Neuropathy Disability Score Research Articles

Prevalence, severity and factors associated with peripheral neuropathy among newly diagnosed diabetic patients attending Mulago hospital: a cross-sectional study.

To determine the prevalence and associated risk factors of diabetic peripheral neuropathy (DPN) among newly diagnosed diabetes mellitus patients in Mulago Hospital. A cross-sectional study was conducted among 248 newly diagnosed adult diabetic patients. Using the standard Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) criteria, we screened them for neuropathy. Data on the socio-demographics, age, duration of symptoms and history of diabetic ulcer were analyzed using a multiple logistic regression. A p-value <0.05 was considered significant. The majority of study patients (62.1%) were male. The overall prevalence of DPN was 29.4 %. Nearly sixteen percent had moderate neuropathy and only five percent had severe neuropathy. Age above 60 years was significantly associated with the presence of DPN; (OR 3.72; 95% CI 1.25 - 11.03; p=0.018). The history of ever having a foot ulcer was significantly associated with peripheral neuropathy (OR 2.59; 95% CI: 1.03 - 6.49, p = 0.042). DPN occurs in 1 in 4 of newly diagnosed diabetic patients in Mulago hospital. Two thirds of these patients had moderate to severe neuropathy. DPN was independently associated with increasing age. Early diagnosis of diabetes mellitus, increased diabetes knowledge and regular blood sugar screenings would play an important role in identifying this problem.

Electrical Muscle Stimulation Induces an Increase of VEGFR2 on Circulating Hematopoietic Stem Cells in Patients With Diabetes

PurposeExternal electric muscle stimulation (EMS) of the thigh muscles was found to reduce pain resulting from diabetic neuropathy (DN), a vascular complication of diabetes. This study investigated circulating hematopoietic stem cells (HSCs) after EMS treatment. Impaired function of HSCs and the subpopulation endothelial progenitor cells (EPCs), important for neovascularization and endothelial repair, has been associated with DN. MethodsTwenty-four patients with painful DN were treated 3 times with EMS over a period of 1 week. Blood samples were collected before and after the first EMS treatment. Before a fourth treatment, neuropathic pain was evaluated and a third blood sample was collected. Cells were used for flow cytometry. FindingsPatients with painful DN reported that the pain decreased after 3 times of 1-hour treatments with EMS (Neuropathy Symptom Score: from 8 to 6, P = 0.001; Neuropathy Disability Score: from 5.5 to 5, P = 0.027, n = 24). At the end of the study, diastolic blood pressure had decreased from 80 to 70 mm Hg (P = 0.043), and plasma adrenaline and noradrenaline metabolites metanephrine and normetanephrine were reduced (both P ≤ 0.01; n = 21). A single EMS treatment caused an immediate and transient decrease in the frequency of CD34+ HSCs in circulation (–20%; P < 0.001; n = 27). In 9 of the patients with DN, the proportion of HSCs expressing vascular endothelial growth factor receptor 2 (VEGFR2; defining the HSCs as EPCs) increased by 36% (P = 0.011) after EMS treatment. Proteins required for binding to endothelium (junctional adhesion molecule A and CD31), homing toward hypoxic tissue (C-X-C chemokine receptor type 4), and endothelial differentiation (CD31) were increased on HSCs immediately after EMS treatment. An increased frequency of VEGFR2 expression was also observed on HSCs of 6 healthy control volunteers (34%; P = 0.046) after EMS treatment, but not after sham treatment. ImplicationsThree EMS treatments decreased symptoms of pain caused by DN and reduced diastolic blood pressure and biomarkers of stress. A single EMS treatment increased molecules mediating attachment and differentiation on the surface of HSCs in circulation. We hypothesize that the EMS-induced increase in surface attachment molecules on the HSCs caused the HSCs to leave circulation and that EMS treatment improves the function of HSCs and EPCs in vivo.

