Nerve Conduction Velocity Measurements Research Articles

Duloxetine to prevent neuropathy in breast cancer patients under paclitaxel chemotherapy (a double-blind randomized trial).

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the major side effects and main reasons for affecting quality of life and dose reduction or even discontinuation of treatment in breast cancer patients. One of the most widely prescribed chemotherapies is the "taxanes." Considering that duloxetine has been used in treating neuropathies in recent years, this study aimed to investigate its effectiveness in preventing taxane-related neuropathy. This is a randomized controlled trial on 47 patients: 24 received a placebo and 23 received duloxetine at 30mg daily in the first week following the injection of paclitaxel and 60mg during the second week in each chemotherapy cycle. Patients objective (nerve conduction velocity (NCV) values) and subjective symptoms (visual analog scale including; neuropathy, paresthesia, pain, cold sensitivity, and numbness), the grades of the patients' neuropathy (calculated according to Common Terminology Criteria for Adverse Events (CTCAE) v.5), and the presence of complications, before and after each chemotherapy cycle, were recorded. The placebo group experienced significantly higher occurrences of new neuropathy (8/23 in duloxetine vs 16/24 in placebo, P = 0.029) in NCV by tibial nerve latency (- 0.28% vs 19.87%, P = 0.006), tibial amplitude (4.40% vs - 10.88%, P = 0.049), and median nerve latency (8.72% vs 31.16%, P = 0.039); administration of duloxetine significantly reduced the scores of neuropathies (P < 0.001), pain (P = 0.027), during chemotherapy, and 6weeks later; however, no significant effect was observed on paresthesia, numbness, cold sensitivity, and other NCV measurements. Paclitaxel can cause neuropathy, lasting for a long time. Our study showed duloxetine is potentially an effective medication that can prevent subjective and objective neuropathy.

Duloxetine to prevent neuropathy in breast cancer patients under paclitaxel chemotherapy (a double-blind randomized trial).

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the major side effects and main reasons for affecting quality of life and dose reduction or even discontinuation of treatment in breast cancer patients. One of the most widely prescribed chemotherapies is the "taxanes." Considering that duloxetine has been used in treating neuropathies in recent years, this study aimed to investigate its effectiveness in preventing taxane-related neuropathy. This is a randomized controlled trial on 47 patients: 24 received a placebo and 23 received duloxetine at 30mg daily in the first week following the injection of paclitaxel and 60mg during the second week in each chemotherapy cycle. Patients objective (nerve conduction velocity (NCV) values) and subjective symptoms (visual analog scale including; neuropathy, paresthesia, pain, cold sensitivity, and numbness), the grades of the patients' neuropathy (calculated according to Common Terminology Criteria for Adverse Events (CTCAE) v.5), and the presence of complications, before and after each chemotherapy cycle, were recorded. The placebo group experienced significantly higher occurrences of new neuropathy (8/23 in duloxetine vs 16/24 in placebo, P = 0.029) in NCV by tibial nerve latency (- 0.28% vs 19.87%, P = 0.006), tibial amplitude (4.40% vs - 10.88%, P = 0.049), and median nerve latency (8.72% vs 31.16%, P = 0.039); administration of duloxetine significantly reduced the scores of neuropathies (P < 0.001), pain (P = 0.027), during chemotherapy, and 6weeks later; however, no significant effect was observed on paresthesia, numbness, cold sensitivity, and other NCV measurements. Paclitaxel can cause neuropathy, lasting for a long time. Our study showed duloxetine is potentially an effective medication that can prevent subjective and objective neuropathy.

Small Molecule Positive Modulator of Hepatocyte Growth Factor (HGF)/MET, ATH-1105, Improves Function and Reduces Disease Biomarkers in a TDP-43 Mouse Model of Amyotrophic Lateral Sclerosis (P8-8.007)

