Early Detection Of Neuropathy Research Articles

RISK OF NON-HEALING IN ISCHEMIC VERSUS NEUROPATHIC DIABETIC FOOT ULCERS IN RELATION TO GRADE, STAGE OF INFECTION AND TREATMENT PROTOCOL: A FOLLOW-UP STUDY

Background & Objectives: Diabetic foot ulcer (DFU) is a potentially crippling consequence of diabetic foot disease. Aim of this study was to determine the risk of non-healing in ischemic as compared to neuropathic diabetic foot ulcers in relation to its grade and stage of infection. Methods: This prospective non-interventional study was conducted from July 2019 to February 2020 in Diabetes Management Center, Services Hospital Lahore Pakistan. Patients presenting with DFU were assessed for neurological and vascular status in the lower limbs. Ulcer grading was determined by Wagner's and Texas classification. Patients were followed up to 2-6 months for healing status of the diabetic foot ulcer.Results: Of 132 patients, 97 (73%) patients presented with neuropathic ulcer and 35 (27%) were having ischemic ulcers. Most participants were aged between 40-59 years. Based on Wagner's ulcer classification, it was observed that patient with score 2 had three times more likely to have their ulcer healed compared to those with score 1 and 3 [OR =3.09(95% CI:0.62-15.38, P=0.17)]. Kaplan-Meier survival curves showed that healing pattern among ischemic ulcer is considerably better compared to neuropathic foot ulcers. The evidence of equal survival hypothesis using Log-rank (Mantel Cox) test was statistically significant (p<0.001). No statistically significant difference in healing pattern through time was found across Wagner's scoring categories.Conclusion: Peripheral neuropathy was the commonest pathology underlying DFU presenting at our tertiary level diabetes clinic. Early detection of neuropathy and timely foot care may help prevent ulceration with its often-grave consequences.

Cervical Vestibular-Evoked Myogenic Potentials in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Vestibular evoked myogenic potentials (VEMPs) in individuals with diabetes mellitus (DM) provide evidence as how diabetes can bring about changes in the peripheral nervous system. Cervical VEMP (cVEMP) evaluates the function and integrity of the sacullo- collic pathway and ocular VEMP (oVEMP) evaluates the utriculo-collic pathway. cVEMP is an ipsilateral inhibitory response of the sternocleidomastoid muscle. cVEMP is recorded at higher intensity above 80-85 dBnHL with biphasic waveforms having initial peak positivity P13 followed by a negativity N23. We performed a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to evaluate cVEMP in diabetes mellitus. The search was conducted in the databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Cochrane library using the keywords "diabetes mellitus" and "vestibular evoked myogenic potential" or "cVEMP." A two-phase selection process was used for the final inclusion of studies, and the methodological quality of these studies was assessed using the Newcastle Ottawa scale (NCOS). Meta-analysis was performed using a random-effects model. For comparisons between DM and healthy controls, a significant difference was observed for cVEMP amplitude (P = 0.01). Our meta-analysis's results suggest peripheral vestibular dysfunction can be observed in DM. It appears that cVEMPs may be useful in the early detection of neuropathy in DM.

A „diabeteses láb” infekciók mikrobiológiája egy egyetemi központban: retrospektív vizsgálat és irodalmi áttekintés

Late-onset complications may cause serious problems in diabetic patients. Among these complications, diabetic foot infections play a signifcant role. In the recognition and management of the disease the microbiological procedures are essential. Neglected infectious complications may lead to gangrene, limb amputation, which not only impairs quality of life but also endangers the patient’s life. Prevention should include careful management of metabolic disease, appropriate medication, early detection of neuropathy, and the detection and treatment of infection by a medical team , including clinical microbiologist. In our present study, we retrospectively assessed the bacteriological culture’ results of patients with “diabetic foot” syndrome in 5-years’ clinical material at he Faculty of Medicine, University of Szeged.

