Usefulness of Monofilament Testing for Detecting Peripheral Neuropathy I

Background. The monofilament test is a simple and inexpensive tool used for the detection of diabetic peripheral neuropathy in the community setting but it is unclear whether its use can be extended to patients with neuropathy that is not due to diabetes. Objective. We aimed to determine the sensitivity and specificity of the monofilament test in detecting peripheral neuropathy, diabetic or non-diabetic, using Nerve Conduction Studies (NCS) as the gold standard. Methods. In a health assessment activity in Marinduque, patients were assessed by a neurologist as to whether or not they have neuropathy. Monofilament testing was done using the NHANES protocol with a 10-g Semmes Weinstein monofilament. Nerve Conduction Study was used as the gold standard. Results. Fourteen patients were included in the study. A positive monofilament test was found to be significantly associated with a positive NCS result (p<0.015). The sensitivity of the monofilament test was 57.1%; the specificity was 100%. Positive predictive value was 1, negative predictive value was 0.7, pre-test probability was 83% and post-test probability was 96%. Conclusion. Monofilament testing was found to be useful in detecting peripheral neuropathy in the community setting. If monofilament testing is positive, then peripheral neuropathy is ruled in. If the test is negative but the clinical suspicion is high, then NCS may be warranted. This cuts back the need for NCS to detect neuropathy in the community setting by more than half.