Neurology # 2003/040667-R2

Clinical and laboratory assessment of distal peripheral nerves in Gulf War veterans and spouses

----ELECTRONIC TABLES---

L. E. Davis, M.D.1,2

S. A. Eisen, M.D., M.Sc3

F. M. Murphy, M.D., M.P.H4

R. Alpern, M.S.5

B. J. Parks, M.D.6

M. Blanchard, M.D.7

D. J. Reda, Ph.D.5

M. K. King, M.D.1,2

F. A. Mithen, M.D., Ph.D.8

H. K. Kang, Dr.P.H.9

From Neurology Service1, New Mexico VA Health Care System, Albuquerque, NM; Department of Neurology2, University of New Mexico School of Medicine; Medical3,7, Research3, and Neurology Service8, St. Louis Department of Veterans Affairs Medical Center; Department of Neurology8, St. Louis University; Departments of Internal Medicine3,7 and Neurology6, Washington University School of Medicine, St. Louis, MO; Deputy Under Secretary for Health for Health Policy Coordination4 and Environmental Epidemiology Service9, Veterans Health Administration, Department of Veterans Affairs, Washington DC; and Cooperative Studies Program Coordinating Center5, Hines VA Hospital, Hines IL.

Corresponding author: Larry E. Davis, MD, Neurology Service, New Mexico VA Health Care System, 1501 San Pedro Dr. SE, Albuquerque, NM, 87108, tel 505-156-2752, fax 505-256-2870, email

E-Table 1 Definitions of types of distal symmetricalpolyneuropathy

Distal sensory neuropathy requires evidence of a distal sensory nerve dysfunction in both feet.

Criteria: On both legs, requires at least 2 abnormalities from group 1 and at least one abnormality from group 2. Ankle reflexes may be reduced or normal. Exclusionary criteria include leg weakness and presence of upper motor neuron findings.

Distal motor neuropathy requires evidence of damage to distal motor nerves in both feet.

Criteria: On both legs, requires at least 2 criteria from group 3. Presence of sensory loss and upper motor neuron findings are exclusionary criteria

Distal sensorimotor neuropathy requires evidence of both a distal sensory and motor nerve dysfunction

Criteria: On both legs, requires at least 2 abnormalities from group 1, at least 1 abnormality from group 2, at least 2 abnormalities from group 3 and reduced or absent ankle reflexes. The presence of upper motor neuron findings is an exclusionary criterion.

Group 1 (sensation of great toe)

  • Pinprick decreased, absent or hyperpathic
  • Light touch decreased or absent
  • Vibration decreased or absent
  • Joint position sense decreased or absent

Group 2 (sensation of little toe)

  • Pinprick decreased, absent or hyperpathic
  • Light touch decreased or absent

Group 3 (motor of lower leg)

  • Atrophy of intrinsic foot muscles
  • Weakness of great toe extensors
  • Weakness of ankle dorsiflexion
  • Ankle reflexes reduced or absent

E-Table 2: Definitions for the electrophysiological diagnosis of distal symmetrical polyneuropathy

Distal sensory neuropathy requires abnormalities of both the sural nerve and superficial radial nerves

Criteria: on the tested nerves of one leg, both parts of group 1 category

Motor neuropathy requires abnormalities of distal latency, amplitudes, conduction velocity or F-wave latency in at least 2 of 3 motor nerves. Dysfunction may be characterized as axonal, demyelinating or mixed.

Criteria: In group 2 motor nerve dysfunction, 2 of 3 parts of motor axonal or 2 of 3 parts of motor demyelinating

Sensorimotor neuropathy requires abnormalities diagnostic of both sensory and motor categories in one leg and one arm (excluding the median nerve distal motor latency).

Criteria: in group C sensorimotor nerve dysfunction, 1 of 2 in Part A and 2 of 3 in part B OR 3 of 3 in part C

Group 1 sensory nerve dysfunction

  • Superficial radial nerve: amplitude of < 15.0 Volts or conduction velocity of < 50 m/sec
  • Sural nerve: amplitude of < 5.0 Volts or conduction velocity of < 40 m/sec

Group 2 motor nerve dysfunction

Axonal dysfunction:

  • Median nerve: amplitude of < 4.0 mVolts
  • Peroneal nerve: amplitude of < 2.0 mVolts
  • Posterior tibial nerve: amplitude of < 4.0 mVolts

Demyelinating dysfunction:

  • Distal Motor nerve latencies: peroneal nerve 8.4 msec and posterior tibial nerve 7.8 msec
  • Motor nerve conduction velocity: median nerve < 36 m/sec, peroneal nerve <32 m/sec or posterior tibial nerve < 32 m/sec

 F-wave latencies: median nerve 40, peroneal nerve 72 msec or posterior tibial nerve  72msec

Group 3 sensory-motor nerve dysfunction

  • Part A:
  • Median nerve: amplitude of < 4.0 mVolts or velocity < 48 m/sec
  • Superficial radial nerve: latency > 2.5 msec or amplitude < 15 Volts or velocity< 50 m/sec
  • Part B
  • Peroneal nerve: latency > 6.5 msec or amplitude < 2.0 mV or velocity < 42 m/sec
  • Posterior tibial nerve: latency > 6.0 msec or amplitude <4.0 mVolts or velocity < 42 m/sec
  • Sural nerve: latency > 4.5 msec or amplitude < 5.0 Volts or velocity < 40 m/sec
  • Part C
  • Peroneal nerve: latency > 6.5 msec or amplitude < 2.0 mVolts, or velocity < 42m/sec
  • Posterior tibial nerve: latency >6.0 msec or amplitude < 4.0 mVolts, or velocity < 42 m/sec
  • Sural nerve: latency > 4.5 msec or amplitude < 5.0 Volts or velocity < 40 m/sec

E-Table 3: Socio-demographic characteristics of spouses of deployed and non-deployed veterans
Characteristic1 /

Deployed

n=484 / Non-deployed
n=533 / p-value
Mean age (s.d.) / 38.21(9.0) / 40.51(10.32) / .0002
Gender (% female ) / 89.3 / 87.8 / .49
Race (%)
Caucasian
African-American
Other / 80.7
13.8
5.5 / 83.2
10.3
6.5 / .21
Highest education at exam (%)
< high school
High school graduate
College graduate
Post graduate / 6.4
65.0
19.1
9.5 / 5.9
64.3
17.9
11.9 / <.0001
Mean family income in $1,000’s (s.d.) / 46.69(18.96) / 50.17(24.73) / .44
1Prevalences were generated in SAS