Changes In Nerve Conduction Velocity Research Articles

Comparison of nerve conduction velocities of lower extremities between football players and controls

This study aimed to compare neuronal function in the lower limbs of elite footballers and an age-matched control group. Conduction velocity, response latency and amplitude following electrical stimulation were investigated. Thirty male football players and 30 untrained males comprised the subject and control groups, respectively. We showed that professional football players have significantly slower sural nerve conduction velocity than untrained controls (p<0.05). Although we found no signs of neuropathy, mild changes in nerve conduction velocity were evident in the sural nerve of the players. Motor conduction velocity of tibial nerve was also significantly prolonged in this group when comparing dominant and non-dominant extremities (p<0.05). The tibial nerve muscle action potential amplitude was lower in the players’ dominant limbs compared with the controls (p<0.05). We found no statistical difference in motor conduction velocities, distal latencies and amplitudes of the common peroneal nerve when comparing players and controls in both dominant and non-dominant limbs (p>0.05). Our results showed abnormalities of function in the sural and tibial nerves in football players compared with untrained controls, which may indicate early signs of neuropathy.

Transcarpal Motor Conduction Velocity: Repeatability and Application in Carpal Tunnel Syndrome.

Conduction velocity of the short segment of the median motor nerve, across wrist (transcarpal motor conduction velocity (TCMCV)), has been used to increase diagnostic yield in carpal tunnel syndrome (CTS). However, repeatability of this parameter has not been studied till date. It has not been used as an indicator of response to treatment. Using surface stimulation techniques, it is difficult to localize the sites of stimulation of transcarpal segment of median nerve in palm. As a result, small errors in measurements of TCMCV can be magnified and variability of TCMCV may occur on successive measurements. Despite this possible variation, TCMCV can be a useful tool for assessing response to therapy, if its repeatability is assessed and a cut-off value determined for a significant change in nerve conduction velocity. In this study, it was determined whether TCMCV is repeatable. If found to be repeatable, we show a method to determine the cut-off value of the change in this parameter for it to be considered significant. Difference between values of TCMCV on successive measurements was obtained in hands of 26 controls. Repeatability of this parameter was determined in this control population following criteria of British Standards Institution. In 19 patients of CTS, treated with intracarpal steroid injection, pre-treatment and post-treatment values of TCMCV, and of symptom severity scale (SSS) and functional status scale (FSS), were obtained at 1, 2, and 3 months after treatment. Repeat measurements of TCMCV were made in each hand of all controls. After applying criteria of British Standards Institution, to such recordings, TCMCV was found to be repeatable and the cut-off value for significant change determined. According to this cut-off value, 4 patients of CTS showed improvement in TCMCV, with consistent improvement in SSS and FSS. Change in TCMCV corroborated qualitatively with changes in SSS and FSS. Repeatability of TCMCV can be assessed by criteria of British Standards Institution and a cut-off value determined to use it as an indicator of response to treatment in CTS.

