Detection Of Peripheral Neuropathy Research Articles

The Detection of Peripheral Neuropathy by Clinical Scales in Patients Diagnosed With Alcohol Use Disorder

The Detection of Peripheral Neuropathy by Clinical Scales in Patients Diagnosed With Alcohol Use Disorder

Neuropathy Screening for Patients with Peripheral Vascular Disease Helps to Identify Those at an Increased Risk of Amputation, Revascularization, and Death

Peripheral neuropathy is associated with amputation risk among patients with diabetes mellitus and chronic limb-threatening ischemia (CLTI). Detection of peripheral neuropathy may help identify those who are at an increased risk, but the predictive ability of the screening tool used in patients with peripheral arterial disease (PAD) needs to be more clearly defined. Patients referred to vascular surgery clinic for PAD were recruited from a single center. Exclusion criteria were a documented history of neuropathy or prior lower limb amputation. Screening utilized the Michigan Neuropathy Screening Instrument (MNSI). Scores >2.5 were considered abnormal and scores >4 were considered positive for peripheral neuropathy. Limb-specific outcomes of amputation and revascularization as well as a composite outcome including death were modeled using time to event analysis. 86 patients were recruited. Mean age was 67±10.2years, 30% were women, 24% were black. Mean ankle-brachial index was 0.74±0.3. PAD symptoms at initial evaluation were claudication in 52% of patients and CLTI in 38% of patients. Neuropathy was present in 20% of the cohort with a significantly higher proportion in diabetics (34% vs. 3%; P=0.0009). Neuropathy was more common in patients with CLTI compared to claudicants (36% vs. 9%; P=0.011). Forty patients (47%) reached the composite outcome of amputation, revascularization, or death with a median time to event of 16months. Abnormal MNSI examination was significantly associated with the increased risk of the composite outcome (hazard ratio=3.19; P 0.0005). A significant proportion of patients presenting to vascular specialists for PAD have undiagnosed neuropathy. Patients with PAD and neuropathy have an increased risk of amputation, revascularization, and death. Expanding neuropathy screening in vascular surgery clinic visits may help to identify patients at higher risk.

Epidemiology and Treatment of Peripheral Neuropathy in Systemic Sclerosis.

The epidemiology and treatment of peripheral neuropathy in systemic sclerosis (SSc) is poorly understood. The objectives of this study were to evaluate the incidence, prevalence, risk factors, and treatments of peripheral neuropathy in SSc. A systematic review of MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for literature reporting peripheral neuropathy in SSc was performed. Studies evaluating incidence, prevalence, risk factors, and treatments were synthesized. A metaanalysis using a random effects model was used to evaluate the prevalence of peripheral neuropathy. This systematic review identified 113 studies that reported 949 of 2143 subjects with at least 1 type of peripheral neuropathy. The mean age was 48.5 years. The mean time between SSc onset and detection of peripheral neuropathy was 8.85 years. The pooled prevalence of neuropathy was 27.37% (95% CI 22.35-32.70). Risk factors for peripheral neuropathy in SSc included advanced diffuse disease, anticentromere antibodies, calcinosis cutis, ischemia of the vasa nervorum, iron deficiency anemia, metoclopramide, pembrolizumab, silicosis, and uremia. There were 73 subjects with successful treatments (n = 36 restoring sensation, n = 37 restoring motor or sensorimotor function). Treatments included decompression surgery, prednisone, cyclophosphamide, carbamazepine, transcutaneous electrical nerve stimulation, tricyclic antidepressants, and intravenous Ig. All-cause peripheral neuropathy is not uncommon in SSc. Compression neuropathies can be treated with decompression surgery. Observational data reporting immunosuppressives and anticonvulsants to treat peripheral neuropathy in SSc are limited and conflicting. Randomized controlled trials are needed to evaluate the efficacy of these interventions.

Utility of MRI Diffusion Tensor Imaging in Carpal Tunnel Syndrome: A Meta-Analysis.

BackgroundAfter successful utilization of diffusion tensor imaging (DTI) in detecting brain pathologies, it is now being examined for use in the detection of peripheral neuropathies. The aim of this meta-analysis was to evaluate the diagnostic potentials of DTI in carpal tunnel syndrome (CTS).Material/MethodsThe literature search was performed in multiple electronic databases using a keyword search and final selection of the studies was based on predetermined inclusion and exclusion criteria. We performed a meta-analyses of mean differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between CTS patient and healthy subjects. Publication bias detection was done with Begg’s test and sensitivity analyses were performed to explore the source/s of higher heterogeneity and the authenticity of results.ResultsFA was significantly lower in CTS patients in comparison with healthy subjects (mean and the difference [95% confidence interval] was −0.06 [−0.10, −0.02] (p=0.003). The ADC was significantly higher in CTS patients (mean difference [95% CI] was 0.10 [0.02, 0.18], p=0.02). Overall sensitivity of FA-based diagnosis was 82.82%, with 77.83% specificity.ConclusionsDTI can be a valuable tool in diagnosing CTS.

