Investigation of risk management and validity about clinical tests in the field of neurological medicine

2005 Fiscal Year Final Research Report Summary

• Project/Area Number: 15590461
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Medical sociology
• Research Institution: Kyoto Prefectural University of Medicine
• Principal Investigator: KONDO Masaki Kyoto Prefectural University of Medicine, Neurology, assistant, 医学研究科, 助手 (20315964)
• Project Period (FY): 2003 – 2005
• Keywords: CSF examination / needle EMG / nerve and muscle biopsy

Research Abstract

A total of 3291 patients were admitted between 1991 and 2005. Admission records confirmed that these patients underwent the following examinations : CSF examination, n=824 (25%) ; needle EMG, n=306 (9.3%) ; muscle biopsy, n=64 (1.9%) ; and nerve biopsy, n=19 (0.6%).
<Usefulness of examinations>
1)CSF examination : In the infection group, pathogen tests were useful in 28.8% of cases, and either general tests or pathogen tests was useful in 81.8% of cases. Comparison between viruses and bacteria, etc. (bacteria, tuberculosis, fungi, syphilis, etc.) showed that CSF examination was more useful for bacteria, etc. than for viruses (100% vs. 76.2%), and pathogen tests alone were also more useful for bacteria, etc. than for viruses (50% vs. 19%). In the immunological and inflammatory disease group, either general tests or specific tests was useful in 53.5% of cases. In addition, specific tests were more useful for MS than for other immunological and inflammatory diseases (43.8% vs. 7-16%).
2)Need le EMG : This examination was useful in 67.1% of cases, specifically in 68.3% of cases of muscle disease and 66.7% of cases of other diseases, and was particularly useful for motor neuron disease (92.3%).
3)Muscle biopsy : This examination was useful in 59.7% of cases, and was more useful for inflammatory muscle disease than for other muscle diseases (89.5% vs. 48.6%).
4)Nerve biopsy : This examination was useful in 66.7% of cases, and tended to be useful for inflammatory neuropathy.
<Complications of examinations>
1)CSF examination : Headache was reported in 20.1% of cases, and was more frequently reported in cases of muscle disease (44.4%), motor neuron disease (33.3%), and neuropathy (28.3%), with an occurrence of 10-20% in most other diseases. Other complications comprised 7 cases of back pain.
2)Needle EMG : No clear complications were reported other than pain and discomfort during examination.
3)Muscle biopsy : Although poor wound healing was observed in 3 cases (5.1 %), no sequelae were reported.
4)Nerve biopsy : Complications were observed in 3 cases (16.7%), including 2 cases of poor wound healing and 1 case of numbness around the wound.