TWO-YEAR RESPONSES OF HEART RATE AND HEART RATE VARIABILITY TO FIRST OCCUPATIONAL LEAD EXPOSURE

Objective: Because of the falling lead exposure, the literature relating autonomous nervous function to blood lead has limited relevance. Design and method: In the longitudinal Study for Promotion of Health in Recycling Lead (URL: https://www.clinicaltrials.gov; Unique identifier: NCT02243904), we recorded the 2-year responses of heart rate, heart rate variability (Cardiax, International Medical Equipment Developing, Budapest, Hungary), and median nerve conduction velocity (Brevio, NeuMed, West Trenton, NJ), a routine test in occupational medicine, to first lead exposure in 195 newly hired workers (91.3% men; mean age, 27.8 years). High- and low-frequency heart rate variability power and orthostatic heart rate variability responses were derived from 5-minute eletrocardiograms in the supine and standing positions by Fourier transform and autoregression. Blood lead was determined by inductively coupled plasma mass spectrometry. Results: From baseline to follow-up, blood lead increased from 4.22 to 14.1 ug/dL and supine/standing HR from 63.6/75.5 to 67.1/78.8 beats per minute. In analyses stratified by fourths of blood lead changes, trends in heart rate and Fourier/autoregressive heart rate variability did not reveal a dose-response curve (0.074< = P< = 0.98). In multivariable-adjusted mixed models, heart rate, Fourier/autoregressive heart rate variability, and nerve conduction velocity changes were unrelated to blood lead except for a weak inverse association between supine heart rate and blood lead changes (-0.55%; P = 0.029). The expected associations between heart rate variability and heart rate changes were preserved with no differences at baseline/follow-up. Analyses ichotomised by baseline median blood lead or cumulative blood lead index (4.30 ug/dL or 32.1 ug/dL × year) suggested an heart rate variability increase versus decrease in the low versus high baseline exposure group. Conclusions: Thus, a > 3-fold blood lead increment did not affect autonomous neural function as captured by heart rate variability.

Is Nerve Electrophysiology a Robust Primary Endpoint in Clinical Trials of Treatments for Diabetic Peripheral Neuropathy?

There is currently no FDA-approved disease-modifying therapy for diabetic peripheral neuropathy (DPN). Nerve conduction velocity (NCV) is an established primary endpoint of disease-modifying therapies in DPN and clinical trials have been powered with an assumed decline of 0.5 m/s/year. This paper sought to establish the time-dependent change in NCV associated with a placebo, compared to that observed in the active intervention group. A literature search identified twenty-one double-blind, randomised controlled trials in DPN of ≥1 year duration conducted between 1971 and 2021. We evaluated changes in neurophysiology, with a focus on peroneal motor and sural sensory NCV and amplitude in the placebo and treatment groups. There was significant variability in the change and direction of change (reduction/increase) in NCV in the placebo arm, as well as variability influenced by the anatomical site of neurophysiological measurement within a given clinical trial. A critical re-evaluation of efficacy trials should consider placebo-adjusted effects and present the placebo-subtracted change in NCV rather than assume a universal annual decline of 0.5 m/s/year. Importantly, endpoints such as corneal confocal microscopy (CCM) have demonstrated early nerve repair, whilst symptoms and NCV have not changed, and should thus be considered as a viable alternative.

Effect of Vitamin D on Aldose Reductase in Indonesian Diabetic Polyneuropathy Patients a Randomized Clinical Trial

Aldose Reductase (AR) is an important factor in the pathogenesis of several Diabetes Mellitus (DM) complications, including diabetic neuropathy (DN). Vitamin D has a direct effect on the pathogenesis of DN. Aldose reductase inhibition is an important element in the prevention of DM complications. The objective of this paper was to assess the effect of vitamin D on AR in Indonesian diabetic polyneuropathy (DPN) patients. This cohort study was undertaken at Haji Adam Malik General Hospital Medan, North Sumatera, Indonesia. In a double-blind, placebo-controlled, clinical trial, eligible patients were randomized to receive vitamin D 50,000 IU/week or placebo for 10 weeks. The primary end-point was mean changes of nerve conduction velocity (NCV) from baseline and after 10 weeks of supplementation. There was no significant correlation between mean changes of vitamin D and AR levels. There was significant correlation with negative direction and weak strength between mean changes of AR level and NCV of motor Tibial nerve (p<0.05; r=-0.337). There was significant correlation with positive direction and moderate strength between mean changes of vitamin D level and NCV of motor Median and Peroneal nerves, and motor and sensory Ulnar nerves (p<0.001; r=0.438 – 0.527). In conclusion, vitamin D supplementation had no effect on AR level in Indonesian DPN patients. Higher AR level was correlated with decreased NCV of motor Tibial nerve. Vitamin D supplementation improved NCV in DPN.

Ranirestat Improves Electrophysiologic but not Clinical Measures of Diabetic Polyneuropathy: A Meta-Analysis.