<h3>Objective:</h3> Evaluate the preclinical efficacy of the small molecule positive modulator of hepatocyte growth factor (HGF)/MET, ATH-1105, in a mouse model of amyotrophic lateral sclerosis (ALS). <h3>Background:</h3> Activation of the MET receptor by HGF promotes neuroprotective, neurotrophic, and anti-inflammatory mechanisms. Small molecule positive modulators of HGF/MET, including ATH-1105, have been developed to explore the therapeutic potential of this target. ALS is characterized by progressive motor neuron degeneration and demyelination, accompanied by systemic inflammation and pathological aggregation of TAR DNA-binding protein 43 (TDP-43) in 97% of patients. We hypothesized that treatment with ATH-1105 would be beneficial in a TDP-43 mouse model of ALS. <h3>Design/Methods:</h3> ATH-1105 at 10 or 20 mg/kg was orally administered daily to male Prp-TDP43_A315T mice (n=10/group) for two months. At baseline and after one and two months of treatment, we conducted a battery of motor behavior tests, and assessed sciatic nerve health by compound muscle action potential (CMAP) and nerve conduction velocity (NCV) measurements. Plasma biomarkers of inflammation (IL-6, TNF-α) and neurodegeneration (neurofilament light chain [NfL]) were interrogated after one and two months of treatment. Sciatic nerves were stained for quantification of axonal and myelin parameters as well as phospho-TDP-43 aggregation at study termination. <h3>Results:</h3> The deterioration of motor function in TDP-43 animals was significantly mitigated in a dose-dependent manner after treatment with ATH-1105, and significant functional improvement of sciatic nerve conduction was observed. Additionally, plasma levels of all biomarkers assessed were significantly decreased, indicating reduced systemic inflammation and neurodegeneration in treated TDP-43 mice. Sciatic nerve histology revealed a protection of motor axon numbers and myelination, as well as a reduction in axonal phospho-TDP-43 aggregation by ATH-1105. <h3>Conclusions:</h3> ATH-1105 was found to be protective across a multitude of functional and structural measures of ALS disease progression. These findings support the continued development of this small molecule positive modulator of HGF/MET for ALS. <b>Disclosure:</b> Mrs. Kleist has received personal compensation for serving as an employee of Athira Pharma. Mrs. Kleist has received personal compensation for serving as an employee of Alpine Immune Sciences. Mrs. Kleist has stock in Athira Pharma. Mrs. Kleist has stock in Alpine Immune Sciences. Dr. Berthiaume has received personal compensation for serving as an employee of Athira Pharma. Dr. Berthiaume has stock in Athira Pharma. An immediate family member of Dr. Berthiaume has stock in Athira Pharma. Dr. Johnston has received personal compensation for serving as an employee of Athira Pharma, Inc. Dr. Johnston has stock in Athira Pharma, Inc. An immediate family member of Dr. Johnston has stock in Athira Pharma, Inc. Dr. Johnston has received intellectual property interests from a discovery or technology relating to health care. Dr. Reda has received personal compensation for serving as an employee of Athira Pharma, Inc. . Dr. Reda has stock in Athira Pharma, Inc. . Dr. Moebius has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for Athira Pharma, Inc.. Dr. Moebius has stock in Athira Pharma, Inc.. Dr. Church has received personal compensation for serving as an employee of Athira Pharma. Dr. Church has stock in Athira Pharma. Dr. Church has received intellectual property interests from a discovery or technology relating to health care.

Increase in conduction velocity in myelinated nerves due to stretch - An experimental verification.

Based on published experimental evidence, a recent publication revealed an anomalous phenomenon in nerve conduction: for myelinated nerves the nerve conduction velocity (NCV) increases with stretch, which should have been the opposite according to existing concepts and theories since the diameter decreases on stretching. To resolve the anomaly, a new conduction mechanism for myelinated nerves was proposed based on physiological changes in the nodal region, introducing a new electrical resistance at the node. The earlier experimental measurements of NCV were performed on the ulnar nerve at different angles of flexion, focusing at the elbow region, but left some uncertainty for not reporting the lengths of nerve segments involved so that the magnitudes of stretch could not be estimated. The aim of the present study was to relate NCV of myelinated nerves with different magnitudes of stretch through careful measurements. Essentially, we duplicated the earlier published NCV measurements on ulnar nerves at different angles of flexion but recording appropriate distances between nerve stimulation points on the skin carefully and assuming that the lengths of the underlying nerve segment undergoes the same percentages of changes as that on the skin outside. We found that the percentage of nerve stretch across the elbow is directly proportional to the angle of flexion and that the percentage increase in NCV is directly proportional to the percentage increase in nerve stretch. Page's L Trend test also supported the above trends of changes through obtained p values. Our experimental findings on myelinated nerves agree with those of some recent publications which measured changes in CV of single fibres, both myelinated and unmyelinated, on stretch. Analyzing all the observed results, we may infer that the new conduction mechanism based on the nodal resistance and proposed by the recent publication mentioned above is the most plausible one to explain the increase in CV with nerve stretch. Furthermore, interpreting the experimental results in the light of the new mechanism, we may suggest that the ulnar nerve at the forearm is always under a mild stretch, with slightly increased NCV of the myelinated nerves.

Selenium deficiency is associated with polyneuropathy in primary Sjögren's syndrome.