Acute phase proteins and diabetes microvascular complications

The association of serum high-sensitivity C-reactive protein and ferritin with diabetes microvascular complications has not been examined concurrently in people with type 2 diabetes. So, we carried out this study in order to investigate this association in a group of type 2 diabetic patients. In a prospective cross-sectional study, 242 people with type 2 diabetes were enrolled. All of the participants were evaluated for diabetes microvascular complications. Retinal status was evaluated by retinal color photography and indirect ophthalmoscopy exam with dilated pupils. Michigan neuropathy screening instrument was used for detection of peripheral neuropathy, and albumin/creatinine ratio in a spot urine sample was considered to diagnose diabetic nephropathy. High-sensitivity C-reactive protein and ferritin were measured as indicators of acute phase proteins. The mean for high-sensitivity C-reactive protein was 5.3 ± 13.02 mg/L, and for ferritin was 126.9 ± 114.4 ng/mL. Statistically significant difference was found between the high-sensitivity C-reactive protein levels and diabetic nephropathy. Spearman’s correlation coefficients test revealed that high-sensitivity C-reactive protein was positively correlated with diabetic nephropathy (P = 0.05, r = 0.14). However, such a correlation was not found for diabetic neuropathy and retinopathy. Using binary logistic regression analysis, a significant odds ratio was defined for nephropathy and high-sensitivity C-reactive protein level (OR = 2.62; CI = 1.13–6.06; P = 0.025). Our findings suggest that low-grade inflammation is an independent predictor of diabetic nephropathy and measurement of high-sensitivity C-reactive protein can be useful for early detection of high-risk individuals.

Diagnostic accuracy of the VibraTip in detection of diabetic peripheral neuropathy

AimsClinical assessment of peripheral neuropathy can be performed by testing vibration sense using a tuning fork and cutaneous sensation using a 10g Monofilament. The VibraTip® is a novel device which produces a constant vibratory stimulus and therefore assesses vibration sense. This study wa evaluated the diagnostic accuracy of the VibraTip compared to the tuning fork. Methods From 100 patients with diabetes, 50 patients had confirmed peripheral neuropathy (PN +ve) and 50 were confirmed to have no peripheral neuropathy (PN -ve) as assessed by neurothesiometer. Both groups were then assessed using both the VibraTip and tuning fork. The sensitivity, specificity, predictive values and likelihood ratios for diagnosing peripheral neuropathy were calculated. Results A statistically significant difference in sensitivity (52%)(P<0.001) between the VibraTip and tuning fork results was observed for subjects +ve for peripheral neuropathy. However no statistically significant difference in specificity (6%)(P<0.25) was seen for subjects –ve for peripheral neuropathy. Conclusion This study confirms that the VibraTip is comparable to the neurothesiometer, and superior to the tuning fork, in the detection of peripheral neuropathy and could be a useful screening tool in clinical practice

Laser Doppler imaging in the detection of peripheral neuropathy

Small fiber neuropathy is common in a number of systemic diseases and is often challenging to diagnose. Laser Doppler imaging (LDI) is a test of small fiber neurovascular function that can quantify the integrity of the vasomotor C-fiber mediated axon-reflex, but no standardized method of analysis exists. We developed a novel LDI analysis technique and tested it in a human model of small fiber neuropathy. Eighteen healthy subjects (age 24 ± 3 years) underwent LDI testing to assess the axon-mediated flare area in response to 10% acetylcholine iontophoresis. LDI measurements were taken before and longitudinally after a 48-hour application of 0.1% capsaicin (to cause a transient small fiber neuropathy) on the skin of the thigh; placebo cream was placed on the contralateral thigh as a control. We compared our new LDI image analysis technique to two previously published methods. The new LDI analysis technique was the only method to show a consistent difference in axon-reflex area between capsaicin treated and placebo treated skin on all testing days (p<0.05) with maximum attenuation of the flare area immediately post-application (438 ± 298 mm(2) vs. 824 ± 375 mm(2), p<0.05). In conclusion, this study demonstrates that our novel flare area method for LDI analysis can detect neurovascular dysfunction in a model of small fiber neuropathy, is an improvement over existing methods, and may supplement clinical assessment of small fiber neuropathy.