Ranirestat, an aldose reductase inhibitor evaluated in several randomised controlled trials (RCTs) in diabetic peripheral neuropathy (DPN). However, to date, no meta-analysis has evaluated the efficacy and safety of ranirestat in DPN. We undertook this meta-analysis to address this knowledge gap. Detailed search of electronic databases for RCTs published till December 2021 was done at Cochrane register, Medline, PubMed, Embase, clinicaltrials.gov, ctri.nic.in, global health and Google Scholar using the Boolean search strategy: ((ranirestat) OR (aldose reductase inhibitor)) AND ((diabetes) OR ("diabetes mellitus")). The primary outcome was to evaluate changes in nerve conduction velocities (NCV) of different nerves. The secondary outcomes were to evaluate alterations in amplitudes, F-wave latencies of nerves, modified Toronto Clinical Neuropathy Score (mTCNS) and adverse events. Data from 5 studies involving 1461 patients with DPN was analysed to establish the impact of ranirestat (20-40 mg/day) as compared to placebo on different electrophysiologic outcomes over a median follow-up of 52 weeks. Patients receiving ranirestat had significantly greater improvement in proximal median sensory NCV [MD 0.77 m/s (95%CI: 0.50-1.05); P < 0.01; I2 = 26%], distal median sensory NCV [MD 0.91 m/s (95%CI: 0.87-0.95); P < 0.01; I2 = 0%], median motor NCV [MD 0.63 m/s (95%CI: 0.60-0.66); P < 0.01; I2 = 0%], tibial motor NCV [MD 0.46 m/s (95%CI: 0.43-0.49); P < 0.01; I2 = 0%] and peroneal motor NCV [MD 0.80 m/s (95%CI: 0.66-0.93); P < 0.01; I2 = 0%]. mTCNS was not significantly different among groups. Treatment-emergent adverse events [risk ratio (RR) 0.85 (95%CI: 0.63-1.14); P = 0.28; I2 = 0%] and severe adverse events [RR 1.35 (95%CI: 0.86-2.11); P = 0.20; I2 = 0%] were comparable across study groups. In people with established DPN with long-standing diabetes, ranirestat is safe and effective in improving electrophysiologic but not clinical DPN.

A Comparative Study Analysis of Lower Limb and Upper Limb Conduction Velocity among Asymptomatic Patients of Type 2 Diabetes Mellitus

Objectives: Diabetes Mellitus is worldwide disease and diabetic peripheral neuropathy (DPN) is one of the most prevalent micro-vascular complication seen during the progress of disease. Frequently there is subclinical involvement seen for peripheral nerve functions which is revealed on nerve conduction study. Present study aims to assess nerve conduction velocity changes among asymptomatic patients with type 2 diabetes mellitus. Materials and Methods: Total 60 subjects were included for the study, 30 of them were of type 2 diabetes mellitus on regular treatment with disease duration of less than 5 years and asymptomatic for neuropathy and 30 were controls. All the participants were subjected to nerve conduction studies. Results: Nerve Conduction Velocity (NCV) of sural sensory nerve was found to be significantly decreased in diabetic patients as compared to controls. Conclusion: Sensory NCV was significantly decreased in the sural nerve compared to upper limb sensory nerves which suggests that long nerves are more prone to neuropathic changes even in asymptomatic diabetic patients.

Reversal of Bortezomib-Induced Neurotoxicity by Suvecaltamide, a Selective T-Type Ca-Channel Modulator, in Preclinical Models.

