Introduction
Methods
Literature search
Data collection
Results
Door-to-door survey studies (Table 1)
Study/country/study year | Study size | Age of the study population | Assessment protocol | Prevalence of polyneuropathy | Prevalence of polyneuropathy related causes (per 1000) |
---|---|---|---|---|---|
Cruz et al. [11] Ecuador 1982 | 1113 | All ages included; >50 years: 18 % | WHO protocola
| Crude: 9.0 per 1000 | |
Osuntokun et al. [12] Nigeria 1982–1983 | 18,954 | All ages included; >50 years: 11 % | WHO protocol | Crude: 2.5 per 1000 | 1.9 tropical 0.4 idiopathic 0.1 diabetic 0.1 hereditary 0.1 nutritional |
Cruz Gutierrez-del-Olmo et al. [13] Spain 1984 | 961 | All ages included; >50 years: 30 % | WHO protocolb
| Crude: 7.3 per 1000 | 3.1 idiopathic 2.1 diabetic 2.1 alcoholic |
Longe and Osuntokun [14] Nigeria 1986 | 2925 | All ages included; >50 years: 10 % | WHO protocol | Crude: 1.4 per 1000 | |
Bharucha et al. [15] India 1985 | 14,010 | All ages included; >50 years: 44 % | Adapted WHO protocol | Crude: 7.1 per 1000 | 3.7 diabetic 2.1 idiopathic 0.4 toxic (alcohol and iatrogenic) 0.3 inflammatory 0.1 hereditary |
Al Rajeh et al. [16] Saudi Arabia 1989 | 22,630 | All ages included; >50 years: 4 % | Adapted WHO protocol | Crude: 0.8 per 1000 | |
Savettieri et al. [17] Italy 1993 | 14,540 | All ages included; >40 years: 40 % | Adapted WHO protocol | Crude: 7 % screen positivec
| 2.1 diabetic |
Lor et al. [18] Malaysia | 100 | Only subjects >65 years included | Bilateral distal symptoms and/or bilateral loss of pinprick or joint position sensation | Crude: 200 per 1000 | |
Kandil et al. [19] Egypt 1997 | 42,223 | All ages included; >50 years: 10 % | Adapted WHO protocol | Crude: 8.3 per 1000 | 6.5 diabetic 0.9 idiopathic 0.5 metabolicd
0.2 inflammatory 0.1 hereditary |
Kruja et al. [20] Albania 2006–2008 | 9869 | All ages included; >50 years: 31 % | ≥2 symptoms + bilateral impairment of strength and/or sensation and/or reflexes with symmetrical distributione
| Crude: 32.5 per 1000 Adjustedf: 23.6 per 1000 | |
Dewhurst et al. [21] Tanzania 2009–2010 | 2232 | Only subjects >70 years included | Self-developed two-phased screening tool. First phase based on questionnaire. Diagnosis according to WHO definition | Crude; 18.8 per 1000 Adjustedf: 18.6 per 1000 |
Case–control studies (Table 2)
Study/country/study year | Selection of cases | Selection of controls | Number of participants | Assessment protocol | Definition of polyneuropathy | Prevalence of polyneuropathy |
---|---|---|---|---|---|---|
Franklin et al. [22] USA 1984–1986 | Medical records from hospitals and physicians, and self-reports of persons aged 20–74 years | Random sample of households, matched on age, sex and ethnicity. Assessment with OGTT | DM: 277 IGT: 89 NGT: 486 | Discomfort in the legs Reflexes Temperature sensation | ≥2 abnormal items | DM: 25.8 % IGT: 11.2 % NGT: 3.5 % |
Walters et al. [23] UK | Medical records from 10 practices. All > 30 years of age | Non-diabetics without glycosuria matched on practice, sex and birthdate. | DM: 1077 No DM: 480 | Symptoms (numbness, burning, prickling, aching, tingling), light touch, pinprick, reflexes, vibration perception threshold (biothesiometer) | ≥2 abnormal items | DM: 16.3 % No DM: 2.9 % |
Harris et al. [24] Finland 1979–1981 | National Health Interview Survey of people over 18 years. Self-reported diabetes | Random sample from those without diabetes | DM: 2829 No DM: 20,037 | Numbness, pain or tingling, decreased ability to feel hot or cold | ≥1 symptom | DM: 37.9 % No DM: males 9.8, females 11.8 %a
|
Partanen et al. [25] Finland 1979–1981 | Newly diagnosed diabetes patients from district health centers, aged 45–64 years, Exclusion criteria: alcoholism, thyroid dysfunction, renal failure | Randomly selected controls without diabetes from the same age group, selected from population registry. Same exclusion criteria as cases | New DM: 132 No DM: 142 | Symptoms: bilateral neuropathic pain, paresthesia Signs: atrophy, reflexes, touch, pinprick, vibration Nerve conduction velocity and amplitude in peroneal (4 values) and sural nerves (2 values) | Definite: ≥4 abnormal NCS values, including peroneal and sural nerve, and symptoms Probable: Same as definite but without symptoms, or one of the nerves involved with symptoms | Baseline:b
