Accuracy of neurophysiological tests in patients with neurological diseases and pelvic floor symptoms: which tests for which patients
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Aims. To evaluate the sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of neurophysiological tests in patients with neurological diseases and pelvic floor symptoms.
Sixty-four of 111 outpatients who came to our attention for pelvic floor symptoms presented with neurological disorders (32 lower motor neuron disease [LMND], 30 upper motor neuron disease [UMND], 2 with mixed clinical picture). Forty-seven patients with chronic pelvic pain served as controls. All underwent neurological/perineal clinical evaluation and a battery of neurophysiological tests: concentric-needle electromyography (CNEMG) of external anal sphincter (EAS) muscle, pudendal evoked potentials (pPEPs), sacral reflexes, and perineal sympathetic skin response (pSSR). Upper and lower limits of normal values were collected and compared to patients' data. SE, SP, PPV, and NPV were calculated for each neurophysiological exam.
CNEMG of the EAS showed the highest SE, PPV, and NPV compared with the other tests in LMND; also in UMND, CNEMG of the EAS showed moderate SE and different patterns of abnormality. Combination of sacral reflexes and CNEMG increased the SE of single electrophysiological tests in LMND and UMND. PSEPs were altered in half of the patients with LMND and demonstrated high SE in UMND. PSSR had moderate SE in UMND but the lowest SP and PPV in patients with LMND or UMND.
Targeted protocols including diverse neurophysiological tests should be chosen on the basis of neurological conditions and level of damage, while other tests should be used for research purposes.
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