Electroneurographic Parameters Research Articles

Impact of Resveratrol and Pharmaceutical Care on Type 2 Diabetes Mellitus and Its Neuropathic Complication: A Randomized Placebo Controlled Clinical Trial

Background. Management of diabetic neuropathy (DN) is a challenging issue. Therefore, integration of pharmaceutical care provided by the clinical pharmacists with pharmacotherapy may provide multifaceted approach to target the management of hyperglycemia and diabetic neuropathic complication. This study aimed to evaluate the effects of resveratrol (Resv) and/or pharmaceutical care (PC) on glycemic control and amelioration of diabetes-associated neuropathic complications. Patients and Methods. A four-arm randomized placebo-controlled clinical trial assigned 120 patients from the Diabetes and Endocrinology Center in Sulaymaniyah City, Iraq. The patients were divided into four groups. The Resv group (n = 30) received 500 mg Resv capsules once daily. The Placebo group (n = 30) received placebo capsules. Resv + PC (n = 30) received Resv 500 mg capsules with PC. Placebo + PC (n = 30) received placebo capsule plus PC. The duration of the intervention was 90 days. Drug therapy problems (DTPs) have been utilized as an important domain in PC. Clinical signs, symptoms, and neuropathic abnormalities were assessed using the Michigan Neuropathy Screening Instrument (MNSI), Douleur Neuropathique 4 (DN4) questions, and nerve conduction studies (NCSs) of the lower-limb sensory and motor nerves. Results. 97 patients from all the groups completed the study. At baseline, 84% of the Resv, 87% of the Placebo, and 92% of each of Resv + PC and Placebo + PC groups, respectively, had at least one DTP. The provision of PC resulted in a dramatic reduction in the number of DTP. Resveratrol with PC significantly ameliorated hyperglycemic status, neuropathic signs, and symptoms, as evidenced by a decrease in MNSI and DN4 scores and improvement in electroneurographic parameters. Conclusion. These findings support the integration of the PC concept into a pharmacotherapy intervention; they also encourage supplementation of Resv with conventional diabetes therapy to emphasize on the importance of this herbal medicine with the provision of PC in the management of diabetes and its neuropathic complications. This trial is registered with NCT05172947.

Comparative analysis of the effects combined physical procedures and alpha-lipoic acid on the electroneurographic parameters of patients with distal sensorimotor diabetic polyneuropathy

[Purpose] Painful diabetic polyneuropathy occurs as a complication in 16% of all patients with diabetes mellitus. [Subjects and Methods] A clinical, prospective open-label randomized intervention study was conducted of 60 adult patients, with distal sensorimotor diabetic neuropathy two groups of 30 patients, with diabetes mellitus type 2 with distal sensorimotor diabetic neuropathy. Patients in group A were treated with combined physical procedures, and patients in group B were treated with alpha lipoic acid. [Results] There where a statistically significant improvements in terminal latency and the amplitude of the action potential in group A patients, while group B patients showed a statistically significant improvements in conduction velocity and terminal latency of n. peroneus. Group A patients showed a statistically significant improvements in conduction velocity and terminal latency, while group B patients also showed a statistically significant improvements in conduction velocity and terminal latency. This was reflected in a significant improvements in electrophysiological parameters (conduction velocity, amplitude and latency) of the motor and sensory nerves (n. peroneus, n. suralis). [Conclusion] These results present further evidence justifying of the use of physical agents in the treatment of diabetic sensorimotor polyneuropathy.

Gender Differences in Biochemical and Electroneurographic Parameters of Median and Ulnar Nerve.