New DM: 8.3 % No DM: 2.1 % After 10 years: New DM: 41.9 % No DM: 5.8 % |
Tapp et al. [26] Australia 1999–2000 | AusDiab survey study of people >25 years of age. Assessment with OGTT to diagnose diabetes (and evaluation of current treatment) | Random sample of those with normoglycemia after OGTT | DM: 398 New DM: 423 IGT: 1009 IFG: 142 NGT: 464 | Modified Neuropathy Symptoms Score (NSS) Modified Neuropathy Disability Score (NDS) Pressure perception test (PPT) with monofilament Postural blood pressure drop | ≥2 of the scales abnormal (NSS > 4, NDS > 5, PPT < 6, fall in systolic blood pressure of ≥20 mmHg) | DM: 13.1 % New DM: 7.1 % IGT: 5.7 % IFG: 5.6 % NGT: 2.8 % |
Ziegler et al. [27] Germany 1997–1998 | Participants with self-reported diabetes from two surveys of the MONICA/KORA study, aged 24–74 years | Matched (age and sex) nondiabetic subjects were assessed with OGTT to determine glycemic status | DM: 195 IGT: 46 IFG: 71 NGT: 81 | Michigan Neuropathy Screening Instrument (MNSI) | MNSI > 2 | DM: 28.0 % IGT: 13.0 % IFG: 11.3 % NGT: 7.4 % |
Dyck et al. [28] USA 2004 | Patients known as having impaired glycemia were selected through databases and assessed with OGTT | Patients known as having a normal glucose, matched on age and sex, were assessed with OGTT | New DM: 218 IG: 174 NGT: 150 | Neuropathy Symptoms and Change (NSC) Neuropathy Impairment Score (NIS) Composite scores of nerve conduction | Clinical judgment after abnormality in nerve conduction, NSC or NIS | New DM: 17.4 % IG: 12.6 % NGT: 12.7 % |
Cohort studies (Table 3)
Study/country/study year | Population | Age of the study population | Assessment protocol | Definition of polyneuropathy | Prevalence of polyneuropathy |
---|---|---|---|---|---|
Beghi et al. [29] Italy 1990–1993 | 4191 patients seen in GP’s office consultations for any reason | All > 55 years | Questionnaire followed by examination (strength, sensation, reflexes) when ≥ 2 symptoms | Possible: ≥1 abnormal item of exam Probable: ≥ 2 abnormal items | Crude: 3.6 %a
Adjusted: 3.5 %b
Diabetes: 44 % Neoplasm: 10 % Alcohol: 6 % |
Nakashima et al. [30] Japan 1991 | Database of 7685 residents of Daisen Town | All ages included, about 45 % > 50 years | Medical records of hospitals, GPs and other sources | Not specified | Crude: 3.3 per 1000 Adjusted: 2.2 per 1000c
|
MacDonald et al. [31] Norway 1999 | Database of 27,657 subjects from 3 GP practices in London | All ages included, about 28 % > 50 years | Medical records and notes from GPs and referral hospital | Clinical objective signs in the presence of an established cause, such as diabetes. Alternatively, an EMG diagnosis was required | Diabetes: Adjusted: 2 per 1000d
Other (excluding alcoholic): Adjusted: 1 per 1000d
Incidencee: Diabetes: adjusted: 0.5 per 1000/yeard
Other: adjusted: 0.2 per 1000/yeard
|
Mygland and Monstad [32] Norway 1999 | Database of 155,464 inhabitants of Vest-Agder | All ages | Database of all patients with polyneuropathy referred to the only neurology center in the county | Clinically and electrophysiologically classified | Crude: 1.2 per 1000 Idiopathic: 26 % Diabetes: 19 % Hereditary: 12 % Alcohol: 10 % CIDP: 8 % |
Mold et al. [33] USA 1999–2000 | 795 non-institutionalized subjects recruited from 9 GP practices | All > 65 years | Symptom questionnaire, fine touch, position and vibration sensation and ankle reflexes | 1 or more complete bilateral peripheral neurologic deficits | Crude: 30.9 % |
Eisen et al. [34] USA 1999–2001 | 1061 deployed and 1128 non-deployed Gulf war veterans | Mean age 31–33 years | Neurologic examination and nerve conduction studies | Idiopathic distal sensory, motor or sensorimotor polyneuropathy based on exam and/or NCSf
