Early Diagnosis Of Peripheral Neuropathy Research Articles

Clinical significance of small nerve fiber involvement in the early diagnosis and treatment of patients with Fabry disease

IntroductionPeripheral nervous system is early involved in Fabry disease (FD) and preferentially the small nerve fibers, causing the characteristic neuropathic pain crises usually beginning in childhood. Early detection of this likely underdiagnosed disease is an important approach because causal therapies are available. MethodsWe conducted a case-series study to investigate the small nerve fiber involvement in FD and its contribution to the diagnosis of the disease but also to the timely effective therapy administration. We used specific structured scales of symptoms and signs to detect peripheral neuropathy, as well as suitable functional and structural tests to diagnose the small fiber neuropathy (SFN). ResultsTwenty-seven consecutive patients (14 men, mean age 44.62 ± 10.70 years) with suspected FD were included in this study. Most of the patients presented symptoms of small nerve fiber involvement, which were accompanied by abnormal test results, fulfilling the criteria for SFN. The detection of SFN in our patients allowed the completion of the FD diagnostic criteria and thus the initiation of therapy. In five patients the SFN diagnosis determined the administration of therapy, whereas in two others it might be considered. ConclusionOur results further suggest the importance of early diagnosis of peripheral neuropathy, especially of small nerve fiber involvement, in patients with suspected FD as it contributes crucially not only to the diagnosis but also to the timely effective initiation of FD therapy.

Reference Values for the Cross Sectional Area of Normal Tibial Nerve on High-resolution Ultrasonography.

The aim of the study was to establish reference values for the cross-sectional area of the tibial nerve on high-resolution ultrasonography and to investigate the relationship between the cross-sectional area of the tibial nerve and subject's age, gender, height (in cm), weight (in kg) and body mass index. Two hundred subjects of either gender and over 18 years of age with no history of peripheral neuropathy or trauma to the lower limb were evaluated with high-resolution ultrasonography. Mean cross-sectional areas of tibial nerves were measured at two different levels in both lower limbs, first at 1 cm below the bifurcation of the sciatic nerve into tibial and common peroneal nerves (level I) and the second at 1 cm superior and posterior to the medial malleolus (level II). The mean cross-sectional area measured at level I (0.196 + 0.014 cm2) was larger than the one measured at level II (0.111 ± 0.011 cm2). A positive correlation was found between the mean cross-sectional area and height, weight, and body mass index (p <0.05). Women had smaller cross-sectional areas of the tibial nerves than men at both sites. In addition, no significant relationship was found with the age of the subjects (p >0.05). The established reference values of the cross-sectional area of the tibial nerve will aid in early diagnosis of peripheral neuropathy.

A New Method for Haptic Shape Discriminability Detection

Touch shape discrimination is not only closely related to tactile mechanoreceptors but also higher cognitive function. However, previous shape discrimination methods are difficult to complete in a short time, and the devices are complicated to operate and not user-friendly for nonprofessionals. Here, we propose a new method, the evaluation quantity of which is the angle discrimination threshold. In addition, to make this method easy to use for nonprofessionals, we designed a haptic angle sorting system, including the device and software. To evaluate this method, the angle sorting and two-angle discrimination experiments were compared, and it was found that participants spent significantly less time in the former experiment than in the latter. At the same time, there is a strong correlation between the performance of angle sorting and two-angle discrimination, which shows that the angle threshold obtained by the new method can also be used to evaluate the ability of touch discrimination. Moreover, the angle sorting results of different age groups also further demonstrate the feasibility of the method. The efficiency of this new method and the effectiveness of the system also provide a convenient means for evaluating haptic shape discrimination, which may have potential clinical application value in the early diagnosis of peripheral neuropathy and even in the evaluation of cognitive function.