Simple SummaryChemotherapy-induced peripheral neurotoxicity (CIPN) is a side-effect of anti-cancer medications, which can lead to pain, disruptions to movement, and eventually results in the need to interrupt or stop chemotherapy. This study sought to test whether the drug suvecaltamide could help to reduce the impact of the chemotherapy agent bortezomib (BTZ) on symptoms of CIPN using animal models and human cells. Suvecaltamide did reverse negative changes in nerve conduction velocity and intraepidermal nerve fiber density indicative of CIPN in rats, and did not interfere with the anti-cancer effect of BTZ. These results indicate that suvecaltamide could potentially be useful for patients experiencing CIPN, although further mechanistic and molecular studies in vitro and in vivo are required before clinical trials.This study evaluated suvecaltamide, a selective T-type calcium channel modulator, on chemotherapy-induced peripheral neurotoxicity (CIPN) and anti-cancer activity associated with bortezomib (BTZ). Rats received BTZ (0.2 mg/kg thrice weekly) for 4 weeks, then BTZ alone (n = 8) or BTZ+suvecaltamide (3, 10, or 30 mg/kg once daily; each n = 12) for 4 weeks. Nerve conduction velocity (NCV), mechanical threshold, β-tubulin polymerization, and intraepidermal nerve fiber (IENF) density were assessed. Proteasome inhibition was evaluated in peripheral blood mononuclear cells. Cytotoxicity was assessed in human multiple myeloma cell lines (MCLs) exposed to BTZ alone (IC50 concentration), BTZ+suvecaltamide (10, 30, 100, 300, or 1000 nM), suvecaltamide alone, or vehicle. Tumor volume was estimated in athymic nude mice bearing MCL xenografts receiving vehicle, BTZ alone (1 mg/kg twice weekly), or BTZ+suvecaltamide (30 mg/kg once daily) for 28 days, or no treatment (each n = 8). After 4 weeks, suvecaltamide 10 or 30 mg/kg reversed BTZ-induced reduction in NCV, and suvecaltamide 30 mg/kg reversed BTZ-induced reduction in IENF density. Proteasome inhibition and cytotoxicity were similar between BTZ alone and BTZ+suvecaltamide. BTZ alone and BTZ+suvecaltamide reduced tumor volume versus the control (day 18), and BTZ+suvecaltamide reduced tumor volume versus BTZ alone (day 28). Suvecaltamide reversed CIPN without affecting BTZ anti-cancer activity in preclinical models.

Two-Year Responses of Heart Rate and Heart Rate Variability to First Occupational Lead Exposure.

[Figure: see text].

The effect of α-lipoic acid treatment on plasma asymmetric dimethylarginine, a biomarker of endothelial dysfunction in diabetic neuropathy

IntroductionDiabetic neuropathy may develop on a background of hyperglycaemia and is associated with increased oxidative stress. Elevated asymmetric dimethylarginine (ADMA) levels are linked to oxidative stress reducing the synthesis of nitric oxide (NO) by uncoupling NO synthase. Oxidative stress induces considerable changes in nerve conduction velocity in diabetic patients. There is strong evidence that α-lipoic acid (ALA) as an antioxidant may improve nerve conduction and relieve neuropathic symptoms. We aimed to investigate the relationship between endothelial dysfunction and NO synthesis in type 2 diabetic patients with peripheral neuropathy after ALA treatment.Material and methodsFifty-four type 2 diabetic patients with neuropathy were included in the study. Serum ADMA concentration, ICAM-1, VCAM-1, oxidised low-density lipoprotein (oxLDL), and TNF-α levels were determined with Enzyme-Linked Immunosorbent Assay (ELISA). Nitric oxide concentration was measured by Griess reaction. Peripheral sensory nerve function was assessed by current perception threshold (CPT) testing. Autonomic function was assessed by Ewing’s five standard cardiovascular reflex tests composite autonomic score (CAS).ResultsAsymmetric dimethylarginine levels were significantly decreased (0.62 ±0.11 vs. 0.53 ±0.11 µmol/l, p &lt; 0.001), as well as TNF-α concentrations (1.21 ±0.42 pg/ml vs. 1.05 ±0.5 pg/ml, p &lt; 0.05), while NO levels were significantly increased (16.78 ±11.1 vs. 21.58 ±8.84 µmol/l, p &lt; 0.05) after six-months of 600 mg/day ALA treatment. VCAM-1, ICAM-1, and oxLDL levels did not change significantly. The CPT and CAS significantly improved after ALA treatment. The improvement of CPT values was correlated positively with the change of ADMA levels (r = 0.58, p &lt; 0.001). The change in ADMA level was more pronounced in responder patients based on both CPT and CAS.ConclusionsOur results suggest that ALA supplementation improves endothelial function characterised by serum levels of ADMA and TNF-α in patients with diabetic neuropathy. Changes in serum ADMA levels may predict the clinical response to ALA treatment.