Introduction:In this article are demonstrated differences in the aspects of the metabolic syndrome (MSy) between genders, as well as the association of MSy and neuropathy.The aim:The aim of our study was that in patients with newly discovered metabolic syndrome of both sexes make comparison of fasting blood glucose levels and after oral glucose tolerance test, as well as neurophysiological parameters of n.medianus and n.ulnaris.Patients and methods:All participants were examined dermatologically. The analysis included the 36 male and 36 female respondents with a newly discovered MSy.Results:The average age of men was 52.75±7.5 (40-65) years and women 52.1±7.7 (38-67) years. The average value of fasting blood glucose in women was 5.86±0.87 (4.5-8) mmol/L, and non significantly higher in men (p=0.0969) as 6.19±0.8 (4.7-8) mmol/L. Average values of blood sugar 120 minutes after oral glucose tolerance test were not significantly different (p=0.7052), and was 5.41±1.63 (3.3-9.7) mmol/L in women and 5.27±1.52 (2.7-9.8) mmol/L in men. Median motor velocity were significantly higher in women for n.medianus on the left (p=0.0024), n.ulnaris on the left (p=0.0081) and n.ulnaris on the right side (p=0.0293), and the median motor terminal latency were significantly longer in n.ulnaris on the left (p=0.0349) and n.ulnaris on the right side (p=0.011). There was no significant difference in the sensory conductivity velocity in n.medianus and n.ulnaris between the groups, but the amplitude with the highest peak of the sensory response was significantly higher in n.medianus on the left (p=0.0269) and n.ulnaris on the left side (p=0.0009) in female patients.Conclusion:The results indicate that there are differences in neurophysiological parameters of the investigated nerves between the genders, and that tested nerve structures in the course of MSy are affected slightly more in men. There were no significant differences in skin changes between genders.

Electroneurographic parameters in patients with metabolic syndrome

Introduction: The aim of this study was to measure electroneurographic (ENG) parameters of the median and ulnar nerve in patients with metabolic syndrome and to determine whether the large imbalance in glycemic control came to neuropathic changes to the template.Methods: The study included 100 patients with metabolic syndrome diagnosed according to the criteria of the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III). The patients were divided into two groups. Group I – patients with normal glycemic control and Group II - patients with diabetes mellitus for up to five years. We measured sensory conductive velocity (SCV), the amplitude of sensory nerve action potential (SNAP), motor conductive velocity (MCV), terminal motor latency (TML) and compose muscle action potential after distal stimulation (CMAP-I) and after proximal stimulation (CMAP-II) for the ulnar and median nerve.Results: Sensory and motor parameters in Group II were amended to neuropathic pattern compared to Group I. There were significant differences in: SNAP amplitude for all tested nerves, SCV values for both left and right median and ulnar nerve; MCV and TML for left median nerve; MCV, TML and CMAP-I for right median nerve area; MCV and TML for left ulnar nerve; MCV, CMAP-I and CMAP-II for right ulnar nerve area.Conclusion: Patients with metabolic syndrome and diabetes mellitus duration of five years have the significant changes in sensory and motor peripheral nerves. Neuropathic changes are possible in patients with metabolic syndrome and normal glycemic control.

Electrophysiological features of lower motor neuron involvement in progressive supranuclear palsy

BackgroundAbnormalities of the spinal cord were considered uncommon in progressive supranuclear palsy (PSP), and therefore spinal symptoms were not included among PSP characteristic features. However there have been some neuropathological reports of spinal cord lesions in patients with PSP. The aim of our study was to find out if the possible lower motor neuron involvement in PSP is reflected by electromyographic (EMG) and/or electroneurographic (ENG) abnormalities. Material24 patients with clinically probable PSP (mean age 67.5yrs; 66% males) were included in the study. The control group for ENG studies consisted 25 age matched healthy volunteers. MethodsNerve conduction studies in the ulnar, peroneal and sural nerves and EMG of the first interosseus dorsal and tibial anterior muscles were performed. ResultsThe only ENG abnormality observed was decreased compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes in the ulnar nerve. Such decrease was registered in 8.3% and 20% of PSP patients respectively. There was no significant difference between the values of ENG parameters between PSP patients and the control group. In EMG abnormalities suggesting chronic reinnervation were recorded in the first interosseous dorsal (FID) muscle in 45.8%, and in the tibialis anterior (TA) muscle in 37.5% of PSP patients. A significant correlation was found between the age of PSP patients and their mean motor unit potential (MUP) amplitude in TA muscle (p=0.04) and also between the age of onset and MUP amplitude in both, the TA and FID muscles (p=0.026 and p=0.03 respectively). ConclusionsIn PSP, neurogenic EMG abnormalities in skeletal muscles are present in nearly half the patients suggesting a loss of motor neurons in the anterior horns of the spinal cord which is in line with our histopathological findings. In contrast, electrophysiological signs of neuropathy in peripheral nerves in PSP are very rare. Concluding, although PSP is characterized by the pathological process in specific basal ganglia and brainstem areas, our electromyographic study suggests the need for broadening the spectrum of PSP for lower motor neurons degeneration.