Early detection of neuropathy in patients with type 2 diabetes with or without microalbuminuria in the absence of peripheral neuropathy and retinopathy

Our goal is early detection of neuropathy in patients with type 2 diabetes with or without microalbuminuria in the absence of diabetic retinopathy and peripheral neuropathy by using in vivo corneal confocal microscopy (IVCCM). A total of 60 type-2 diabetic patients, assigned to either a diabetes mellitus (DM) with microalbuminuria group (DM/MA+, n=30) or a DM without microalbuminuria group (DM/MA-, n=30), and 30 age-matched control subjects were enrolled in this study. All cases underwent evaluation of blood glucose level, HbA1c, lipid fractions, body mass index (BMI), and corneal sensitivity (CS). Corneal nerve fiber length (NFL), nerve fiber density (NFD), nerve branch density (NBD), and tortuosity coefficient (TC) were quantified by IVCCM. None of the patients had peripheral neuropathy or retinopathy. Compared with the healthy subjects, NFL and NFD were reduced in both diabetic groups (P<0.0001), while NBD was significantly reduced in the DM/MA+ group. Between the diabetic groups, NFL, NFD, and NBD were significantly higher in the DM/MA- group (all P's<0.001). CS was significantly lower in DM/MA+ compared with DM/MA- and controls (both P's<0.0001). NFD and NFL were inversely correlated with age, triglyceride level, and BMI. These results indicate that significant damage to small nerves, quantified using IVCCM, can be detected in the absence of retinopathy, peripheral neuropathy or microalbuminuria in type 2 diabetic patients. The severity of corneal nerve involvement may further increase in the presence of nephropathy. This feature may also be valuable for early detection of microvascular complications of DM, allowing for the prevention of progression of life threatening microvascular complications.

Diabetic Foot Spa Implementation in Early Neuropathy Diagnosis Based on Blood Glucose Levels, Foot Sensitivity and the Ankle Brachial Index in Patients with Diabetes Mellitus

Introduction: Diabetes Mellitus (DM) is a cause of morbidity mainly due to vascular complications. The prevention of diabetic foot problems can be done through metabolic control and foot exercises. The purpose of this study was to determine the effect of diabetes foot spa measures on blood glucose levels, foot sensitivity and the ankle brachial index.Methods: This research was a pre-experimental design. The population totaled 170 DM patients and the sample was finalized at 30 respondents. The independent variable was diabetic foot spa, while the dependent variables were blood glucose levels, blood sensitivity and the ankle brachial index. The data was analyzed using a t-test and Wilcoxon rank test.Results: Diabetic foot spa in early neuropathy detection testing has a blood glucose level of t=9.523 and a p value=0.000. Diabetic foot spa also significantly affects foot sensitivity with a ρ &lt;α (0.001&lt;0.05) and an ankle brachial index of (ABI) ρ&lt;α (0.008 &lt; 0.05).Conclusion: Diabetic foot spa conducted regularly and independently can reduce the level of complications in Diabetes Mellitus patients. Furthermore, the tingling and pain in the feet can be reduced or even disappear as well as preventing complications such as foot ulcers that can often become amputations.

P91-T Neurophysiological assessment of asymptomatic TTRVal50Met carriers (transthyretin amyloid polyneuropathy) from the endemic foci of Mallorca

Hereditary transthyretin amyloidosis (hATTR) is a rare, multisystem disease caused by amyloid deposition, characterized by heterogeneous presentation and symptomatology. Therefore, early diagnosis remains a challenge.For carriers of the most common mutation (Val50Met-TTR variant), axonal sensorimotor polyneuropathy (AxSMP) and small fiber and autonomic neuropathy (SFN) are the main clinical features. Very few studies have used neurophysiological tests for the assessment of SFN and AxSMP in the monitoring of carriers of the Val50Met mutation. However, few alterations that can serve as an alert to identify the possible onset of neuropathy have been identified in asymptomatic carriers. The aim of this project is to evaluate SFN and AxSMP in undiagnosed individuals carrying the TTR Val50Met variant by the assessment of Nerve Conduction Studies, Sympathetic Skin Response, RR variability, QST (thermotest) and Sudoscan. 46 carriers have been included in the study. Baseline evaluation unraveled a low amplitude of the plantar SSR as a frequent finding (14/46) using the cut-off point of 0,2 mV for plantar response. This amplitude is significantly lower than the detected for the control group (n = 20). Prevalence of carpal tunnel syndrome was similar to general population. Study of asymptomatic carriers allowed the diagnosis of two subjects after the first examination. Also, 3 subjects are under suspicion of SFN. Early detection of neuropathy, specially the small fiber and autonomic neuropathy, is essential to improve diagnosis and prognosis of hATTR-PN. A complete neurophysiological test battery is the best approach to detect changes from the basal examination.