Selenium plays an important role in the regulation of the immune system. Selenium deficiency is associated with Hashimoto's thyroiditis, a common comorbidity in primary Sjögren's syndrome (pSS). Therefore we aimed to identify whether or not selenium deficiency is also associated with pSS. 107 consecutive female patients with pSS and, as a control, 59 female patients with axial spondyloarthritis were recruited. Later, 11 male pSS patients, 5 of these suffering from polyneuropathy, and 15 male axSpA patients were additionally recruited in order to confirm the results from the female patients. All patients were consulted about their diet and food intolerances and their plasma selenium concentrations were analyzed. Current and previous extraglandular manifestations of pSS were recorded. Patients complaining of misperceptions and tingling paraesthesia underwent measurement of nerve conduction velocity. The proportion of patients and controls with a selenium deficiency was compared using Fisher's exact test. The proportion of female pSS patients with a low selenium concentration <0.63μmol/L (22.4%) was significantly higher than of the controls (1.7%) (p<0.001). Within the group of female patients with pSS, selenium deficiency was significantly associated with the presence of polyneuropathy (45.8% with vs 14.5% without polyneuropathy, p=0.003) and particularly polyneuropathy with motor nerve involvement measured by nerve conduction velocity (41.7% with vs 10.8% without motor neuropathy, p=0.001). The mean selenium concentrations of the 5 male pSS patients with polyneuropathy were significantly lower compared to the 6 pSS patients without polyneuropathy and to the 15 male axSpA controls. PSS and in particular its complication polyneuropathy is associated with selenium deficiency. Measurement of the selenium concentration in blood is advisable in patients with pSS and in particular in the subset of patients with polyneuropathy. Substitution of selenium may be a possible therapy of polyneuropathy associated with pSS.

Efficacy of electroacupuncture with different frequencies in the treatment of chemotherapy-induced peripheral neuropathy: A study protocol for a randomized controlled trial.

IntroductionChemotherapy-induced peripheral neuropathy (CIPN) is a common complication in patients with cancer during chemotherapy. It mainly leads to severe numbness of the hands and feet and causes great pain in patients. Electroacupuncture (EA) is considered to be beneficial in improving peripheral neuropathy and relieving numbness of the hands and feet. This trial aims to evaluate the therapeutic effect of different frequencies of EA on CIPN in patients with cancer.Methods and analysisThis study is a randomized controlled trial. In total, 160 eligible CIPN patients are randomly assigned to the 2 Hz EA group, 100 Hz EA group, 2/100 Hz EA group, and control group in the ratio of 1:1:1:1. All patients in the EA treatment groups receive treatment with EA three times a week for 4 weeks and following up for 4 weeks. The patients in the control group are given Mecobalamin (MeCbl) tablets orally, one tablet at a time, three times a day, for 4 weeks, and following up for 4 weeks. The primary outcome measures are the participant neurotoxicity questionnaire (PNQ) and the peripheral neurotoxicity assessment rating (NCI CTCAE V5.0). Secondary outcomes are the quality of life scale (EORTC QLQ-C30) and the measurement of peripheral nerve conduction velocity (NCV). The results are evaluated at baseline, post-treatment phase, and following up for 4 weeks. All major analyses are based on the intention to treat principle.Ethics/disseminationThis protocol was approved by the Medical Ethics Committee of the Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) on 7 December 2021. The license number is IRB-2021-458. This study provides clinical efficacy data of different frequencies of EA in the treatment of CIPN. The results help to prove whether EA is an effective therapy for CIPN and optimize the frequency of EA for CIPN. The results of this study are shared with health care professionals, the public, and relevant organizations through the publication of manuscripts and conference reports.Trial registration numberChiCTR2100054458.

Surgical Procedures Required for Measurement Reduce Nerve Conduction Velocity: An In Vivo and In Vitro Comparative Study

Background: Although in vitro methods have disadvantages, they are still commonly used to measure nerve conduction velocity (NCV) in experimental studies. Therefore, this study was designed to demonstrate the effect of the surgical procedures required for in vitro methods on nerve fibers and the effect of in vivo and in vitro methods on the results of electrophysiological measurements. Methods: Rats were assigned to the in vivo (control-1, injury-1, and diabetic-1) and in vitro (control-2, injury-2, and diabetic-2) groups. The NCV and compound action potential amplitudes were measured, and the nerve fibers were histologically examined. Results: Damaged axons and myelin sheaths were observed in the control-2 group. The electrophysiological values of the in vitro groups were lower than those of the in vivo groups. Furthermore, these values were lower for the diabetic and injury groups than for the control groups. Conclusions: This study showed that the surgical procedures required for the in vitro method reduced the measured values. Owing to the previous and current disadvantages of the in vitro method, the in vivo method was more sensitive for the NCV measurement. Moreover, measurements can be performed using the current in vivo method for small nerve fibers.

