Abstract Details

Title Diagnostic Utility of Qualitative vs. Quantitative Tuning Fork for Axonal Neuropathy: A Prospective, Single-Site Cross-Sectional Study

Topic Peripheral Nerve

Presentation(s) P02 - (-)

Poster/Presentation
Number 177

Objective

Background BACKGROUND: Sensation testing in neurological examinations is usually subjective. The quantitative Rydel-Seiffer (RS) tuning fork has shown good correlation with sural sensory responses in case series. However, the qualitative 128 Hz tuning fork is more ubiquitous in clinical practice. To our knowledge, no study has compared the diagnostic utility of both tuning forks.

Design/Methods DESIGN/METHODS: 100 consecutive patients seen at the Neurology Outpatient Electromyography (EMG) clinic at Wayne State University were consented for this study. Information gathered included a neuromuscular examination, nerve conduction data, and standardized vibratory perception testing with both the RS and the 128 Hz tuning forks at bilateral (a) great toe, (b) medial malleolus, and (c) distal inter-phalangeal joint on the second digit. Published normative data was used to determine abnormal scores for the RS and 128 Hz tuning fork; axonal neuropathy was determined based on our EMG laboratory standards. A 2x2 decision matrix table was constructed to calculate the sensitivity and specificity of both tuning forks corresponding to the EMG data. To compare the sensitivity and specificity of the two tuning forks to each other, a 4x4 table was constructed and an extended McNemars test was applied.

Results RESULTS: The sensitivity and specificity of the Rydel-Seiffer tuning fork was 28.8% and 86.5% respectively, and the sensitivity and specificity of the conventional 128 Hz tuning fork was 21.2% and 88.0% respectively. The extended McNemars test showed no significant difference in sensitivity or specificity of the two tuning forks (chi sq = 0.83).

Conclusions CONCLUSIONS: The quantitative Rydel-Seiffer tuning fork has become increasingly popular, especially in trial settings; however, our study shows it has no superior diagnostic utility for detecting axonal neuropathies compared to the qualitative 128 Hz tuning fork.

Authors/Disclosures
Saien Lai, MD (Kaiser Permanente Panorama City) PRESENTER	Dr. Lai has nothing to disclose.
	No disclosure on file
Aruna Bollineni, MD (Carroll Health Group Neurology)	No disclosure on file
Richard A. Lewis, MD, FAAN (Cedars-Sinai Medical Center)	Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CSL Behring. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grifols. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Takeda. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Nuvig. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Dianthus. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Janssen. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medscape. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunovant. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BioCryst. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NervoSave. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Annexon. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immunovant. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TGTX. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boehringer-Ingleheim. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intellia. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cartesian. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for CME Outfitters. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PeerVision. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Up to Date. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer Ingelheim. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Intellia. Dr. Lewis has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Shernoff et al. Dr. Lewis has received publishing royalties from a publication relating to health care.
Sindhu Ramchandren, MD (Janssen Pharmaceutical Companies of Johnson & Johnson)	Dr. Ramchandren has received personal compensation for serving as an employee of Janssen Pharmaceutical Companies of Johnson & Johnson.
Linda P. Lowes, PT PhD	The institution of Ms. Lowes has received research support from Sarepta Therapeutics.

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