Combination of Alpha Lipoic Acid and Superoxide Dismutase Leads to Physiological and Symptomatic Improvements in Diabetic Neuropathy

Background and Objective: The management of diabetic neuropathy is still a challenge for physicians. The aim of this study was to assess the efficacy of a new combination of alpha lipoic acid and superoxide dismutase for the treatment of diabetic neuropathy. p] Methods: The setting of this study was ambulatory (outpatient) care. A prospective, non-randomized, open-label study was conducted in 50 patients with diabetes mellitus and with a deficit in both motor and sensory nerve conduction. Treatment was with a new combination of alpha lipoic acid and superoxide dismutase (ALA600SOD®) for 4 months. Electroneurographic parameters and perceived pain were assessed at baseline and after treatment.Results: After 4 months of treatment, patients significantly (p < 0.001) improved their electroneurographic parameters and their perception of pain. Best improvements were observed in sensory nerve conduction.Conclusion: The combination of two powerful antioxidant agents leads to improvement in both subjective and objective parameters in patients with diabetic neuropathy. New profitable directions for investigations are opened for a non-invasive treatment of diabetic neuropathy in the future.

The Influence of CSII Treatment on the Function of the Peripheral and Visceral Nerves in Type I Diabetics*

The distal latencies, motor and sensory nerve conduction velocities, and respiratory heart arrhythmia (RHA) were measured in 14 patients with type I diabetes but without clinical signs of polyneuropathy. The electroneurographic parameters tended to improve as the HbA1 value decreased. The RHA was not affected.

Comparaison de l’échographie et de l’électroneurographie pour le diagnostic du syndrome du canal carpien en pratique courante

Introduction Many studies had been performed in the last years to prove the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). We wanted to determine its reliability and to compare this technology with electromyography (EMG) in ordinary diagnostic conditions. Methods The study involved 90 wrists with suspected CTS, 35 controlateral wrists and 52 control wrists. The diagnosis of CTS was confirmed in 81 cases by the hand symptom diagram and the Tinnel and Phalen sign. The EMG examination evaluated medianulnar sensory latency difference to the ring finger and wrist-to-palm sensory conduction velocity. For the ultrasound diagnosis, the cross sectional area of the median nerve at the level of the pisiform bone, was considered. The sensitivity and specificity of the two techniques was calculated. Results Sensitive electroneurographic parameters showed a sensibility and specificity respectively of 79 and 80%. The cut-off point for ultrasound sensibility and specificity using ROC analysis was 11 mm 2 for mean cross-sectional area. Sensitivity and specificity found in this way were 72% and 56%. Reliability was good with intra- and inter-reader intraclass correlation coefficients of 0.99, and interobserver coefficient of 0.88. Sonography found seven CTS among the 17 clinical CTS with normal electrophysiological findings. A statistically correlation was found between the cross-sectional section and the sensitive electrophysiologic parameters ( r = 0.43, p < 0.001). Conclusions In our study, ultrasonographic diagnostic value are not as good as electrophysiological value, like found in recent literature, probably because of the composition of our group of patients which is including many causes of acroparesthesias. This can mean that in clinical practice, sonography is a complementary tool instead, for example in cases of equivocal EMG.