Feasibility and Effectiveness of Electrochemical Dermal Conductance Measurement for the Screening of Diabetic Neuropathy in Primary Care. Decoding Study (Dermal Electrochemical Conductance in Diabetic Neuropathy).

Diabetes mellitus (DM) is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy (DNP) is the most common complication of diabetes and is of great clinical significance mainly due to the pain and the possibility of ulceration in the lower limbs. Early detection of neuropathy is essential in the medical management of this complication. Early unmyelinated C-fiber dysfunction is one of the typical findings of diabetic neuropathy and the first clinical manifestation of dysfunction indicating sudomotor eccrine gland impairment. In order to assess newly developed technology for the measurement of dermal electrochemical conductance (DEC), we analyzed the feasibility and effectiveness of DEC (quantitative expression of sudomotor reflex) as a screening test of DNP in primary health care centers. The study included 197 people (with type 2 diabetes, prediabetes and normal tolerance) who underwent all the protocol tests and electromyography (EMG). On comparing DEC with EMG as the gold standard, the area under the receiver operating characteristic (ROC) curve (AUC, area under the curve) was 0.58 in the whole sample, AUC = 0.65 in the diabetes population and AUC = 0.72 in prediabetes, being irrelevant in subjects without glucose disturbances (AUC = 0.47). Conclusions: In usual clinical practice, DEC is feasible, with moderate sensitivity but high specificity. It is also easy to use and interpret and requires little training, thereby making it a good screening test in populations with diabetes and prediabetes. It may also be useful in screening general populations at risk of neuropathy.

Peripheral nerve disease secondary to systemic conditions in children.

This review is an overview of systemic conditions that can be associated with peripheral nervous system dysfunction. Children may present with neuropathic symptoms for which, unless considered, a causative systemic condition may not be recognized. Similarly, some systemic conditions may be complicated by comorbid peripheral neuropathies, surveillance for which is indicated. The systemic conditions addressed in this review are critical illness polyneuropathy, chronic renal failure, endocrine disorders such as insulin-dependent diabetes mellitus and multiple endocrine neoplasia type 2b, vitamin deficiency states, malignancies and reticuloses, sickle cell disease, neurofibromatosis, connective tissue disorders, bowel dysmotility and enteropathy, and sarcoidosis. In some disorders presymptomatic screening should be undertaken, while in others there is no benefit from early detection of neuropathy. In children with idiopathic peripheral neuropathies, systemic disorders such as celiac disease should be actively excluded. While management is predominantly focused on symptomatic care through pain control and rehabilitation, some neuropathies improve with effective control of the underlying etiology and in a small proportion a more targeted approach is possible. In conclusion, peripheral neuropathies can be associated with a diverse range of medical conditions and unless actively considered may not be recognized and inadequately managed.

Early detection of neuropathy in leprosy: a comparison of five tests for field settings