Novel Biomarker Serum Calprotectin for Early Diagnosis of Diabetic Peripheral Neuropathy in Type 2 Diabetes Patients

Background: Calprotectin was identified as an endogenous activator of Toll-like receptor 4 (TLR4) and as receptor for advanced glycation end product (RAGE). Elevated plasma levels of calprotectin have been reported in a variety of chronic inflammatory conditions. Elevated calprotectin levels have been reported to predict microvascular alterations in type 2 diabetes (T2DM) patients. Objective: To make an up to date review of serum level of calprotectin as a predictor for early diagnosis of peripheral neuropathy in type 2 diabetes patients. Patients and methods: A total number of 90 subjects were included in the study after fulfillment of the inclusion and exclusion criteria. Calprotectin was measured for all the 90 subjects. Results: Serum calprotectin levels were significantly higher in group III “diabetics with neuropathy” compared to group II “diabetics without neuropathy “and group I “healthy controls”. Conclusion: High levels of calprotectin were detected in type 2 diabetic patients with peripheral neuropathy.

Novel Biomarker Serum Calprotectin for Early Diagnosis of Diabetic Peripheral Neuropathy in Type 2 Diabetes Patients

Background: Calprotectin was identified as an endogenous activator of Toll-like receptor 4 (TLR4) and as receptor for advanced glycation end product (RAGE). Elevated plasma levels of calprotectin have been reported in a variety of chronic inflammatory conditions. Elevated calprotectin levels have been reported to predict microvascular alterations in type 2 diabetes (T2DM) patients. Objective: To make an up to date review of serum level of calprotectin as a predictor for early diagnosis of peripheral neuropathy in type 2 diabetes patients. Patients and methods: A total number of 90 subjects were included in the study after fulfillment of the inclusion and exclusion criteria. Calprotectin was measured for all the 90 subjects. Results: Serum calprotectin levels were significantly higher in group III “diabetics with neuropathy” compared to group II “diabetics without neuropathy “and group I “healthy controls”. Conclusion: High levels of calprotectin were detected in type 2 diabetic patients with peripheral neuropathy.

Sensory nerve conduction study in patient of thyroid dysfunction in central India

Introduction: Hypothyroidism is a endocrine disorder which results in neurological dysfunction. It also affects brain, peripheral nerves and muscular system. The neurologic manifestations, which may be noted incidently, occur in conjunction with the systemic features of the disease. Peripheral neuropathy occurs early in hypothyroidism and its detection is necessary for early diagnosis and treatment. Study aimed to know the sensory nerve conduction in patients of hypothyroidism and to compare sensory nerve conduction parameters in patients of hypothyroidism with normal healthy controls. Materials and Methods: Comparative study. Study Design: Total 100 subjects were taken in the study in the age group of 18–66 years. Out of 100 subjects 50 were diagnosed thyroid dysfunction patient and 50 subjects were healthy individual. Informed written consent was taken from all the subjects. Nerve conduction study consists of sensory nerve conduction study of Median, Ulnar and Sural nerves. In the department of Physiology. Electrophysiological parameters such as Sensory Nerve Action Potential amplitude and conduction velocity were evaluated. Results: It was found that sensory nerve action potential amplitude and conduction velocity were significantly reduced in median and ulnar nerves in cases as compared to controls. Conclusion: Nerve conduction study very effective test for early diagnosis of peripheral neuropathy in thyroid dysfunction.

Clinical utility of the DN4 questionnaire in the assessment of neuropathic pain in patients with type 2 diabetes: experience from a newly-created diabetes clinic in Cameroon

INTRODUCTION: Early diagnosis of peripheral neuropathy in people with diabetes mellitus is important. Screening tools are either expensive or cumbersome, and thus impractical in low-resource settings. The DN4 questionnaire is a simple alternative. We assessed the performance of the DN4 Questionnaire in detecting neuropathic pain associated with diabetic peripheral neuropathy in patients with type 2 diabetes.