Influence of low-intensity laser therapy on spatial perception threshold and electroneurographic finding in patients with diabetic polyneuropathy

Low-intensity laser therapy (LILT) can be applied in cases when patients with diabetic polyneuropathy (DPN) suffer from chronic severe neuropathic pain. We wanted to analyse influence of LILT on spatial perception threshold (SPT) and electroneurographic (ENG) parameters in patients with painful DPN. We analysed 45 patients (25 males), average age 54.3 years (54.3 +/- 10.9), with clinical and ENG signs of painful DPN. The patients were divided into two groups: A and B. Group A consisted of 30 patients with DPN who had 30 LILT treatments over the period of 12 weeks and group B consisted of 15 patients with DPN who received only vitamin therapy per os within the same period. Prior to and after 12 weeks of treatment, the following ENG parameters were determined using surface electrodes: motor (MCV) and sensory conduction velocities (SCV) values (in m/s) of nervus (n.) peroneus (NP), n. tibialis (NT) and n. medianus (NM) and their motor distal latency (MDL) values (in ms). SPT value (score as number from 1 to 8) was determined with Tactile Circumferential Discriminator on dorsal part of foot's big toe skin. For statistical analysis, we used Student's t-test and Pearson correlation (sig. 2 tailed) study. RESULTS; We registered statistically significant difference between SPT (p < 0.01) values prior to (5.25 +/- 1.11) and after (4.87 +/- 0.90) LILT, as well as NMMCV (p < 0.05) values prior to (47.18 +/- 5.08) and after (49.12 +/- 3.72) LILT. Besides, we registered, only after LILT, statistically significant correlation beetwen SPT and NMDML (p < 0.01) values and also beetwen SPT and NMSCV (p < 0.05) values. The differences and correlations beetwen other analysed parameters before and after treatments were not significant (p > 0.05). In this study we registered significant decrease of SPT and increase of NMMCV after LILT and that indicated a favourable effect of this treatment in analysed patients with painful DPN. In our opinion these results need further investigation.

ELECTRONEUROGRAPHY IN GUILLAIN‐BARRE, SYNDROME (GBS): SENSITIVITY AND SPECIFICITY

We assessed clinical sensitivity and specificity of different electroneurographic (ENG) parameters versus clinical diagnosis of GBS.Clinical data of 24 patients affected by upper and lower limb neuropathy were revised. In all the patients the neurophysiologic examination was performed according to the AAEM guidelines for GBS diagnosis. Fourteen patients (10 males, mean age 47.9, range 13‐70, and 4 females 71.5, 69–76) received a diagnosis of GBS. The non‐GBS group included nine males (59.11, 35–78) and one female (41 years) with different neuropathies (3 diabetic, 2 alcoholic, 5 unknown ethiology). Sensitivity and specificity of various neurophysiologic parameters were calculated.The single classical neurophysiological paremeters gave variable values of sensitivity and specificity. The new variables we introduced, Polineuropathy (diffusion of abnormal findings and F ‐ Wave latency) and Demyelination (distal motor evoked potential amplitude and/or motor conduction blocks) gave the highest value of sensitivity and specificity, when associated.

NORMATIVE VALUES OF THE MOST COMMON ELECTRONEUROGRAPHIC PARAMETERS IN PEOPLE AGED FROM SEVENTY FIVE TO NINETY

The average lifespan is 78 years for women and 74 years for men. By the year 2025, the average life expectancy for Italians is estimated to reach 82 years. Today people aged 70 years or more will no longer accept illnesses as in the past. In our lab, the number of older outpatients referred for a neurophysiological tests is increasing continously. Patients above 75 years represent 9% of the total number of our outpatients. Generally, the normative values of the majority of the most common electroneurographic parameters are available until a maximum age of 75–80 years. We examined 49 patients (28 women and 21 men). The examined parameters were motor nerve conduction (MNC) along median, ulnar, peroneal, posterior tibialis, axillary, and musculocutaneous nerves, and sensory nerve conductions (SNC) along median, ulnar, and superficial peroneal nerves.