530-P: Longitudinal Characterization of Peripheral Neuropathy in a Cafeteria Diet and Low-Dose Streptozotocin Rat Model of Type 2 Diabetes

Diabetic peripheral neuropathy is a major complication of diabetes with complex and incompletely understood pathophysiology. We utilised a cafeteria-style diet (Caf) and low dose streptozotocin (STZ) to model varying degrees of hyperglycemia. Adult male Sprague-Dawley rats were divided into four groups: control (chow diet), prediabetic (Caf diet for 21 weeks), diet reversal (13 weeks Caf diet then 8 weeks chow; all n=12) and type 2 diabetic (T2D - Caf+STZ 25mg/kg i.p, n=24). STZ was administered after 5 weeks of diet; one week later, non-fasted blood glucose was 16.09 ± 1.19 [SEM] and 78% of T2D rats had glucose levels ≥10mmol/L. Metabolic phenotyping revealed significantly increased body weight, fat mass, fasting blood HDL cholesterol, plasma insulin and impaired glucose tolerance in both prediabetic and T2D rats compared to controls; fasting glucose and HbA1c were significantly elevated only in T2D. Neuropathy phenotyping included sensory behavioural testing (thermal and mechanical nociceptive sensibility) and electrophysiology (nerve conduction studies and nerve excitability) which were assessed at two timepoints, early (8-11 weeks of diet) and late (17-19 weeks of diet). Nerve excitability abnormalities were present in prediabetes and T2D groups at the early stage (superexcitability p&amp;lt;0.05) while changes in nerve conduction velocity and amplitude emerged later. Mechanical and thermal hypoalgesia was observed in prediabetic and T2D rats only at the late stage. Diet reversal improved body weight, fat mass, HDL, HbA1c, glucose clearance and mechanical nociception response, with no changes in nerve conduction and excitability. Together these data suggest that Caf diet combined with low dose STZ could be utilized to investigate the onset of neuropathological changes in T2D and assessment of subsequent peripheral neuropathy. Disclosure M. Hossain: None. M.D. Kendig: None. B.M. Wild: None. M.J. Morris: None. R. Arnold: None. Funding National Health and Medical Research Council of Australia (1126929, 1091006); Rebecca L. Cooper Foundation (RG160627)

Cold effect in median nerve conductions in clinical carpal tunnel syndrome with normal nerve conduction studies

Clinical diagnosis of carpal tunnel syndrome (CTS) is confirmed by nerve conduction studies (NCS). In some cases, NCS may be normal. We aimed to demonstrate changes of distal motor latency (DML) and nerve conduction velocity (NCV) pathology of demyelination in entrapment neuropathy with cold application in case of clinical CTS with normal NCS. This prospective, cross-sectional, randomise, case-control involved 15 patients (25 hands) with clinically definite unilateral or bilateral CTS and normal nerve conduction studies (NCS), and 11 controls (22 hands). Ice pack was applied to median nerve trasse at wirst with monitoring skin temperature. NCS of median nerve were examinated again. Increases of DML, decrease of velocity of median nerve were observed in two groups after post-cooling. The change in NCV was greater than the change in DML. Cold effect was evident in DML and NCV in the patient group. This could be sign of the demyelination pathology. We think that cold application is influential to determine electrophysiologic abnormalities in clinic CTS with normal NCS.

Local Pressure Application Effects on Neurological and Circulatory Function.