Withdrawal: “Efficacy of cervical manual therapy plus conventional physical therapy on clinical outcomes in patients with carpal tunnel syndrome: A double blind randomized controlled trial” Milad Zarrin, Maryam Saadat, Mohammad Jafar Shaterzadeh Yazdi, Davood Shalil Ahmadi

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Current physical therapy treatment options show limited effects or low-quality evidence, especially in the long-term. To date, there has been little research to look at the effects of treating the cervical spine for decreasing symptoms distally to the carpal tunnel. So the aim of this study was to compare the effects of cervical manual therapy plus conventional physical therapy with conventional physiotherapy only in Carpal Tunnel Syndrome Subjects. A group of 46 patients with CTS was randomly allocated into two groups: Cervical manual therapy plus conventional physiotherapy (n = 23), and conventional physiotherapy (n = 22). All patients received 10 sessions of supervised intervention treatment for 2 weeks. The efficacy of the therapies was assessed before initiation of therapy and after completion of therapy using a visual analog scale (VAS), a symptom severity scale, the functional capacity scale of the Boston Carpal Tunnel Questionnaire (BCTQ), functional status of DASH questionnaire, measurement of median nerve motor distal latency (mMDL) and median sensory nerve conduction velocity (mSNCV). Cervical manual therapy plus conventional physiotherapy group showed significantly greater improvement in VAS, DASH score, mMDL and mSNCV (p < 0.05) compared to the conventional group. There was no significant difference in BCTQ for two groups (p > 0.05). The analysis of the results showed that conventional physiotherapy combined with Cervical manual therapy could be more effective in improving the pain, functional abilities, median nerve motor distal latency and median sensory nerve conduction velocity of patients with CTS compared with conventional physiotherapy only.

Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial.

Aim: To investigate the effect of normalizing vitamin B12 (B12) levels with oral B12 (methylcobalamin) 1000 μg/day for one year in patients with diabetic neuropathy (DN). Patients and methods: In this prospective, double-blind, placebo-controlled trial, 90 patients with type 2 diabetes on metformin for at least four years and both peripheral and autonomic DN were randomized to an active treatment group (n = 44) receiving B12 and a control group (n = 46) receiving a placebo. All patients had B12 levels less than 400 pmol/L. Subjects underwent measurements of sural nerve conduction velocity (SNCV), sural nerve action potential (amplitude) (SNAP), and vibration perception threshold (VPT), and they performed cardiovascular autonomic reflex tests (CARTs: mean circular resultant (MCR), Valsalva test, postural index, and orthostatic hypotension). Sudomotor function was assessed with the SUDOSCAN that measures electrochemical skin conductance in hands and feet (ESCH and ESCF, respectively). We also used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE, respectively) and questionnaires to evaluate quality of life (QoL) and level of pain (pain score). Results: B12 levels increased from 232.0 ± 71.8 at baseline to 776.7 ± 242.3 pmol/L at follow-up, p < 0.0001, in the active group but not in the control group. VPT, MNSIQ, QoL, pain score, SNCV, SNAP, and ESCF significantly improved in the active group (p < 0.001, p = 0.002, p < 0.0001, p < 0.000, p < 0.0001, p < 0.0001, and p = 0.014, respectively), whereas CARTS and MNSIE improved but not significantly. MCR, MNSIQ, SNCV, SNAP, and pain score significantly deteriorated in the control group (p = 0.025, p = 0.017, p = 0.045, p < 0.0001, and p < 0.0001, respectively). Conclusions: The treatment of patients with DN with 1 mg of oral methylcobalamin for twelve months increased plasma B12 levels and improved all neurophysiological parameters, sudomotor function, pain score, and QoL, but it did not improve CARTS and MNSIE.

Sympathetic innervation of canine pulmonary artery and morphometric and functional analysis in dehydromonocrotaline-induced models after pulmonary artery denervation.