BackgroundEarly detection and treatment of neuropathy in leprosy is important to prevent disabilities. A recent study showed that the Nerve Conduction Studies (NCS) and Warm Detection Thresholds (WDT) tests can detect leprosy neuropathy the earliest. These two tests are not practical under field conditions, however, because they require climate-controlled rooms and highly trained staff and are expensive. We assessed the usefulness of alternative test methods and their sensitivity and specificity to detect neuropathy at an early stage.MethodsThrough a literature search we identified five alternative devices that appeared user-friendly, more affordable, portable and/or battery-operated: the Neuropad®, Vibratip™, NC-Stat®DPNCheck™, NeuroQuick and the Thermal Sensibility Tester (TST), assessing respectively sweat function, vibration sensation, nerve conduction, cold sensation and warm sensation. In leprosy patients in Bangladesh, the posterior tibial and sural nerves that tested normal for the monofilament test and voluntary muscle test were assessed with the NCS and WDT as reference standard tests. The alternative devices were then tested on 94 nerves with abnormal WDT and/or NCS results and on 94 unaffected nerves. Sensitivity and specificity were the main outcomes.ResultsThe NeuroQuick and the TST showed very good sensitivity and specificity. On the sural nerve, the NeuroQuick had both a sensitivity and a specificity of 86%. The TST had a sensitivity of 83% and a specificity of 82%. Both the NC-Stat®DPNCheck™ and Vibratip™ had a high specificity (88% and 100%), but a low sensitivity (16% and 0%). On the posterior tibial nerve, the NeuroQuick and the TST also showed good sensitivity, but the sensitivity was lower than for the sural nerve. The Neuropad® had a sensitivity of 56% and a specificity of 61%.ConclusionsThe NeuroQuick and TST are good candidates for further field-testing for reliability and reproducibility. The feasibility of production on a larger scale should be examined.

Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy.

Here we review some seldom-discussed presentations of diabetic neuropathy, including large fiber dysfunction and peripheral autonomic dysfunction, emphasizing the impact of sympathetic/parasympathetic imbalance. Diabetic neuropathy is the most common complication of diabetes and contributes additional risks in the aging adult. Loss of sensory perception, loss of muscle strength, and ataxia or incoordination lead to a risk of falling that is 17-fold greater in the older diabetic compared to their young nondiabetic counterparts. A fall is accompanied by lacerations, tears, fractures, and worst of all, traumatic brain injury, from which more than 60% do not recover. Autonomic neuropathy has been hailed as the "Prophet of Doom" for good reason. It is conducive to increased risk of myocardial infarction and sudden death. An imbalance in the autonomic nervous system occurs early in the evolution of diabetes, at a stage when active intervention can abrogate the otherwise relentless progression. In addition to hypotension, many newly recognized syndromes can be attributed to cardiac autonomic neuropathy such as orthostatic tachycardia and bradycardia. Ultimately, this constellation of features of neuropathy conspire to impede activities of daily living, especially in the patient with pain, anxiety, depression, and sleep disorders. The resulting reduction in quality of life may worsen prognosis and should be routinely evaluated and addressed. Early neuropathy detection can only be achieved by assessment of both large and small- nerve fibers. New noninvasive sudomotor function technologies may play an increasing role in identifying early peripheral and autonomic neuropathy, allowing rapid intervention and potentially reversal of small-fiber loss.

Frequency and determinants of subclinical neuropathy in type 1 diabetes mellitus

Background Diabetic neuropathy is the most common complication of diabetes. We hypothesized that uncontrolled diabetes is associated with subclinical diabetic neuropathy that is influenced by duration of disease. Assessment of the prevalence and associated determining factors will be important for the prevention and treatment of neuropathy. Objective This aim of this study was to assess the frequency and determining factors of subclinical peripheral neuropathy in type 1 diabetic (T1DM) patients. Patients and methods The current hospital-based, case–control study was conducted at Zagazig University Hospitals. It included three age-matched and sex-matched groups. Each group comprised 30 participants: group A included diabetic patients with a duration of T1DM of 5 years or less; group B included patients with a duration of T1DM of more than 5 years; and the control group included normal healthy individuals. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including fasting and 2-h postprandial blood glucose level, glycosylated hemoglobin (HbA1c), lipid profile, liver function, kidney function, and nerve conduction studies were carried out for every participant. Results The frequency of subclinical neuropathy in group A and group B was 46.6 and 76.6%, respectively, and this difference was statistically significant (P=0.03). Univariate analysis revealed significantly higher levels of HbA1c, dyslipidemia, and nerve conduction parameters in group B compared with group A and the control group. Multivariate logistic regression analysis showed that duration of diabetes (P=0.02) and HbA1c (P=0.02) were the only independent factors associated with subclinical neuropathy. Conclusion The high frequency of subclinical neuropathy in diabetic patients highlights the importance of nerve conduction studies for the early detection of neuropathy in T1DM.

