeks to establish the cause of the neuropathy. Currently, the procedure includes measuring nerve conduction and doing blood tests, and in selected cases determination of nerve fibre density in skin biopsies.
This research program will implement nerve fibre density determined in skin biopsies in all cases of suspected polyneuropathy, and introduce confocal microscopy of the cornea to study small nerve fibres as a diagnostic test. Further, the programme will do extra blood testing and imaging to determine the aetiology of polyneuropathy. Finally, it will establish a biobank with blood, serum and skin biopsies for all participants. Comprehensive information on the participants with regard to history, clinical findings, scoring of neuropathy severity, and diagnostic test results will be entered into a research database. The biobank material can e.g. be used to search for serum factors causing neuropathy and alternative staining of nerve fibres in skin biopsies.
The rationale of the study is that by obtaining detailed information on a large number of patients with suspected polyneuropathy we will be able to:
- Describe the pattern of nerve affection comprehensively and compare it between different aetiologies\n
- Estimate the diagnostic sensitivity of the different diagnostic tests in general and in subpopulations\n
- Increase the number of cases with polyneuropathy aetiology determined and maybe establish new causes of polyneuropathy\n
Thus, the overall aim of the research programme is to develop an improved and more rational procedure for evaluating patients with suspected polyneuropathy. \n
Description of the cohort
Patients referred to the neuromuscular team at Department of Neurology for examination for chronic polyneuropathy.
We consecutively include patients aged 18+ with suspected polyneuropathy. Study data will collected at study entry and the patients will be re-examined 2 and 5 years after being diagnosed with polyneuropathy.
Data and biological material
Clinical data concerning diagnosis, symptoms, neurological signs, scores of disease severity and quality of life, risk factors for neuropathy and cardiovascular diseases.
Results of neurophysiology examination, intra-epidermal nerve fibre density in skin biopsies, quantitative sensory examination and confocal microscopy of the cornea.
Blood (DNA), serum, spinal fluid.
Photos of corneal nerve fibers obtained during microscopy.\n
Collaborating researchers and departments
Department of Neurology, Odense University Hospital
- Professor Søren Hein Sindrup, MD, DMSc
- Professor David Gaist, MD, PhD
- Neurologist and PhD-student Thomas Krøigård, MD
- Neurologist Jakob Holbech, MD, PhD
Department of Clinical Pathology, Odense University Hospital
- Professor Henrik D. Schrøder, MD, DMSc
- Pathologist Martin Wirenfeldt, MD, PhD