| Crude: Deployed: 4.8 % Non deployed: 5.9 % |
Baldereschi et al. [35] Italy 1992–1993 | 4500 participants of the Italian Longitudinal Study on Aging (ILSA): population-based cohort study | 65–84 years | Screening: self-reported diagnosis, symptoms, ankle reflexes, heel gait, touch and pain sensation. | Full neurological exam, history and record review when positive on any of the screening items Diagnosis: clinical judgment | Crude: 7.4 % Adjusted: 7.0 %g
Diabetes: 39.2 % Idiopathic: 51.5 % Other: 9.3 % Incidence: 7.9 per 1000/year |
Bruce et al. [36] Canada 2003 | 467 nonpregnant community members of the Sandy Bay First Nation | All > 18 years >50y: 18 % | 10-g Monofilament on 10 sites of the foot | Unable to sense monofilament on one or more sites | Crude: 7.3 % |
Lin et al. [37] China 2009 | 5385 subjects from the She population of China | All > 20 years, mean age 47 years | Toronto Clinical Neuropathy Scoring System (TCSS) | TCSS ≥ 6 | Crude: 12.6 % |
Lu et al. [38] China 2011–2012 | 2035 nonpregnant Han community members without type 1 diabetes or renal failure. | All > 25 years | Modified Neuropathy Deficit Score (NDS) and Neuropathy Symptom Score (NSS) | NDS ≥ 6, or NDS ≥ 3 and NSS ≥ 5 | Crude: 4.0 % |
Visser et al. [39] Netherlands 2010 | Adult population of the province of Utrecht: 953,110 | All ≥ 18 years | New cases that are registered in databases of all hospitals in the proximity of the province of Utrecht during a period of 1 year | Local guidelines: combination of symptoms and deficits compatible with polyneuropathy and diagnostic work-up for etiological diagnosis | Only incidence: Crude: 0.7/1000/year Adjusted: 0.5/1.000/yearh
Diabetes: 32 % Idiopathic: 26 % Toxic: 14 % Immune-mediated: 9 % |
Age and sex-specific prevalence across all studies
Risk factors for chronic polyneuropathy
Study | George and Twomey [42] | Lin et al. [43] | Johannsen et al. [44] | Mygland et al. [32] | Verghese et al. [45] | Rosenberg et al. [46] | Vrancken et al. [47] | Rudolph and Farbu [48] | Visser et al. [39] | |
---|---|---|---|---|---|---|---|---|---|---|
Country | UK | Taiwan | Denmark | Norway | USA | Netherlands | Netherlands | Norway | Netherlands | |
Study period | 1980–1984 | 1988–1989 | 1993–1999 | 1999 | 1990–1999 | 1993–1997 | 1999–2002 | 2000–2005 | 2010 | |
Population | Patients referred to hospital for NCS | Patients seen in 5 neurological centers | Patients referred to hospital for NCS | Patients referred to hospital neurologist | Patients referred to EMG laboratory | Patients at outpatient department | Multicenter study of patients with a diagnostic work-up for PNP | Patients referred to hospital neurologist | New hospital-registered cases | |
Number of patients | 74 | 520 | 147 | 192 | 231 | 171 | 172 | 137 | 226 | 743 |
Age | ≥65 | – | 18–70 | – | 65–75 | ≥75 | 26–93 | ≥18 | 9–92 | ≥18 |
Associated risk factor (%) | ||||||||||
Cryptogenic/CIAP | 28 | 12 | 25 | 26 | 13 | 27 | 20 | 49e
| 28 | 26 |
Diabetes | 27 | 49 | 32 | 19 | 46 | 31 | 38 | 26 | 18 | 32 |
Malignancy | 13 | 2 | 1 | 4 | 3 | 4 | 1 | 3 | 3 | |
Inflammatory | 11 | 8 | 2 | 8 | 7 | 4 | 1 | 4 | 16 | 9f
|
Toxic medication | 4 | 3 | 5 | 6 | 7 | 6 | 5 | 3 | – | 14 g
|
Connective tissue disorder/vasculitis | 4 | – | 3 | 5 | 1 | 2 | 1 | 4 | 4 | 5 |
Nutritional deficiencya
| 4 | 1 | 2 | 4 | 1 | 1 | 1 | 9 | 4 | 3 |
Alcohol | 3 | 9 | 19 | 10 | 6 | 1 | 9 | 6 | 10 | 14 g
|
Renal failure | 3 | 4 | 1 | – | 2 | 2 | 4 | 4 | – | 4 h
|
Hereditary | 1 | 4 | 1 | 12 | 7 | 8 | 3 | 7 | 14 | 5 |
Sarcoidosis | 1 | – | – | 2 | – | – | 1 | – | – | – |
Hypothyroidism | – | 2 | – | – | 1 | 1 | 1 | 3 | 4 | 4 h
|
Ischemic | – | 2 | 1 | – | 0 | 2 | – | – | – | – |
Paraproteinemia | – | 2 | 5 | 4 | 1 | 4 | 1 | 9 | – | – |
Liver disease | – | 1 | – | – | – | – | – | – | 1 | – |
Infectionb
| – | – | 1 | 1 | 0 | 1 | 1 | – | 2 | – |
Critical illness | – | – | 1 | – | 3 | 4 | 1 | – | – | – |
HIV | – | – | 1 | – | – | – | 12d
| – | – | – |
Other causes | – | 2 | 3c
| – | 2 | 3 | – | – | – | – |