A Comparative Study of Sensory and Motor Nerve Conduction Velocity in Prediabetes and Diabetes

Diabetic neuropathy is a very common clinical problem and troublesome complication of diabetes mellitus. The prevalence of peripheral neuropathy is rising with the global burden of diabetes mellitus. Prediabetes is increasingly being viewed as an important contributor to neuropathy. Neuropathy can be assessed electrophysiologically. Monitoring of the nerve conduction velocity is a sensitive method for detection of neuropathies. In this study we try to look for changes in nerve conduction velocity in prediabetes and diabetes. A total of 120 subjects were categorized as: Group I: 40 subjects with normal glucose level, Group II: 40 prediabetes and Group III: 40 diabetic subjects. Nerve conduction study was done on these subjects using RMS EMG EP MARK-11 equipment which works on Windows XP with Microsoft Office 2007. The nerve conduction velocity of Peroneal and Sural nerve were measured. The data obtained from this study showed that the conduction velocity of peroneal nerve in prediabetes was decreased when compared with controls and the sural nerve conduction velocity was significantly decreased in prediabetes (p value of 0.047) and diabetes (p value of <0.001) when compared with the controls indicating early onset of neuropathy even in prediabetes. Nerve conduction studies should be of value to determine neuropathy in prediabetes. This study supported the idea that prediabetes is a transitional state before diabetes and also the importance of the nerve conduction for early detection of neuropathy.

P613: Detection of early neuropathy in type 2 diabetes mellitus

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S215 P612 Small and large fibre neuropathy in patients with diabetes type 1 compared with type 2: a follow-up study S. Loseth1,2, E. Stalberg3, S. Lindal4, R. Jorde5, S.I. Mellgren6 1University of Tromso, Tromso, Norway; 2University Hospital of North Norway, Department of Clinical Neurophysiology, Tromso, Norway; 3Uppsala University Hospital, Department of Clinical Neurophysiology, Uppsala, Sweden; 4University Hospital of North Norway, Department of Pathology, Tromso, Norway; 5University Hospital of North Norway, Department of Internal Medicine, Tromso, Norway; 6University Hospital of North Norway, Department of Neurology, Tromso, Norway Question: Are there differences in the spectrum of large and small fibre involvement in patients with diabetes type 1 versus those with type 2? Methods: Fifty-nine patients (35 type 1 and 24 type 2 diabetes) were included in a follow-up study after 5 years. Nerve conduction studies (NCS), quantitative sensory testing (QST) at the distal calf and skin biopsy for quantification of intraepidermal nerve fibre density (IENFD) in addition to symptom scoring and clinical evaluations were performed. Z-scores were calculated to adjust for the physiologic effects of age, height and gender. Results: Patients with type 1 diabetes were younger with longer disease duration; they had higher HbA1c and lower BMI. Neuropathic symptoms tended to be more frequent in type 2 (54% versus 37%; ns). Comparing data to the baseline study, the overall NCS score was more abnormal after 5 years in both type 1 (p=0.006) and type 2 diabetes (p=0.02). IENFD became significantly lower only in those with type 2 (reduction from 7.9±4.8 to 4.3±2.8 fibres/mm, p=0.006). Cold perception threshold was higher in type 2 at follow-up compared to baseline (p=0.049). Between the two types of diabetes the difference of progression of abnormalities was only significant for the IENFD (more progression in type 2, p=0.048). Conclusions: A 5 year follow-up study in diabetics showed progression of large fibre neuropathy in both type 1 and type 2. Small fibre neuropathy seems to progress more rapidly in those with type 2. P613 Detection of early neuropathy in type 2 diabetes mellitus R. Remli1, S.A. Md Rani1, W.N.N. Wan Yahya1, R. Sahathevan1, Z. Md Zain2, N. Mohamed Ibrahim1, R. Azman Ali1, H.J. Tan1 1National University of Malaysia, Medical Department, Kuala Lumpur, Malaysia; 2National University of Malaysia, Community Health Department, Kuala Lumpur, Malaysia Question: To determine the frequency and predictors of asymptomatic lower limb neuropathy amongst type 2 diabetic patients in University Kebangsaan Malaysia Medical Centre (UKMMC). Methods: This was a cross sectional study which recruited diabetic patients in UKM Medical Centra who did not have any neuropathy symptoms. All patients who obtained a score of “0” in diabetic neuropathy symptoms score (unsteadiness in walking, neuropathic pain, paraesthesia, numbness [1] (Table 1). Figure 1. The frequency of nerve conduction parameters abnormalities in motor and

