Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis

•The best approach for electrodiagnosis of polyneuropathy (PNP) were tested in 313 patients.•Electrodiagnostic screening for distal symmetric PNP (DSP) should start with tibial and sural NCS.•Examination of lower limbs at one side is sufficient for electrodiagnostic screening of DSP. The purpose of this report is to recommend evidence-based strategies for polyneuropathy (PNP) electrodiagnosis based on a large cohort of patients examined prospectively. Nerve conduction studies (NCS) of bilateral tibial, peroneal and sural nerves, the latter with both near-nerve-technique (NNT) and surface recordings, were done in 313 patients with clinically suspected PNP. Bilateral dorsal sural and medial plantar nerves, and unilateral median and ulnar nerves were further examined in a subgroup of patients. The final clinical diagnosis retrieved from the patientś medical records 1–6 years after the neurophysiological investigation served as diagnostic reference standard. The clinical follow-up diagnosis confirmed PNP in 219 patients. The tibial nerve was the most sensitive nerve (75%), with prolonged tibial F-wave as the most sensitive parameter (72%). Sural NNT recordings were more sensitive (66%) than surface recordings (49%) (p