Tumor necrosis factor-\u03b1 is a novel biomarker for peripheral neuropathy in type II diabetes mellitus: a clinical and electrophysiological study

BackgroundTumor necrosis factor-α (TNF-α) is an adipocytokine locally produced by Schwann cells and has a role in nerve regeneration and regulation of apoptosis. The role of TNF-α in the development of diabetic peripheral neuropathy (DPN) is controversial.ObjectiveThe objective of this study was to evaluate TNF-α serum level in a group of type II diabetes mellitus (DM) patients with and without neuropathy in comparison with healthy age-matched control group.DesignThis is a cross-sectional case–control study.SettingsThe study was conducted in outpatient clinics of the diabetes and physical medicine, rheumatology, and rehabilitation departments.PatientsNinety patients diagnosed with type II diabetes were included in the study.Main outcome measuresAll patients were assessed for clinical neuropathy using neuropathy symptom score and neuropathy disability score. All patients underwent nerve conduction studies of both upper and lower limbs. They were divided into two groups: group I with confirmed DPN (n=60) and group II with DM but no peripheral neuropathy (n=30). Serum TNF-α level was measured in all previous DM patients (90 patients) in addition to 48 healthy age-matched controls.ResultsA statistically significant difference was detected between serum TNF-α level in controls and diabetic patients. Similarly, a significant difference was detected between its level in non-DPN patients and confirmed DPN patients, being higher in the latter. A positive significant correlation has been detected between TNF-α level and patients’ age, as well as blood cholesterol level. A positive significant correlation has been found between TNF-α level and both neuropathy symptom score and neuropathy disability score. A significant negative correlation had been detected between TNF-α level and motor amplitudes of both tibial nerves.ConclusionSerum TNF-α level might be a potential biomarker for peripheral neuropathy in type II DM.

Cutaneous manifestations of diabetic peripheral neuropathy.

ABSTRACTThere is a rise in number of people diagnosed with Diabetes Mellitus. The incidence is rising in modern Indian society because of Industrial development and drastically changing lifestyles. Diabetic neuropathies are microvascular disorders that are usually associated with the duration of Diabetes. Among the various forms, the most common is Diabetic Peripheral Neuropathy. The disease if neglected leads to chronic ulcer formation leading to amputations frequently. Hence the aim of this study is to document the early cutaneous changes and create an early awareness in the importance of controlling Diabetes. The study consisted of 205 patients with Type 2 DM. Participant's neuropathy status was determined based on Neuropathy Disability Score and Diabetic Neuropathy Symptom Score. Among the Skin changes documented, the common changes seen were: Peripheral hair loss in 185 (90.2%), Xerosis in 168 (82%), Anhydrosis in 162 (79%), Plantar Fissures in 136 (66.3%), Plantar Ulcer in 80 (39%), common nail changes documented were Onychomycosis in 165 (80.5%) and Onychauxis in 53 (25.8%) patients in relation to the occupation and duration of Diabetes mellitus. In conclusion, it is important to control glycemic levels in the all stages of Diabetes and institute foot care measures to prevent the complications of neuropathy.

Study of advanced glycation endproducts and their receptors in Egyptian type 2 diabetic individuals with peripheral neuropathy

Context Diabetic neuropathy is one of the commonest long-term complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy in developed world.Aim The aim of our work was to measure advanced glycation endproducts (AGEs) and their receptors (RAGEs) in diabetic peripheral neuropathy (DPN), both painful and painless DPN.Patients and methods Our study was conducted on 50 type 2 diabetes mellitus patients with peripheral neuropathy, divided into two subgroups: the first group included 25 patients with painful DPN and the second group included 25 patients with painless DPN. Moreover, a third group included 20 diabetic patients without peripheral neuropathy, and a fourth group that included 20 healthy participants. All groups were subjected to full history taking and clinical examination, anthropometric parameters, the calculation of neuropathy disability score, and nerve conduction studies (peroneal, sural, and tibial nerves). Laboratory investigations included serum AGEs and RAGEs.Results Our study demonstrated that hemoglobin A1c, AGE, and RAGE showed statistically significant difference between the studied groups. Hemoglobin A1c was significantly high in both neuropathic and diabetic groups in comparison with control. Regarding AGE, it was statistically higher in neuropathic group than in control (P<0.011). On the contrary, RAGE was significantly higher in both neuropathic and diabetic groups rather than control (P<0.02). Although the neuropathic group has higher levels of AGE and RAGE than diabetic group, the difference was statistically nonsignificant. Significant difference was found between studied groups regarding nerve conduction studies of sural and tibial nerves. Statistically significant difference was found in the parameters of nerve conduction studies between neuropathic group and both non-neuropathic diabetic and control groups.Conclusion Our study concluded that AGE and RAGE are significantly higher in diabetic patients with neuropathy versus control, with more elevation in neuropathic group than in diabetic without neuropathy.