Peripheral Nerve Abnormalities in Patients with Newly Diagnosed Type I and II Diabetes Mellitus

Background: Early detection of neuropathy may prevent further progression of this complication in the diabetic patients. The purpose of this study was to evaluate the prevalence of early neuropathic complication in patients with newly diagnosed type 1 and type 2 diabetes. Methods: Nerve conduction studies (median, ulnar, posterior tibial, peroneal, and sural nerves) were performed for 49 type 1 (27 males, mean 14.1±7.5 years) and 40 type 2 (27 males, 42.0±14.1 years) diabetic patients at onset of diabetes. Children with age at onset under 4 years and adults over 55 years were excluded to eliminate the aging effect and the influence of obstructive arteriosclerosis. Neuropathy was defined as abnormal nerve conduction findings in two or more nerves including the sural nerve. Results: Mean HbA1c level was 12.6±3.3% for type 1 and 10.5±2.9% for type 2 diabetes. The prevalence of neuropathy was 12.2% for type 1, and 35.0% for type 2 diabetes, respectively. There were significant trends in the prevalence of neuropathy with increasing age (p<0.05). The effect of the mean level of glycosylated hemoglobin on the prevalence of polyneuropathy at onset of diabetes was borderline (p=0.0532). Neither sex of the patients nor the type of diabetes affected the neurophysiologic abnormalities at the diagnosis. Conclusions: Even in a population with diabetes at the diagnosis, the prevalence of subclinical neuropathy was not low. Neuropathy has been significantly associated with increasing age indicating the possibility of longer duration of undetected diabetes among them, especially in type 2 diabetes. (Korean J Clin Neurophysiol 2014;16:8-14)

Electrophysiological changes in sensorimotor nerves in diabetes mellitus &amp; usefulness of nerve conduction studies for early diagnosis of diabetic neuropathy

Background: Diabetes Mellitus(DM) a metabolic disorder is the most common cause of peripheral neuropathy. Nerve conduction studies(NCS) are commonly employed to detect the neuropathy. The present study was undertaken to find out the utility of NCS as an early indicator of neuropathy in diabetic patients. Materials & methods: Study was carried out in 50 diagnosed DM patients attending OPD in Medicine, Civil Hospital, Ahmedabad. Diabetic subjects were selected having FBS >110 mg/dL with duration of DM > 5 years. Their HbA1c levels were measured for glycaemic control. Diabetic patients with good glycaemic control were grouped in group A & that with poor glycaemic control in group B. 25 age matched non-diabetic & healthy subjects were selected for control group C. NCS was performed at Institute of Spine, Civil Hospital Campus, Ahmedabad. Nerve conduction parameters like compound muscle action potential(CMAP), sensory nerve action potential(SNAP), nerve conduction velocity(NCV) & distal latency(DL) were studied. Results: In our study there is increase in DL of peroneal, sural; median & ulnar sensory nerves in group B subjects. NCV of sensorimotor nerves is significantly decreased in group B subjects. SNAP of all nerves is reduced in group A & B. CMAP is reduced significantly in all nerves in group B. Conclusion: As DM progress further, it increases risk of neuronal involvement which can be accelerated by poor glycaemic control. Our result indicates demyelinating type of neuropathy with some changes of axonopathy. Therefore NCS is done for early detection of neuropathy in DM patients.