We aimed to describe the anatomic distribution of periarterial pulmonary sympathetic nerves and to observe the long-term morphometric and functional changes after pulmonary artery denervation (PADN), a novel therapy for pulmonary arterial hypertension (PAH). A total of 45 beagles were divided into a sympathetic innervation group (n = 3, 33.3% were females), a PAH group (n = 35, 34.3% were females) and a control group (n = 7, 28.5% were females). The PAH group was randomly divided into no-PADN (n = 7), instant-PADN (n = 7), 1M-PADN (n = 7), 2M-PADN (n = 7) and 3M-PADN (n = 7) subgroups. The sympathetic innervation group was sacrificed to reveal the sympathetic innervation of pulmonary arteries. PAH was induced by injecting dehydromonocrotaline (DHMCT) through the right atrium. The pulmonary capillary wedge pressure, right ventricular systolic pressure, right ventricular mean pressure, pulmonary artery systolic pressure and pulmonary artery mean pressure of each group were continuously measured. The cardiac output was detected to calculate the pulmonary vascular resistance. PAH and control groups were subjected to immunofluorescence assay, sympathetic nerve conduction velocity measurement and transmission electron microscopy. The no-PADN group had significantly higher PVSP, PVMP, pulmonary artery systolic pressure, pulmonary artery mean pressure and pulmonary vascular resistance but lower cardiac output than those of the control group (P < 0.05). Instant-PADN, 1M-PADN, 2M-PADN and 3M-PADN groups had significantly lower PVSP, PVMP, pulmonary artery systolic pressure, pulmonary artery mean pressure and pulmonary vascular resistance but higher cardiac output than those of the no-PADN group (P < 0.05). Most sympathetic nerves were located within 2.5 mm of the intimae of the bifurcation and proximal trunk, mainly in the left trunk. The diameter and cross-sectional area of myelinated fibres in the PAH group were significantly larger than those of the control group. Sympathetic nerve conduction velocity of the PAH group gradually decreased, and nerve fibres were almost demyelinated 3 months after PADN. PADN effectively relieved dehydromonocrotaline-induced canine PAH and decreased sympathetic nerve conduction velocity.

Vasomodulation of peripheral blood flow by focused ultrasound potentiates improvement of diabetic neuropathy

ObjectiveEffective treatment methods for diabetic peripheral neuropathy are still lacking. Here, a focused ultrasound (FUS) technique was developed to improve blood flow in diabetic peripheral vessels and potentially treat diabetic...

Клинико-электронейромиографический алгоритм топической диагностики синдрома мышечной гипотонии у детей раннего возраста

Study Objective: To develop a clinical electroneuromyography (ENMG) protocol based on routine electromyography (EMG), standardization of needle EMG, and EMG parameters of the suprasegmental structures, for localization diagnosis of hypotonia syndrome (HS) in young children. Study Design: This was a comparative prospective study. Materials and Methods: One hundred and twenty-three patients, aged 1 month to 3 years, with HS of various origin underwent clinical examination and EMG. The following techniques were used for localization diagnosis by ENMG: surface EMG, needle EMG, measurement of nerve conduction velocity in peripheral motor and sensory nerves in the upper and lower limbs, F-wave measurement, and rhythmic stimulation. Study Results: The authors evaluated the possibility of describing suprasegmental disorders using the following parameters: F-wave monomorphism, myotatic reflex, and amplitude of voluntary muscular contractions. They proposed a clinical ENMG protocol for localization diagnosis of HS and a pediatric protocol for needle EMG; these approaches increased the rate of detecting HS up to 90-100%. They also developed a pediatric linear protocol for needle EMG to differentiate between myogenic and central HS. Conclusion: The study results demonstrated the high diagnostic value of ENMG-based differential diagnosis of HS, relying on the proposed protocols and on parameters indicating the condition of the suprasegmental structures. Keywords: neuromuscular disorders, hypotonia syndrome, electroneuromyography, diagnostic protocol, young children.

Comparing the Diagnostic Accuracy of Simple Tests to Screen for Diabetic Peripheral Neuropathy: Protocol for a Cross-Sectional Study.

BackgroundVarious tests are used to detect diabetic peripheral neuropathy by assessing sense perception in the feet. Tests vary in terms of time and resources required. Simple tests are those that can be conducted quickly and easily in primary care without laboratory equipment. There are some limitations to these simple tests, an example being the variable amplitude of the 128 Hz tuning fork. A new test, VibraTip (McCallan Medical, UK), might be a valuable alternative as it emits a consistent amplitude and may offer improved diagnostic accuracy.ObjectiveThe aims of this study are to estimate the diagnostic accuracy of the VibraTip device for diabetic peripheral neuropathy against the reference standard of sural nerve conduction velocity measurement, and to assess whether the VibraTip offers superior diagnostic accuracy to other routine tests based on vibration or touch.MethodsThe study will prospectively recruit adults with type 2 diabetes who are due to attend a routine follow-up clinic. A cross-sectional study design will be employed to assess the diagnostic accuracy of 5 standard index tests for peripheral neuropathy, including VibraTip. The reference test will be sural nerve conduction velocity measurement.ResultsFunding is being sought to conduct this research. The outcomes assessed will be the diagnostic accuracy of the 5 index tests against sural nerve conduction velocity measurement, including sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic curves will be constructed and compared for each test.ConclusionsThis study will be the first within-study comparison of 5 simple tests for screening diabetic peripheral neuropathy and will address uncertainties in the potential benefits of using VibraTip in comparison with the other tests.