Pain and discomfort reported during sitting is a significant problem for aviators during prolonged missions. Previous work has determined that areas of local pressure exist during prolonged sitting in UH-60 seat systems; however, no work has examined the effects of this local pressure on measures of neurological and circulatory function. A total of 30 healthy subjects completed the study in which focal pressure was applied in three conditions (no pressure, pressure to the ischial tuberosity, and pressure to the posterior thigh). We applied pressure using a purpose-built pressure application system allowing subjects to sit in a position mimicking the sitting position in a UH-60 Black Hawk helicopter and measurements were taken before, during, and after pressure application. We measured neurological function with the soleus Hoffmann reflex and sural nerve conduction velocity, and circulatory function with dynamic infrared thermography. We found a decrease in soleus Hoffmann reflex by 0.87 V and 0.52 V during pressure application at the posterior thigh and ischial tuberosity, respectively. No changes in nerve conduction velocity were found among the conditions during or after pressure application. Limb temperature increased 0.42-0.44°C during pressure application, but began to return to baseline once pressure was removed. This study examined the development of neurological and circulatory alterations due to local pressure application in an aviation specific functional position. These results may be used in the development of future interventions to mitigate the negative effects of localized pressure in military aviators.Games KE, Lakin JM, Quindry JC, Weimar WH, Sefton JM. Local pressure application effects on neurological and circulatory function. Aerosp Med Hum Perform. 2018; 89(8):693-699.

Peripheral Neuropathy Induced by Microtubule-Targeted Chemotherapies: Insights into Acute Injury and Long-term Recovery.

Chemotherapy-induced peripheral neuropathy (CIPN) is a major cause of disability in cancer survivors. CIPN investigations in preclinical model systems have focused on either behaviors or acute changes in nerve conduction velocity (NCV) and amplitude, but greater understanding of the underlying nature of axonal injury and its long-term processes is needed as cancer patients live longer. In this study, we used multiple independent endpoints to systematically characterize CIPN recovery in mice exposed to the antitubulin cancer drugs eribulin, ixabepilone, paclitaxel, or vinorelbine at MTDs. All of the drugs ablated intraepidermal nerve fibers and produced axonopathy, with a secondary disruption in myelin structure within 2 weeks of drug administration. In addition, all of the drugs reduced sensory NCV and amplitude, with greater deficits after paclitaxel and lesser deficits after ixabepilone. These effects correlated with degeneration in dorsal root ganglia (DRG) and sciatic nerve and abundance of Schwann cells. Although most injuries were fully reversible after 3-6 months after administration of eribulin, vinorelbine, and ixabepilone, we observed delayed recovery after paclitaxel that produced a more severe, pervasive, and prolonged neurotoxicity. Compared with other agents, paclitaxel also displayed a unique prolonged exposure in sciatic nerve and DRG. The most sensitive indicator of toxicity was axonopathy and secondary myelin changes accompanied by a reduction in intraepidermal nerve fiber density. Taken together, our findings suggest that intraepidermal nerve fiber density and changes in NCV and amplitude might provide measures of axonal injury to guide clinical practice.Significance: This detailed preclinical study of the long-term effects of widely used antitubulin cancer drugs on the peripheral nervous system may help guide clinical evaluations to improve personalized care in limiting neurotoxicity in cancer survivors. Cancer Res; 78(3); 817-29. ©2017 AACR.

Skin thermophysiological effects of 448 kHz capacitive resistive monopolar radiofrequency in healthy adults: A randomised crossover study and comparison with pulsed shortwave therapy

ABSTRACTRadiofrequency-based electrophysical agents (EPA) have been used in therapy practice over several decades (e.g., shortwave therapies). Currently, there is insufficient evidence supporting such devices operating below shortwave frequencies. This laboratory-based study investigated the skin physiological effects of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) and compared them to pulsed shortwave therapy (PSWT). In a randomised crossover study, seventeen healthy volunteers received four treatment conditions – High, Low and Placebo dose conditions receiving 15-min CRMRF treatment and a Control condition receiving no intervention. Fifteen participants also received high dose PSWT for comparison. Treatment was applied to the right lower medial thigh. Pre, post and 20-min follow-up measurements of skin temperature (SKT), skin blood flow (SBF) and nerve conduction velocity (NCV) were obtained using Biopac MP150 system. Group data were compared using the ANOVA model. Statistical significance was set at p ≤ 0.05 (0.8P, 95%CI). Significant increase and sustenance of SKT with both high and low dose CRMRF was demonstrated over the other groups (p < 0.001). PSWT increased SKT significantly (p < 0.001) but failed to sustain it over the follow-up. However, among the five conditions, only high dose CRMRF significantly increased and sustained SBF (p < 0.001). Overall, the CRMRF physiological responses were significantly more pronounced than that of PSWT. No significant changes in NCV were noted for any condition. Physiological changes associated with CRMRF were more pronounced when compared to PSWT, placebo or control. Any potential stronger therapeutic benefits of CRMRF need to be confirmed by comparative clinical studies.