Quantitative Epidermal Nerve Fiber Density Is More Sensitive Than Sudomotor Test To Detect Neuropathy in Type 2 Diabetes (P03.200)

Objective: The aim of this study is to find sensitive method detecting early diabetic neuropathy and to evaluate relationship between somatic and sudomotor small nerve fiber function in diabetic neuropathy. Background It is known that small nerve fiber is involved first in diabetic neuropathy. Quantitative epidermal nerve fiber density and sudotmor function test are well known method to detect dysfunction of small nerve fiber. Design/Methods: Type 2 diabetic patients with putative neuropathy based on clinical symptoms or signs were included prospectively. Neurological examinations using neuropathy impairment score (NIS) and NCS were conducted. Quantification of intraepidermal nerve fiber (IENF) density and quantitative sudomotor axon reflex test using Q-sweat were done on the distal leg. Heart rate variability according to deep breathing (DB ratio) and Valsalva ratio were done to examine cardiovagal function. The results of the tests were compared between the patients with normal nerve conduction (small fiber neuropathy group, SFN) and abnormal nerve conduction (mixed fiber neuropathy group, MFN). Results: IENF density abnormality was most frequently detected, and Q-sweat, NCS, and cardiovagal function abnormalities were followed in order. Abnormality of the IENF density was found more frequently than that of Q-sweat and cardiovagal function in both SFN group and MFN group. Cardiovagal dysfunction, especially DB ratio, and NCS abnormality were significantly correlated with duration of the diabetes mellitus. There was no correlation between IENF density and Q-sweat performed on the same site. Conclusions: Quantitation of IENF density is more sensitive than Q-sweat to detect early diabetic neuropathy. Analyses of IENF density and Q-sweat are complementary for early detection of neuropathy in type 2 diabetes. Cardiovagal dysfunction and NCS abnormality are proportional to duration of the diabetes mellitus, so that regular follow-up of these tests are mandatory regardless of clinical symptoms. Disclosure: Dr. Sohn has nothing to disclose. Dr. Song has nothing to disclose. Dr. Lee has nothing to disclose.

Diagnostic Tools for Diabetic Sensorimotor Polyneuropathy

Diabetes and its complications are major causes of mortality in the United States, with increasing rates of morbidity and increasing health care costs. Patients diagnosed with diabetes attempt to control cholesterol levels, blood pressure, and blood glucose levels to decrease the risk of diabetic microvascular complications (DMC), such as diabetic sensorimotor polyneuropathy (DSP) [also known as diabetic peripheral neuropathy (DPN)]. Despite control of these risk factors for vascular disease, many patients still develop DSP. Research investigating diabetic neuropathy holds promise for specific treatment of diabetic complications. Intrinsic to the success of new therapies is the accurate diagnosis and evaluation of DSP. Symptom scores, quantitative sensory testing and electrophysiology are some of the diagnostic tools to identify the signs and symptoms of DSP. Early detection of neuropathy enables clinicians to prevent long-term complications like ulcers and amputations in patients with diabetes. The focus of this review is to describe the composite of tools necessary for diagnosis of DSP.

Thalidomide-induced peripheral neuropathy. A prospective clinical, neurophysiological and pharmacogenetic evaluation.

Prospective clinical and electrophysiological follow-up was performed on nine patients under thalidomide treatment in order to detect the very beginning of possible drug-induced peripheral neuropathy. For neurophysiological assessment, nerve conduction measurements of the median, peroneal and sural nerves (7 conduction parameters) and needle EMG examination of the anterior tibial muscle were performed. The results of a first control after about 3 months of treatment were compared with the starting point examination, and the patients were then classified as "affected" or "not affected" according to clinical and neurophysiological criteria. At this point, three patients showed clinical and electrophysiological, and another two only electrophysiological alterations suggesting early neuropathy. This classification did not change after further clinical and electrophysiological controls. Without starting-point values, the early detection of neuropathy would not have been possible in all patients. No single reliable neurophysiological parameter for detection of thalidomide-induced neuropathy could be found. Pharmacogenetic classification with regard to hydroxylation and acetylation phenotypes was then performed in some patients and interpreted with relation to thalidomide neurotoxicity. A possible relationship between slow acetylators and development of thalidomide-induced neuropathy was found.