Acupuncture Treatment of Diabetic Peripheral Neuropathy in an American Indian Community

Diabetic peripheral neuropathy (DPN) develops in 30% of type 2 diabetes patients, increases the risk for foot ulcers and amputation, and is a significant source of disability and medical costs. Treatment remains challenging, propelling research to focus on therapeutic methods that aim to improve blood circulation or ameliorate oxidative stress that drives development of DPN. The aim of this study was to assess the effectiveness of acupuncture treatment for DPN symptoms and lower extremity arterial circulation in people with type 2 diabetes. Twenty-five patients seen at a Southern California Tribal Health Center who reported a threshold level of diabetic neuropathy symptoms in the lower extremities during the previous 4 weeks received acupuncture treatment once per week over a 10-week period between 2011 and 2013. The Neuropathy Total Symptom Scale (NTSS-6), Neuropathy Disability Score (NDS), and laser Doppler fluxmetry (LDF) were used for assessment at baseline and 10 weeks. A total of 19 of 25 study participants completed the study and reported a significant reduction in the NTSS symptoms of aching pain, burning pain, prickling sensation, numbness, and allodynia. Lancinating pain did not decrease significantly. LDF measures improved but not significantly. Acupuncture may effectively ameliorate selected DPN symptoms in these American Indian patients.

Focal loss volume of ganglion cell complex in diabetic neuropathy

BackgroundThe aim was to investigate the relationship between diabetic peripheral neuropathy (DPN) and abnormalities in ganglion cell complex (GCC); specifically, focal loss volume (FLV) and global loss volume (GLV).MethodsThe ganglion cell complex was evaluated using optical coherence tomography on 193 individuals (84 with type 1 diabetes, 67 with type 2 diabetes and 42 without diabetes). In those with diabetes, 88 had diabetes but no diabetic retinopathy (no DR group) and 63 had diabetes with diabetic retinopathy (DR group). Seventeen individuals in the no DR group and 27 in the DR group had diabetic peripheral neuropathy according to the neuropathy disability score (NDS). The probability of FLV and GLV being abnormal was determined. Forty four individuals had diabetic peripheral neuropathy (NDS of three or greater). Binary logistic regression analysis was performed, adjusting for the presence of diabetic retinopathy, age, sex, type of diabetes, duration of diabetes and HbA1c levels.ResultsTwenty‐five per cent of individuals with diabetic peripheral neuropathy had abnormal FLV compared to 11 per cent of those with diabetes but no diabetic peripheral neuropathy and five per cent in the control group (p = 0.011). Fourteen per cent of individuals with diabetic peripheral neuropathy, 10 per cent without diabetic peripheral neuropathy and two per cent in the control group had abnormal GLV (p = 0.185). For every unit increase in the neuropathy disability score, the odds of having an abnormal FLV increased by a factor of 1.25 (p = 0.007), after adjusting for potentially confounding factors. Abnormal GCC FLV is an independent predictor of diabetic neuropathy, (odds ratio = 2.94, 95 per cent CI [1.16, 7.40], p = 0.023).ConclusionDiabetic peripheral neuropathy is associated with abnormal GCC FLV at the macula, which is independent of diabetic retinopathy, age, sex, type of diabetes, duration of diabetes and HbA1c levels. An abnormality in GCC FLV is an independent predictor of diabetic peripheral neuropathy.