High Prevalence and Incidence of Diabetic Peripheral Neuropathy in Children and Adolescents With Type 1 Diabetes Mellitus: Results From a Five-Year Prospective Cohort Study

BackgroundIn this prospective cohort study, we investigated the prevalence of diabetic peripheral neuropathy at baseline and after five years of follow-up in children and adolescents with type 1 diabetes mellitus using both measurements of nerve conduction velocity and clinical neurological examination. MethodsA total of 38 patients who underwent insulin pump or intensive insulin therapy were included. The subjects averaged 12.6 ± 2.4 years of age and their diabetes duration averaged 5.6 ± 3.2 years. All patients underwent a detailed physical, neurological, and electrophysiological examination, as well as laboratory testing at their annual checkup. ResultsAt baseline, the prevalence of diabetic peripheral neuropathy diagnosed using neurological examination was 13.2%, whereas nerve conduction velocity testing revealed diabetic peripheral neuropathy in 31.6%, highlighting a high prevalence of subclinical diabetic peripheral neuropathy. During follow-up, there was a strong increase in the prevalence of clinically diagnosed diabetic peripheral neuropathy, which reached 34.2% (P = 0.039) after five years; the proportion of patients with subclinical diabetic peripheral neuropathy even reached 63.2% (P = 0.002). The most significant changes in electrophysiological parameters were observed in the tibial sensory nerve (P = 0.001). ConclusionsThe prevalence of diabetic peripheral neuropathy in children and adolescents with type 1 diabetes mellitus was high, and there was a rapid increase in the prevalence of diabetic peripheral neuropathy during a five-year follow-up interval. Importantly, our data show that a mere clinical evaluation is not sensitive enough to diagnose diabetic peripheral neuropathy in these patients. Nerve conduction velocity measurement, which is regarded as the gold standard for the assessment of diabetic peripheral neuropathy, should be applied more broadly.

Comparison of Ultrasonography and Short-Segment Nerve Conduction Study in Ulnar Neuropathy at the Elbow

ObjectiveTo assess the correlation between ultrasonographic and electrodiagnostic findings to determine the localization of the ulnar trapping at the elbow. DesignCross-sectional and noninterventional trial. SettingPhysical medicine and rehabilitation department of a teaching hospital. ParticipantsPatients (N=14) diagnosed with ulnar nerve entrapment using short-segment nerve conduction study. InterventionsThe elbow area was divided into 4 segments with 2-cm intervals. All patients underwent ultrasonographic and electrodiagnostic examinations. Main Outcome MeasuresThe nerve conduction velocity (NCV) of each segment was measured. The cross-sectional area (CSA) of the ulnar nerve was measured at 5 levels. The proximal CSA/distal CSA ratio (PDR) was calculated by proportioning the CSA values for each segment. The highest PDR was accepted as a trapping segment, whereas the segment with the lowest NCV was accepted electrophysiologically (provided it was <50m/s). ResultsA total of 80 PDR and NCV measurements were taken from 20 elbows. A statistically significant negative correlation (r=−.554; P<.001) was found between general PDR and NCV values. When we assumed that the NCV value <50m/s as the criterion standard for diagnosis, the cutoff value for the PDR was found to be 1.08, with a sensitivity of 70% and a specificity of 92.5%. The minimum NCV value and the maximum PDR value were mostly seen in the third segment compatible with the cubital tunnel. ConclusionsUltrasonography seems to be advantageous because it is more comfortable for the patient and requires shorter time than does electroneuromyography. To our knowledge, this is the first study to detect ulnar nerve entrapment by using not only CSA but also PDR as a ratio method with ultrasound.

