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Neurology. 2014 May 13;82(19):1745-8. doi: 10.1212/WNL.0000000000000397. Epub 2014 Apr 2.

Quality improvement in neurology: Distal symmetric polyneuropathy quality measures.

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From the Department of Neurology (J.D.E.), Louisiana State University Health Sciences Center School of Medicine, New Orleans; the Department of Environmental and Occupational Sciences, Neurology, and Health Services (G.F.), School of Public Health, University of Washington, Seattle; American Academy of Neurology (G.G., R.S.-E.), Minneapolis, MN; the Peripheral Neuropathy Center (T.H.B.), Neurological Institute, Columbia University, New York, NY; Massachusetts General Hospital (W.S.D.), Boston; the Department of Neurology (R.M.D.), University of Kansas Medical Center, Kansas City; and the Department of Neurology (B.E.S.), Mayo Clinic in Arizona, Scottsdale.


Peripheral neuropathy is a common neurologic disorder, affecting 2% to 8% of the population in population-based studies with confirmation by neurologist examination. These prevalence numbers are remarkably stable across developed countries. In 1999, 8.6% of Medicare beneficiaries had neuropathy as a primary or secondary diagnosis, and the cost of treatment was estimated at $3.5 billion (Consumer Price Index adjusted to 2013 $4.9 billion), which did not include outpatient medications. Peripheral neuropathy has many causes and varies in regard to its clinical manifestations and severity. Distal symmetric polyneuropathy (DSP) is the most common pattern of peripheral neuropathy generally and the most common phenotype of neuropathy due to diabetes. Reported prevalence rates of DSP among diabetic patients range from 15% to 37% across large population-based studies, and the prevalence among those with impaired glucose tolerance has been reported to be 11%. DSP can result in weakness, sensory loss, pain, autonomic dysfunction, gait impairment, falls, disability, and impaired quality of life.

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