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Quantitative sensory testing

Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

From the Departments of Neurology and Center for Molecular Medicine and Genetics (Dr. Shy), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (Dr. Frohman), UT Southwestern Medical Center, Dallas, TX; Department of Neurology and Neurosciences (Dr. So), Stanford University Medical Center, CA; Department of Neuroscience (Dr. Arezzo), Albert Einstein College of Medicine, New York, NY; Department of Neurology (Dr. Cornblath), Johns Hopkins University School of Medicine, Baltimore, MD; Clinical Research and Development (Dr. Giuliani), Wyeth-Ayerst, Collegeville, PA; Department of Neurology (J.C. Kincaid), University of Indiana School of Medicine, Indianapolis; Department of Neurology (Dr. Ochoa), University of Oregon, Portland; Department of Neurology (Dr. Parry), University of Minnesota, Minneapolis; and Department of Neurology (Dr. Weimer), Columbia Presbyterian Medical Center, New York, NY.

Address correspondence and reprint requests to the Therapeutics and Technology Assessment Subcommittee, American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.

Objective: This assessment evaluates the clinical utility, efficacy, and safety of quantitative sensory testing (QST).

Methods: By searching MEDLINE, Current Contents, and their personal files, the authors identified 350 articles. Selected articles utilized computer operated threshold systems, manually operated threshold systems, and electrical threshold devices. The authors evaluated the use of normal values and the degree of reproducibility between the same and different systems. Articles were rated using a standard classification of evidence scheme.

Results: Because of differences between systems, normal values from one system cannot be transposed to others. Reproducibility of results was also an important concern, and there is no consensus on how it should be defined. The authors identified no adequately powered class I studies demonstrating the effectiveness of QST in evaluating any particular disorder. A number of class II and III studies demonstrated that QST is probably or possibly useful in identifying small or large fiber sensory abnormalities in patients with diabetic neuropathy, small fiber neuropathies, uremic neuropathies, and demyelinating neuropathy.

Conclusions: QST is a potentially useful tool for measuring sensory impairment for clinical and research studies. However, QST results should not be the sole criteria used to diagnose pathology. Because malingering and other nonorganic factors can influence the test results, QST is not currently useful for the purpose of resolving medicolegal matters. Well-designed studies comparing different QST devices and methodologies are needed and should include patients with abnormalities detected solely by QST.

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