Reproducibility of normal facial motor nerve conduction studies and their relevance in the electrophysiological assessment of peripheral facial paralysis

To determine the intra-examiner intertrial reproducibility of normal facial motor nerve conduction studies (FNCS) and their relevance in electrophysiological assessments of peripheral facial paralysis, 52 patients with acute unilateral Bell's palsy were examined on two separate occasions 1 months apart. Three electroneurographic methods were assessed. On the unaffected side of the face, FNCS are reliable when performed by a single examiner over time. Nevertheless, compound muscle action potential (CMAP) baseline-to-peak and peak-to-peak amplitude showed a rather high intertrial variability. Reproducibility of the assessed surface electrode recording procedures was similar. Regarding the affected side, in patients with mild axonotmesis of the facial nerve variations of electroneurographic parameters 1 months apart fell within the range of normal intertrial variability. In patients with severe or moderate axonotmesis, the distal latency and the M wave amplitude variations showed significant intertrial variations. Reproducibility of FNCS appears to be similar to that found in limb motor nerves. Normal variability curtails the sensitivity of FNCS in detecting mild facial nerve axonotmesis, although this technique remains useful in severe cases.

Effect of Hemodialysis and Hemodiafiltration on Uremic Neuropathy

This study was undertaken to compare the effect of 1 year hemodialysis (HD) or hemodiafiltration (HDF) treatment on peripheral neuropathy. Thus 21 of 42 patients on chronic HD (1-1.3 m2 cuprophane dialyzer, Qb 300 ml/min) were switched to HDF (1.3 m2 polysulfone dialyzer, Qb 400 ml/min, substitution volume 9-13 liters, ultrafiltration rate 60-70 ml/min), while the remaining patients were considered as a control group. Treatment time was scheduled both in HD and HDF to maintain adequate BUN levels in relation to protein catabolic rate. However, HDF provided a significantly greater weekly inulin (MW 5,000) clearance than HD (5.8 +/- 1.2 vs. 1.6 +/- 0.2 ml/min; p less than 0.001). HD and HDF groups were comparable for age, time on dialysis and starting electroneurographic parameters, which were on average within the normal range. After 1 year follow-up, creatinine, hematocrit, calcium, phosphate, PTH, BUN, protein catabolic rate and residual GFR were comparable in the two groups, whereas beta 2-microglobulin was significantly reduced in HDF patients (29 +/- 6.7 vs. 38.8 +/- 13.9 mg/l in HD patients, p less than 0.01). During the 1-year treatment, electroneurographic parameters did not change in HDF patients, whereas a significant decrease of ulnar motor nerve conduction velocity, ulnar muscle action potential amplitudes, median sensory nerve conduction velocity and peroneal muscle action potential amplitudes was detected in HD patients. We conclude that HDF might prevent the worsening of the electroneurographic indices occurring during chronic HD treatment, as it provides a more effective removal of middle and larger molecules than HD. The use of a more biocompatible membrane in HDF might further contribute to this favorable effect on uremic neuropathy.

An electroneurographic assessment of subclinical lead neurotoxicity.

While heavy exposure to inorganic lead is capable of inducing symptomatic neuropathy in man, the subclinical neuropathy due to low levels of occupational lead exposure remains to be proved. The reported results of electroneurographic studies on lead workers, however, have been controversial. In this study, 40 lead smeltery workers and 50 non-exposed referents were investigated. The air concentrations of lead at worksites were 0.25 to 42.5 mg/m3. The geometric means of PbB, PbU and delta-ALAU in lead exposed group were 40.03 micrograms/dl, 71 micrograms/l and 4.68 mg/l respectively, which were significantly higher (P less than 0.001) than those (7.01 micrograms/dl, 6.0 micrograms/l and 1.81 mg/l respectively) in the reference group. There were no clinical symptoms or signs of nerve damage in either group. Alcoholism and diabetes were excluded in both groups. Nerve conduction velocity was measured by a DISA 1500 electromyograph in both groups. Eleven electroneurographic parameters, including motor nerve conduction velocity (MCV) and distal latency (DML) of median, ulnar and peroneal nerves as well as sensory nerve conduction velocity (SCV) and distal latency (DSL) of median, ulnar and sural nerves, showed statistically significant differences between the two groups. However, the results of electroneurographic measurements of each individual in the lead-exposed group were all within the normal range. There was no correlation between the blood-lead levels and the neurophysiological measurements except for the median MCV. No correlation was seen between the median MCV and the exposure duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Sensitivity and localizing significance of motor and sensory electroneurographic parameters in the diagnosis of ulnar nerve lesions at the elbow. A reappraisal.