Characterization of patients with diabetic foot disease presenting to an Irish Podiatry Centre: profiling suitability for entry to a clinical trial of advanced wound therapeutics.

Diabetes mellitus, coined the 'Black Death of the Twenty-First Century', is associated with complications, including foot ulceration with potential loss of limb. There is a need for development of new wound therapies through completion of robust clinical trials. To profile demographics and wound characteristics of an Irish cohort with diabetes, forecast eligibility for entry to a clinical trial of advanced wound therapeutics, and adjust criteria to optimize eligibility for enrolment. A cross-sectional study of out-patients attending a Podiatry centre over 12weeks was conducted. Information was collected through clinical assessment, including Neuropathy Disability Score and Ankle-Brachial Pressure Index. Ulcers were characterised as 'healing' or 'non-healing'; a 'healing' wound decreased by 30% over the previous month, accomplished by retrospective analysis of files. Statistics, including binomial logistic regression and column analysis for eligibility assessment, were conducted. Seventy-four participants were identified with a mean age of 67 (±8.79) years. Non-healing DFU status correlated significantly with larger wound area (P=0.013), infection (P=0.009), and greater degrees of ischaemia (P=0.015). The eligibility criteria were modelled after those proposed by the EU consortium project REDDSTAR. In this Irish population, these criteria limit eligibility to 1.4%. This research found an eligibility criterion of wound area 2-10cm2 for enrolment in a clinical trial of mesenchymal stromal cell therapy too restrictive. Extension of wound area to 1-10cm2 and the inclusion of neuro-ischaemic ulcers increased eligibility for enrolment from 1.4 to 20%.

Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients.

Aims/IntroductionThe aim of the present study was to use the sudomotor function test, Sudoscan, as a screening method for the evaluation of asymptomatic diabetic distal symmetric polyneuropathy in Chinese type 2 diabetes patients. As a result, more attention could be paid to those asymptomatic patients who could be easily neglected and underdiagnosed in everyday clinic.Materials and MethodsA total of 394 Chinese type 2 diabetes patients were enrolled and tested for symptoms and clinical signs of neuropathy using the Neurological Symptom Score, Neuropathy Disability Score, and vibration perception threshold. Sudoscan was carried out, and the results were collected as the measurement of the electrochemical skin conductance of both hands and feet.ResultsIn the present study, we found that the abnormal rate of Sudoscan results in patients with asymptomatic neuropathy was higher than those without neuropathy and those with symptomatic neuropathy. This study also showed that lower electrochemical skin conductance at the feet was significantly associated with increasing symptoms, Neurological Symptom Score (r = −0.124, P < 0.05), Neuropathy Disability Score (r = −0.3, P < 0.01) and vibration perception threshold value (r = −0.18, P < 0.05). Logistic analysis showed that age (odds ratio 1.042, 95% confidence interval 1.014−1.071, P < 0.05) and feet electrochemical skin conductance levels (odds ratio 0.98, 95% confidence interval 0.962–0.993, P < 0.01) were independently associated with diabetic distal symmetric polyneuropathy.ConclusionsSudoscan might be a promising tool to screen asymptomatic diabetic distal symmetric polyneuropathy in Chinese patients with type 2 diabetes mellitus.

Diabetic Peripheral Neuropathy as a Predictor of Asymptomatic Myocardial Ischemia in Type 2 Diabetes Mellitus: A Cross-Sectional Study.

IntroductionDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and has been associated with cardiovascular disease, the leading cause of mortality in diabetes. As asymptomatic myocardial ischemia (MI) is frequent in diabetes, we hypothesized that DPN may be associated with MI in patients with type 2 diabetes mellitus and no history of cardiovascular events.MethodsEighty-two patients with DPN (n = 41) or without DPN (n = 41) were included. Among the DPN group, 15 had active foot ulcers. All subjects underwent Technetium-99 m sestamibi single-photon emission computed tomographic imaging for the estimation of myocardial ischemia, expressed as Summed Stress Score (SSS). The Neuropathy Disability Score (NDS) was used to quantify DPN and abnormal ratio of the longest electrocardiographic RR interval between the 28th and 32nd beats, after standing to the shortest interval between the 13th and 17th beats (RR ratio) was used as an index of cardiovascular autonomic neuropathy (CAN).ResultsAbnormal SSS was observed in 9.8% of patients without DPN and in 46.3% of patients with DPN (p < 0.001). In the multivariate analysis, NDS was the strongest predictor for SSS (β = 0.32, p = 0.003). When excluding patients with abnormal RR ratio (β = 0.32, p = 0.003) or with foot ulcers (β = 0.24, p = 0.04), this association remained significant. The RR ratio was also significantly associated with SSS in univariate (ρ = −0.30, p = 0.005) and multiple regressions (β = 0.24, p = 0.02).ConclusionsMI was strongly associated with DPN, and this association remained significant in patients with normal RR ratio. These results suggest that DPN assessment could help in identifying patients at risk of cardiovascular disease (CVD).Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0399-1) contains supplementary material, which is available to authorized users.

Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy

PurposeTo examine the diagnostic capability of the full retinal and inner retinal thickness measures in differentiating individuals with diabetic peripheral neuropathy (DPN) from those without neuropathy and non-diabetic controls. MethodsIndividuals with (n=44) and without (n=107) diabetic neuropathy and non-diabetic control (n=42) participants underwent spectral domain optical coherence tomography (SDOCT). Retinal thickness in the central 1mm zone (including the fovea), parafovea and perifovea was assessed in addition to ganglion cell complex (GCC) global loss volume (GCC GLV) and focal loss volume (GCC FLV), and retinal nerve fiber layer (RNFL) thickness. Diabetic neuropathy was defined using a modified neuropathy disability score (NDS) recorded on a 0–10 scale, wherein, NDS ≥3 indicated neuropathy and NDS indicated <3 no neuropathy. Diagnostic performance was assessed by areas under the receiver operating characteristic curves (AUCs), 95 per cent confidence intervals (CI), sensitivities at fixed specificities, positive likelihood ratio (+LR), negative likelihood ratio (−LR) and the cut-off points for the best AUCs obtained. ResultsThe AUC for GCC FLV was 0.732 (95% CI: 0.624–0.840, p<0.001) with a sensitivity of 53% and specificity of 80% for differentiating DPN from controls. Evaluation of the LRs showed that GCC FLV was associated with only small effects on the post-test probability of the disease. The cut-off point calculated using the Youden index was 0.48% (67% sensitivity and 73% specificity) for GCC FLV. For distinguishing those with neuropathy from those without neuropathy, the AUCs of retinal parameters ranged from 0.508 for the central zone to 0.690 for the inferior RNFL thickness. For distinguishing those with moderate or advanced neuropathy from those with mild or no neuropathy, the inferior RNFL thickness demonstrated the highest AUC of 0.820, (95% CI: 0.731–0.909, p<0.001) with a sensitivity of 69% and 80% specificity. The cut-off-point for the inferior RNFL thickness was 97μm, with 81% sensitivity and 72% specificity. ConclusionsThe GCC FLV can differentiate individuals with diabetic neuropathy from healthy controls, while the inferior RNFL thickness is able to differentiate those with greater degrees of neuropathy from those with mild or no neuropathy, both with an acceptable level of accuracy. Optical coherence tomography represents a non-invasive technology that aids in detection of retinal structural changes in patients with established diabetic neuropathy. Further refinement of the technique and the analytical approaches may be required to identify patients with minimal neuropathy.