Impact of Aging on Nerve Conduction Velocities and Late Responses in Healthy Individuals.

Background:Nerve conduction studies are performed to diagnose the disorders of the peripheral nervous system. The reference values for nerve conduction velocity (NCV) and late responses for different nerves considerably vary in different group and type of population. Physiological factors such as age, temperature, height, and gender affect the NCV. However, there are very few studies which show the age group at which these changes become significant.Aim and Objectives:The aim of the study was to establish the electrophysiological data of the specific age group at which changes in NCV as well as late responses of median common peroneal nerve and also see the late response in the form of F-waves and H-reflex.Methodology:Study groups were divided into three categories based on the age: Group I (18–30 years) (n = 80), Group II (31–45 years) (n = 43), and Group III (46–60 years) (n = 27). Out of which, 93 patients were male and 57 were female. The NCVs were determined for median, common peroneal nerve (motor component and sensory component) along with late responses in the form of H-reflex and F-waves.Results:The mean and standard deviation of median, ulnar, peroneal, and tibial nerve was studied for latencies, amplitude, and velocities for both sensory and motor components. Patients with older age had longer latencies, smaller amplitudes, and slower conduction velocities compared with the younger age group. The change with age was greater in sensory nerve conduction and late responses in all the peripheral nerves.Conclusions:Aging has a definite correlation with the NCV and late responses of different peripheral nerves. There is a need to have reference values with relation to age.

Chinese herbal medicine TangBi Formula treatment of patients with type 2 diabetic distal symmetric polyneuropathy disease: study protocol for a randomized controlled trial

BackgroundDiabetic distal symmetric polyneuropathy (DSPN) is one of the most common microvascular complications of diabetes mellitus, and it has become a major public health problem worldwide because of its high and increasing prevalence, morbidity, and disability rate. The current medications for DSPN are not entirely satisfactory. Preliminary studies indicated that the Chinese herbal TangBi Formula may alleviate signs and symptoms and improve the velocity of nerve conduction in patients with DSPN. This study was designed to determine if Chinese herbal medicine used in combination with conventional treatment is more effective than conventional treatment alone.Methods/designWe are conducting a multicenter, placebo-controlled, double-blind, randomized, controlled clinical trial as a means of assessing the therapeutic effects of traditional Chinese medicine (TCM) treatment. A total of 188 patients will be randomized in a 1:1 ratio to a treatment group (TangBi Formula plus mecobalamin) and a control group (placebo plus mecobalamin). The test period lasts 6 months, during which all of the patients will be given standard medical care as recommended by established guidelines. The primary outcome will be development of differences in changes in clinical symptoms and signs in patients and changes in Michigan Diabetic Neuropathy Score (MDNS) between the two groups before and after treatment. The secondary outcome will be changes in nerve conduction velocity and in single clinical signs and symptoms. Safety assessments and adverse events will also be evaluated.DiscussionWe postulate that patients with DSPN will benefit from therapy that includes TCM. If successful, this work will provide an evidence-based complementary therapeutic approach for treatment of DSPN.Trial registrationClinicalTrials.gov, NCT03010241. Registered on 2 January 2017

MRI Assessment of Changes in Swelling of Wrist Structures Following OMT in Patients With Carpal Tunnel Syndrome

