Einar P Wilder-Smith1, Yaling Guo, Adeline Chow. 1. Division of Neurology, National University Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. mdcwse@nus.edu.sg
Abstract
OBJECTIVE: To determine the usefulness of stimulated skin wrinkling using EMLA and water immersion in detecting abnormal intraepidermal nerve fibre density. METHODS: In a prospective study of patients with predominantly sensory polyneuropathy, we tested sensitivity and specificity of stimulated skin wrinkling using EMLA and water immersion in detecting abnormal intraepidermal nerve fibre density (IENFD). RESULTS: EMLA stimulated wrinkling showed a sensitivity of 81.6% and specificity of 74.7% in detecting abnormal IENFD and water wrinkling a sensitivity of 71.4% and specificity of 73%. The positive and negative predictive values for detecting abnormal IENFD were 88.3% and 63.3% for EMLA wrinkling, for water wrinkling 83.3% and 57.4%. Intra-observer EMLA score variability was good with no change in assignment of wrinkling and inter-observer score variability resulted in 1-5 changes in wrinkling score which translated into a change of the wrinkling status from normal to abnormal on two occasions. CONCLUSIONS: Stimulated skin wrinkling correlates well with abnormal intraepidermal nerve fibre density. SIGNIFICANCE: Our study suggests that EMLA induced stimulated skin wrinkling is a useful alternative parameter for predicting abnormal intraepidermal nerve fibre density.
OBJECTIVE: To determine the usefulness of stimulated skin wrinkling using EMLA and water immersion in detecting abnormal intraepidermal nerve fibre density. METHODS: In a prospective study of patients with predominantly sensory polyneuropathy, we tested sensitivity and specificity of stimulated skin wrinkling using EMLA and water immersion in detecting abnormal intraepidermal nerve fibre density (IENFD). RESULTS: EMLA stimulated wrinkling showed a sensitivity of 81.6% and specificity of 74.7% in detecting abnormal IENFD and water wrinkling a sensitivity of 71.4% and specificity of 73%. The positive and negative predictive values for detecting abnormal IENFD were 88.3% and 63.3% for EMLA wrinkling, for water wrinkling 83.3% and 57.4%. Intra-observer EMLA score variability was good with no change in assignment of wrinkling and inter-observer score variability resulted in 1-5 changes in wrinkling score which translated into a change of the wrinkling status from normal to abnormal on two occasions. CONCLUSIONS: Stimulated skin wrinkling correlates well with abnormal intraepidermal nerve fibre density. SIGNIFICANCE: Our study suggests that EMLA induced stimulated skin wrinkling is a useful alternative parameter for predicting abnormal intraepidermal nerve fibre density.
Authors: Kay Wei Ping Ng; Jonathan J Y Ong; Thaw Dar Nyein Nyein; Shen Liang; Yee Cheun Chan; Kok Onn Lee; Einar Patrick Wilder-Smith Journal: Front Neurol Date: 2013-09-02 Impact factor: 4.003
Authors: Arthur H P Mawuntu; Corry N Mahama; Herlyani Khosama; Riwanti Estiasari; Darma Imran Journal: Medicine (Baltimore) Date: 2018-07 Impact factor: 1.889