Distribution characteristics of sweat gland nerve fibres in normal humans identified by acetylcholinesterase histochemical staining

ObjectiveTo quantitatively analyze distribution characteristics of sweat gland nerve fibres (SGNF) in normal Chinese individuals for obtaining a reference for early diagnosis of peripheral neuropathy. Patients and methodsSkin biopsy samples were collected from 192 normal Chinese individuals and divided into six, four and two groups according to anatomic sites, age and gender, respectively. SGNF morphology was observed and SGNF density (SGNFD) was determined. ResultsThere was a significant difference in SGNFD among different anatomic sites, age and gender. A degressive tendency was observed from proximal to distal anatomic sites. SGNFD was the lowest in subjects in the 21–40-year-old age group, but was the highest in subjects in the >61-year-old age group. Overall, SGNFD fluctuated with age. SGNFD in males was significantly higher than that in females. ConclusionsDistribution characteristics of SGNF in normal individuals may serve as a reference for early diagnosis of nerve fibre damage.

The feasibility of using high-resolution ultrasonography to assess ulnar nerve in patients with diabetes mellitus.

ObjectiveThe aim of this study was to investigate the usefulness of high-resolution ultrasonography for the diagnosis of polyneuropathy in diabetes mellitus patients by the examination of the ulnar nerves.MethodWe recruited 100 healthy age-matched volunteers (50 women and 50 men) with 200 arms without diabetes or cubital tunnel syndrome as the control group. We assessed the upper limbs of 100 diabetes mellitus patients (45 women and 55 men), 40 of whom had electrophysiologically confirmed diabetic peripheral neuropathy and 60 had no diabetic peripheral neuropathy in the upper limbs. Age, sex, height and weight were recorded and the cross-sectional area of the ulnar nerve was measured at every predetermined site.ResultsThe cross-sectional area of the ulnar nerve was measured at six sites (mid-humerus, inlet of the cubital tunnel, outlet of the cubital tunnel, upon the medial epicondyle, 6 cm upon the wrist crease and Guyon tunnel). The ulnar nerve in two measuring sites (mid-humerus, upon the medial epicondyle) in the control group showed a statistical difference between men and women (p < 0.05). There was no statistical difference in the cross-sectional area in the control group when dominant and non-dominant arms were compared. The cross-sectional area was larger in the diabetic peripheral neuropathy group in three sites (inlet of the cubital tunnel, outlet of the cubital tunnel, Guyon tunnel) compared with those in the control group.ConclusionHigh-resolution ultrasonography may be helpful in the early diagnosis of peripheral neuropathy in diabetic patients.

Perception of vibration threshold is a marker of diabetic neuropathy

Background: Diabetes mellitus is a chronic progressive disorder and is concerned because of its devastating complications. Among this, nervous system is most frequently affected. Symptom varies widely in peripheral neuropathy due to diabetes. In majority of cases, sensory symptoms predominate. Vibration perception threshold (VPT) has added much to early diagnosis of peripheral neuropathy. The previous studies showed that, in mild-to-moderate diabetic neuropathy, VPT serves as excellent tool. Aims and Objectives: This study is planned to assess if VPT testing can be applied as early diagnostic tool in diabetic neuropathy. Materials and Methods: The studies on VPT were conducted in the Department of Physiology with the help of Department of Medicine at VIMSAR, Burla, within the time period of February 2015-November 2015. Vibration sense was detected in 60 diabetic patients, of which 30 had clinical neuropathy and 30 without clinical neuropathy. Chi-square test has been applied between parameters. The instrument used was Vibrotherm Dx. Results: In these 60 diabetic patients, VPT was conducted. This study shows the diverse result of VPT testing. Among the clinical neuropathy patients, 26.66% had Grade I severity and 43.33% had Grade II severity. It was found that in diabetic patients without the clinical neuropathy 50% had Grade I severity and 6.66% had Grade II severity. Hence, it was confirmed that nerve fibers are affected in subclinical states without any symptom. Conclusion: All diabetic patients irrespective of their clinical symptoms of neuropathy should be assessed by VPT testing. It will help to identify at risk group with diabetic peripheral neuropathy by detecting their VPT. It is also a cost-effective procedure. We can also prevent the devastating diabetic foot complications.