Cutaneous Thermal Sensitivity in Diabetic Neuropathy

The goal of this investigation was to determine if cutaneous thermal sensitivity could be used as a discriminator of peripheral neuropathy in diabetic subjects who were sensate to the Semmes-Weinstein 5.07 monofilament. Sixty adult subjects were separated into two groups. The control group (A) was composed of 30 young healthy individuals without a history of diabetes. The focus group (B) was composed of 26 individuals with adult onset diabetes and four with juvenile onset. All of the subjects underwent thermal sensitivity testing in peripheral nerve root dermatomes of their hands and feet. Testing was performed with custom devices fabricated from materials with different thermal conduction capacities (copper, steel, glass, and plastic). Similar tests were performed with glass tubes containing heated or cooled water to develop a range of thermal sensitivity for the subjects. There was a strong relationship between cold perception and stimulation with the copper probe in dermatomes of the radial nerve of the upper limb and the superficial peroneal dermatome of the lower limb. Thermal sensitivity to copper and cold stimulation may be more discriminative and have a higher threshold than sensitivity to the Semmes-Weinstein monofilament. This simple method may have a role in the early detection of peripheral neuropathy in adult-onset diabetes mellitus.

Thalidomide in Crohn Disease

To the Editor: We were interested to read the letter from Dr. Ahmed regarding the use of thalidomide in Crohn disease, which endorsed the use of regular nerve conduction studies to detect early peripheral neuropathy (1). Thalidomide is a promising drug for the treatment of Crohn disease (2) that is being increasingly used in our practice. This has highlighted the need for further study to establish its indications, dosage protocol and an appropriate surveillance schedule for adverse effects. In this context it is important that the limitations of nerve conduction studies are appreciated. We are concerned that the interpretation of regular nerve conduction studies might compromise optimal treatment regimens. Although peripheral neuropathy is an important adverse effect, the sensitivity of nerve conduction studies in detecting early and significant changes is doubtful. Nerve conduction studies provide a useful means of monitoring the progression of a peripheral neuropathy after it has become clinically apparent (3). However, there is no evidence to suggest that abnormal nerve conduction studies in the absence of symptoms are predictive of neuropathy. Furthermore the results of nerve conduction studies show significant variation over short periods of time and are subject to variable interpretation. On our eight patients who have been treated with thalidomide, we have adopted a policy of performing nerve conduction studies before commencing treatment with thalidomide and repeating them only if there are symptoms or significant clinical findings. Thus it is important to inform children and parents of the risks and to ask regularly about symptoms of tingling, painful paresthesia, numbness and weakness. Careful neurologic examination at regular review is essential and must include assessment of vibration sensibility (4). We have discontinued therapy in several patients who presented with symptoms of distal paresthesia, without recourse to nerve conduction studies. Symptoms resolved in all of these patients. Regarding the regimen endorsed by Dr. Ahmed, we are concerned that thalidomide will be stopped in many patients who might derive considerable benefit from it. These patients are generally those who have refractory disease and therefore will have experienced many treatment failures before the introduction of thalidomide. With greater understanding of the role of thalidomide in Crohn disease we should be able to rationalize its administration and monitoring to provide the best outcome for patients. Thus, there is some evidence to suggest that the risk of neuropathy increases with cumulative dose of thalidomide. It might therefore be prudent to establish therapeutic effect with a standard dose and subsequently to reduce dose or frequency. Also care should be taken when it is used with other medications, such as metronidazole, that might also cause neurologic damage. In conclusion we are concerned that thalidomide may be stopped unnecessarily in cases in which there may be few other treatment options. We stress the importance of clinical symptoms and signs as paramount in the detection of peripheral neuropathy. If used, nerve conduction studies should be a component of a composite neuropathy score. We would encourage informed debate on this subject so that a potentially very useful drug can be used to its optimal potential. A. Pigott D. Casson Royal Liverpool Children's Hospital; Liverpool, UK

0366 Quantitative sensory testing with the method-of-limits enables early detection of peripheral neuropathy in genetically verified FAP without electrophysiological abnormalities

0366 Quantitative sensory testing with the method-of-limits enables early detection of peripheral neuropathy in genetically verified FAP without electrophysiological abnormalities

The Monitoring of Potential Long-Term Complications in Treated Adult Cancer Patients

A wide variety of long-term complications may be noted following conventional cancer treatment. These include overwhelming postsplenectomy sepsis syndrome, central and peripheral nervous system toxicity, cardiovascular complications, chronic liver damage, and secondary malignancy. Follow-up monitoring usually incorporates both physical examination and the result of radiological and laboratory investigations. Primary care physicians will often be responsible for the majority of the follow-up monitoring involving cured cancer patients and need to be aware of possible long-term therapy-related problems, especially those that present years after successful treatment of the original malignancy.