Influence of Diabetes and Hemodialysis against Nerve Conduction Studies

Background: Diabetic peripheral neuropathy (DPN) has been prevalent and discussed, and nerve conduction studies (NCS) has been continued. We have checked NCS using recently introduced useful DPN-Check device. Subjects and Methods: The subjects were 66 patients (pts) classified into 4 groups according to existence of diabetes mellitus (DM) and hemodialysis (HD); Group1: DM (+), HD (+) in 15 pts, group 2: DM (-), HD (+) in 15 pts, group 3: DM (+), HD (-) in 20 pts, group 4: 16 healthy controls. Methods included measurements of sural nerve conduction velocity (SNCV) and sural nerve action potential (SNAP) using HDN-1000. Results: Average age in each group was 64.4 years to 72.6 years. SNCV value of 4 group in average was 37.1 m/sec, 46.3 m/sec, 49.3 m/sec, 53.2 m/sec, respectively, and value of group 1 was significantly lower than those of group 2,3,4 (p<0.01). Similarly, average SNAP was 4.1 μV, 8.7 μV, 8.0 μV, 21.6 μV, respectively, and group 1,2,3 were significantly lower than group 4 (p<0.01). There was significant correlation between SNCV and SNAP in all subjects (p<0.01). Significant correlations were shown between DM duration and SNCV, and DM duration and SNAP (p<0.01). Discussion and Conclusion: SNCV and SNAP were measured successfully and easily by HDN-1000, indicating clinical availability. Obtained data suggested that 1) SNCV is not significantly decreased due to only uremic neuropathy, 2) SNCV is significantly decreased in patients with both HD and DM, 3) SNAP is significantly decreased in patents with DM for years and 4) SNAP would be remarkably decreased when HD is in addition to DM. These results would become the basal data of future NCS for DM and HD.

Quantifying Demyelination in NK venom treated nerve using its electric circuit model.

Reduction of myelin in peripheral nerve causes critical demyelinating diseases such as chronic inflammatory demyelinating polyneuropathy, Guillain-Barre syndrome, etc. Clinical monitoring of these diseases requires rapid and non-invasive quantification of demyelination. Here we have developed formulation of nerve conduction velocity (NCV) in terms of demyelination considering electric circuit model of a nerve having bundle of axons for its quantification from NCV measurements. This approach has been validated and demonstrated with toad nerve model treated with crude Naja kaouthia (NK) venom and also shows the effect of Phospholipase A2 and three finger neurotoxin from NK-venom on peripheral nerve. This opens future scope for non-invasive clinical measurement of demyelination.

Co-Graft of Bone Marrow Stromal Cells and Schwann Cells Into Acellular Nerve Scaffold for Sciatic Nerve Regeneration in Rats

The conventional strategy for bridging large nerve defects, namely nerve autograft transplantation, results in donor-site morbidity. This detrimental consequence currently drives the search for alternatives. The authors used an acellular nerve scaffold filled with bone marrow stromal cells (BMSCs) and Schwann cells (SCs) to enhance regeneration. In 60 adult rats, a 10-mm sciatic nerve defect was bridged with a nerve autograft (positive control), an acellular nerve scaffold (negative control), an acellular nerve scaffold with BMSCs (group I), an acellular nerve scaffold with SCs (group II), or an acellular nerve scaffold with BMSCs plus SCs (group III). After regenerating for 4 and 16 weeks after surgery, nerve regeneration was functionally assessed by a walking track analysis. The compound muscle action potential (CMAP), nerve conduction velocity (NCV) along regenerated sciatic nerves, and gastrocnemius muscle index (GMI) were recorded to assess the conduction properties and extent of denervation atrophy. The number of retrograde-labeled lumbar motor neurons identified by fluorescent dyes in the ipsilateral ventral horn and spinal ganglia were counted to assess the regeneration of axons. After 4 and 16 weeks, improvement of the sciatic function index of the sciatic nerve in group III was statistically greater than that of the negative control group, group I, and group II. At 16 weeks after grafting, obvious differences in the GMI were found among groups. Group III had a statistical increase in GMI compared with the negative control group, group I, and group II. The CMAP and NCV measurements showed comparable results at 16 weeks after reconstruction: group III had statistically better results compared with the negative control group, group I, and group II. Fluorescent dye analysis of the retrograde-labeled lumbar motoneurons in the ipsilateral ventral horn and spinal ganglia showed that more motor neurons in the ipsilateral ventral horns and spinal ganglia were labeled in group III than in the negative control group, group I, and group II at 16 weeks after the operation. All results consistently showed that when BMSCs and SCs were loaded together in an acellular nerve scaffold, functional recovery of the sciatic nerve was enhanced to the greatest degree among the 3 cell-treated groups; furthermore, its beneficial effect on sciatic injury regeneration was similar to the autograft group, although it never exceeded it. This study is a step forward in the search for an alternative to the nerve autograft because it showed that co-grafting of BMSCs and SCs into an acellular nerve scaffold enhanced sciatic nerve functional recovery in rats. Its beneficial effect on sciatic injury regeneration was similar to the autograft group, although it did not exceed it.