A Prospective Study on the use of the Indicator Test Neuropad® for the Early Diagnosis of Peripheral Neuropathy in type 2 Diabetes

The aim of this prospective study was to evaluate the contribution of the indicator test for sudomotor function Neuropad® to the early diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Included were 109 type 2 diabetic patients (55 men, mean age 56.15 ± 6.14 years), whose initial clinical examination (Neuropathy Disability Score, NDS) was negative for neuropathy. Patients were first examined between January and June 2004 and re-examined 5 years later by the NDS and Neuropad ®. Initially, 70 patients (64.22%) had normal and 39 (35.78%) patients had abnormal Neuropad® (groups A and B, respectively). NDS was significantly higher in group B on both examinations (p < 0.001). On the second examination, 2 patients (2.86%) in group A and 10 patients (25.64%) in group B had developed neuropathy (p = 0.001). Neuropad® had 83.33% sensitivity and 68.04% specificity for neuropathy. There was a modest but significant agreement (kappa = 0.259, p < 0.001) between Neuropad® and NDS for neuropathy. Among type 2 diabetic patients with normal NDS, development of neuropathy is significantly more frequent in those with abnormal Neuropad®. These results suggest a potential utility of Neuropad® for the earlier diagnosis of neuropathy in type 2 diabetes.

Identification of peripheral neuropathy in type-2 diabetic subjects by static posturography and linear discriminant analysis

Background An early diagnosis of peripheral neuropathy in diabetic patients is useful in order to slow down the progress of this complication. Nerve conduction tests are the gold standard for this diagnosis but they are challenging for the patients. This study examines whether it is possible to assess the presence of diabetic neuropathy at an early stage by static posturography tests. Methods Static posturography tests were performed on 37 type-2 diabetic subjects (25 neuropathic patients and 12 non-neuropathic control subjects). Each subject was tested twice under two visual conditions: open and closed eyes. Both “global” (classic) and “structural” (model-based) posturographic parameters (PP) were derived from centre-of-pressure trajectories. A total of 65 PP were computed but only five were selected, normalized and fed to a linear classifier based on linear discriminant analysis. Results This method correctly classified 86.5% of the patients. Five subjects were misclassified and only 2 false negatives out of 25 neuropathic subjects were erroneously diagnosed as control subjects. Conclusions This paper shows that “global” and “structural” parameters derived by static posturography tests, and classic linear statistical approaches, can be used for the diagnosis of neuropathy provided PP are properly chosen and normalized.

Neuropad: early diagnostic test for diabetic peripheral neuropathy

AbstractDiabetic foot syndrome is a significant cause of morbidity in patients with diabetes, and early diagnosis of peripheral neuropathy can improve prognosis. In this New product review Professor Malik describes Neuropad, a new prescribable diagnostic test for peripheral diabetic neuropathy. Copyright © 2008 Wiley Interface Ltd

Significance of nueroelectrophysiological tests in the early diagnosis of sub-clinical neuropathay with diabetes mellitus

To evaluate the application of nueroelectrophysiological tests in early diagnosis of sub-clinical neuropathy in diabetes mellitus (DM), The routine nerve conductive velocity (NCV), F-wave and sympathetic skin response (SSR) were detected in 27 patients with diabetes mellitus but without symptoms and signs of lesions of nerve system. Our results showed that 48.1%, 44.4%, 51.9% of the patients were found to have abnormal NCV, F-wave and SSR respectively. The abnormalities were mainly characterized by prolonged latency, reduced velocity and absence of wave-form. There were significant differences between the controls and the DM group (P < 0.05). Both the distal and proximal segments of nerves were affected and the distal lesions took place earlier than proximal ones and the changes in low extremities were more severe than those of upper extremities. F-wave can be used as a sensitive indicator for the early diagnosis of peripheral neuropathy and it can help to detect the subclincial lesions. SSR can be used for the evaluation of functional status of autonomic nerves in DM patients.