A total of 103 patients (40 with pure sensory disturbances, 63 with sensory and motor deficits) with ulnar nerve lesions at the elbow were examined neurophysiologically. The measurement of motor conduction velocity across the cubital tunnel alone did not completely localize the lesion. The latency to an ulnar-innervated flexor muscle was of outstanding importance. The measurement of amplitudes was only rarely of localizing significance. The results of sensory recording proved to be important in patients with pure sensory disturbances. In cases with additional motor deficits, sensory recordings were too often abnormal in all segments of the ulnar nerve to be of substantial localizing value.

Relationship between sensory nerve conduction and temperature of the hand

Electroneurographic and thermographic investigations were carried out in 32 persons. Sensory nerve conduction velocity, the amplitude of sensory nerve potential, subjective and objective electrical threshold were determined during the stimulation of each finger. Thermograms were taken before and after the standard cooling test. Statistical analysis has revealed that all the results of electroneurographic and thermographic parameters obtained from the fingers of the same person as well as of all investigated persons are directly connected. Highly significant (p = 0.001 and 0.01) correlations of second degree were found between electroneurographic and temperature parameters.

Sensory electroneurographic parameters and clinical recovery in sutured human nerves

The tissue distribution of toxic doses of 14C-acid-, 14C-alcohol-, and 14C-cyano-labeled deltamethrin was followed after iv administration to rats. All three radiolabeled preparations were found in every tissue examined within 1 min of injection. Peak central nervous system (CNS) levels were achieved within 1–5 min, but did not correspond to the onset of choreoathetosis. In the majority of the tissues examined the levels of deltamethrin label were similar, proportionately, to those found after administration of alcohol-labeled cismethrin. A major exception was the CNS which contained approximately 20% of the anticipated level of radiolabel suggesting that the CNS threshold for deltamethrin was approximately 0.5–1.0 nmol/g. Progressive accumulation of radioactivity in the erythrocyte fraction of the blood was observed following administration of cyano-labeled deltamethrin. This may contribute to the selective retention of 14C with this radiolabeled preparation.

Sensory electroneurographic parameters and clinical recovery of sensibility in sutured human nerves.

A total of 37 patients with traumatic transection of median or ulnar nerves at the wrist (total 41 nerves) were examined clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. There was a significant increase of cumulative amplitude with the time after suture, whereas maximum sensory nerve conduction velocity and maximum amplitude of nerve action potentials did not reveal such a correlation. The recovery of two-point discrimination, vibration threshold and sensibility scored according to the scale of Nicholson and Seddon were also not related to the passage of time after operation. Though there were significant correlations between cumulative amplitude and both two-point discrimination and recovery of sensibility, electrophysiological parameters were shown to be inadequate predictors of clinical recovery.

Uremic neuropathy: correlations between electroneurographic parameters and serum levels of parathyroid hormone and aluminum.

An electrophysiological investigation on 29 dialysis patients was performed with the aim of verifying whether serum parathyroid hormone (PTH) and aluminum (Al) levels may play a role in the pathogenesis of uremic neuropathy. All patients except 1 showed electrophysiological abnormalities. Both PTH and Al levels were found to be significantly correlated with the time on dialysis. On the contrary, the values of each single electroneurographic parameter did not show any correlation with the duration of dialysis, PTH levels and Al levels. The authors conclude that PTH and Al does not seem to play a role in the etiology of uremic neuropathy.