Efficacy and safety of nerve growth factor for the treatment of neurological diseases: a meta-analysis of 64 randomized controlled trials involving 6,297 patients.

OBJECTIVE:China is the only country where nerve growth factor is approved for large-scale use as a clinical medicine. More than 10 years ago, in 2003, nerve growth factor injection was listed as a national drug. The goal of this article is to evaluate comprehensively the efficacy and safety of nerve growth factor for the treatment of neurological diseases.DATA RETRIEVAL:A computer-based retrieval was performed from six databases, including the Cochrane Library, PubMed, EMBASE, Sino Med, CNKI, and the VIP database, searching from the clinical establishment of nerve growth factor for treatment until December 31, 2013. The key words for the searches were “nerve growth factor, randomized controlled trials” in Chinese and in English.DATA SELECTION:Inclusion criteria: any study published in English or Chinese referring to randomized controlled trials of nerve growth factor; patients with neurological diseases such as peripheral nerve injury, central nerve injury, cranial neuropathy, and nervous system infections; patients older than 7 years; similar research methods and outcomes assessing symptoms; and measurement of nerve conduction velocities. The meta-analysis was conducted using Review Manager 5.2.3 software.MAIN OUTCOME MEASURES:The total effective rate, the incidence of adverse effects, and the nerve conduction velocity were recorded for each study.RESULTS:Sixty-four studies involving 6,297 patients with neurological diseases were included. The total effective rate in the group treated with nerve growth factor was significantly higher than that in the control group (P < 0.0001, RR: 1.35, 95%CI: 1.30–1.40). The average nerve conduction velocity in the nerve growth factor group was significantly higher than that in the control group (P < 0.00001, MD: 4.59 m/s, 95%CI: 4.12–5.06). The incidence of pain or scleroma at the injection site in the nerve growth factor group was also higher than that in the control group (P < 0.00001, RR: 6.30, 95%CI: 3.53–11.27), but such adverse effects were mild.CONCLUSION:Nerve growth factor can significantly improve nerve function in patients with nervous system disease and is safe and effective.

Early Surgical Decompression Restores Neurovascular Blood Flow and Ischemic Parameters in an in Vivo Animal Model of Nerve Compression Injury.

Chronic nerve compression neuropathies result in decreased blood flow at the site of compression. Surgical decompression of the nerve often has variable postoperative results. The current study examines whether the timing of surgical intervention is an important variable in reversing the compression-induced ischemia and associated changes in biochemical markers. An established model of chronic nerve compression injury was created in 100 C57BL/6 mice, and serial electrophysiological examinations were used to confirm the creation of a chronic nerve compression injury. Laser speckle imaging was used to measure neural blood flow. Nerves in the animals that did not undergo decompression were harvested at two, four, and six weeks after injury and analyzed for hypoxia-inducible factor 1α (HIF1α), catalase, superoxide dismutase (SOD), and matrix metalloproteinases (MMPs) 2 and 9. Surgical decompression in other animals was performed at either an early (two-week) or late (six-week) time point after injury, with specimens harvested at multiple time points after decompression. One-way analysis of variance with Bonferroni correction was performed. Chronic nerve compression injury initially induced hyperemia (1.37 ± 0.50 times that in the contralateral, uninjured nerve) followed by a decline in neural blood flow by four weeks (0.66 ± 0.14, p = 0.0313). In parallel, HIF1α, catalase, and SOD were elevated early after compression, whereas extracellular matrix-altering proteins were elevated later in the disease. Although early decompression yielded a return of blood flow to a hyperemic state (1.35 ± 0.16, p = 0.0057), late decompression did not result in reversal of the abnormal neurovascular flow. With late decompression, an MMP9-mediated structural alteration of the extracellular matrix was seen, producing irreversible changes in blood flow parameters. Although nerve conduction velocity measurements returned to normal two weeks after decompression irrespective of the timing of the surgical intervention, distal latency returned to normal only after early decompression (0.97 ± 0.06 msec compared with 1.22 ± 0.06 msec for late decompression, p = 0.009). Chronic nerve compression injuries decreased neurovascular flow and induced ischemia by upregulating HIF1α, catalase, and MMP9. Early surgical intervention offered better return to normal electrophysiological parameters compared with late intervention. These data present a clinical correlate to the variable functional outcomes seen following surgical release of chronic nerve compression injuries and provide early support for using distal latency as a predictor of outcomes following surgical release.