Abstract We treated patients with carpal tunnel syndrome using OMT. Treatments were focused on the upper thoracic spine, lower cervical spine, and tenderpoints in the forearm muscles. OMT was not applied to the wrist in an attempt to stretch the transverse carpal ligament. MRI images were used to assess changes in fluid content in both the carpal tunnel and median nerve after OMT treatment. MRI measurements of median nerve area, carpal tunnel area and length of the transverse carpal ligament were also obtained. These measurements were correlated with changes in nerve conduction velocities (NCVs), pain ratings, wrist motion measurements, and somatic dysfunction information. The numeric data were compared and contrasted using Hest statistics. Significance probabilities of P &amp;lt; 0.05 were computed. Statistically significant changes were noted in pain ratings, wrist motions and nerve conduction (sensory amplitude). Five patients responded with improvement in symptoms and one did not. The responder group demonstrated a decrease in the amount of swelling of both the median nerve and carpal tunnel. The nonresponder demonstrated increased swelling in both the median nerve and carpal tunnel. Changes in the swelling of both the median nerve and carpal tunnel appear to more closely parallel changes in hand symptoms than nerve conduction results.1 No statistically significant increases occurred in the length of the transverse carpal ligament or the carpal tunnel area. Minimal changes in both the length of the transverse carpal ligament and carpal tunnel area did occur despite no active attempts to stretch this region. All six patients had a predominance of acute changes in the upper thoracic spine and upper ribs. Most patients had tension in the flexor muscles of the forearm. Treatment of the upper thoracic spine, upper ribs, and forearms are all important in the management of carpal tunnel syndrome.

Association of Insulin and Cholesterol Levels With Peripheral Nervous System Function in Overweight Adults: A 3-Year Follow-up.

The purpose of this prospective 3-year follow-up was to investigate the association of glucose, insulin, and cholesterol levels with peripheral nervous system function in overweight and obese subjects. Forty nondiabetic overweight and obese adults were enrolled, of whom 29 completed the follow-up. Peripheral nervous system function was measured and defined by conduction studies of the peroneal motor nerve and the radial, sural, and medial plantar sensory nerves. Serum insulin and glucose levels were determined with an oral glucose tolerance test, and cholesterol levels were measured. The measurements were performed at baseline and after 3 years. The change in serum insulin level at 120 minutes after an oral glucose tolerance test was positively associated with changes in peroneal nerve conduction velocities and F-wave mean, sural nerve conduction and medial plantar nerve conduction velocities. Action potential amplitudes decreased consistently and significantly in all sensory nerves. The change in serum insulin level at 120 minutes appears to be positively associated with changes in nerve conduction velocities more than 3 years but not with nerve action potential amplitudes. Significant decreases in the action potential amplitudes of all sensory nerves suggest that such changes might be the earliest detectable sign of damage to the peripheral nervous system in overweight and obese people without type 2 diabetes.

Electrophysiological and pathological features of peripheral nerve in rats exposed to 1-bromopropane

Objective: To study the electrophysiological changes and pathological characteristics of peripheral nerve in rats exposed to 1-bromopropane through chronic inhalation. Methods: 40 male SD rats were randomed divided into 4 groups, and exposed to 1-bromopropane vapor at concentrations of 1 000 mg/m(3), 2 000 mg/m(3), 4 000 mg/m(3) and fresh air respectively, 6 hours per day, 5 days per week for 12 weeks. The changes of nerve conduction velocity (NCV) , electromyography (EMG) and pathology were observed. Results: After 4 weeks of exposure, the body weights of high dose group are lower than that of the control group. Compared with the control group, the high and medium dose group have a decline in MCV and CMAPs, while SCV and SNAPs descend in the high dose group (P<0.05) . The EMG examination showed that there are denervation changes in high dose group. Sciatic nerve biopsy observed by electron microscope showed that axonal degeneration and demyelination coexist in the rats exposed to high concentration. Conclusion: Chronic inhalation of 1-bromopropane at the concentration of 4 000 mg/m(3) can cause peripheral nerve injury, which is characterized by axonal degeneration and demyelination. Axonal degeneration is the main pathological change.