Diabetic neuropathy and risk of diabetic foot syndrome during implementation of the national protocol in management of diabetes

The implementation of unified clinical protocol (UCP) has set a target to primary care physicians (PCP) to identify the diabetic neuropathy and angiopathy, screening the risk of diabetic foot syndrome and its prevention. The aim of our research - to determine the frequency of diabetic neuropathy, the risk of diabetic foot syndrome and level of type 2 diabetes control in patients of Kyiv region in terms of implementation of new clinical protocol in type 2 diabetes management. Materials and methods. The reports of health establishments of Kiev region were analyzed and 173 patients with type 2 diabetes were examined (aged 55,13 ± 0,61 years): group 1 - observed by PCP (n=45), group 2 - by endocrinologists (n=128). Patients examination included laboratory tests of diabetes control and evaluation of the lower limbs by Neuropathy Disability Score and determination the "ankle-shoulder" index with the portable Doppler. Statistical analysis - Excel 2007, SPSS, Statistica 6.0. Results. Despite treatment, the average levels of blood glucose, HbA1c, lipidogramme exceeded target levels in patients with type 2 diabetes, indicating their lack of control. In this regard, at 7-9 years of the disease in 19.65% of patients were founeded signs of severe and in 36.42% - moderate diabetic neuropathy of the lower limbs and in 15.03% of patients - occlusion, leading to the development of diabetic foot syndrome in 9.82% of patients, and 70.52% of the patients had moderate (44.51%) or high (26.01%) risk of its development. The differences between patients of PCP and endocrinologists were not found. However, the significant decrease of neuropathy and angiopathy of lower limbs in patients with type 2 diabetes in the Kiev region and reducing the number of amputations for 2012-2014 demonstrates the positive effect of the implementation of UCP. Conclusion. The frequency of diabetic neuropathy and angiopathy of lower limbs, the number of amputations in Kiev region decreased, that indicates a positive effect of implementation of UCP, but the risk of diabetic foot syndrome in patients remains high due to inadequate control of type 2 diabetes by patients and PC physicians and specialists that require optimization.

Rare human nerve growth factor-β mutation reveals relationship between C-afferent density and acute pain evaluation.

The rare nerve growth factor-β (NGFB) mutation R221W causes a selective loss of thinly myelinated fibers and especially unmyelinated C-fibers. Carriers of this mutation show altered pain sensation. A subset presents with arthropathic symptoms, with the homozygous most severely affected. The aim of the present study was to investigate the relationship between peripheral afferent loss and pain evaluation by performing a quantification of small-fiber density in the cornea of the carriers, relating density to pain evaluation measures. In vivo corneal confocal microscopy (CCM) was used to quantify C-fiber loss in the cornea of 19 R221W mutation carriers (3 homozygous) and 19 age-matched healthy control subjects. Pain evaluation data via the Situational Pain Questionnaire (SPQ) and the severity of neuropathy based on the Neuropathy Disability Score (NDS) were assessed. Homozygotes, heterozygotes, and control groups differed significantly in corneal C-nerve fiber density, with the homozygotes showing a significant afferent reduction. Importantly, peripheral C-fiber loss correlated negatively with pain evaluation, as revealed by SPQ scores. This study is the first to investigate the contribution of small-fiber density to the perceptual evaluation of pain. It demonstrates that the lower the peripheral small-fiber density, the lower the degree of reported pain intensity, indicating a functional relationship between small-fiber density and higher level pain experience.

Retinal Tissue Thickness is Reduced in Diabetic Peripheral Neuropathy

ABSTRACTAim: To investigate the relationship between diabetic peripheral neuropathy (DPN) and retinal tissue thickness.Methods: Full retinal thickness in the central retinal, parafoveal, and perifoveal zones and thickness of the ganglion cell complex and retinal nerve fiber layer (RNFL) were assessed in 193 individuals (84 with type 1 diabetes, 67 with type 2 diabetes, and 42 healthy controls) using spectral domain optical coherence tomography. Among those with diabetes, 44 had neuropathy defined using a modified neuropathy disability score recorded on a 0–10 scale. Multiple regression analysis was performed to investigate the relationship between diabetic neuropathy and retinal tissue thickness, adjusted for the presence of diabetic retinopathy (DR), age, sex, duration of diabetes, and HbA1c levels.Results: In individuals with diabetes, perifoveal thickness was inversely related to the severity of neuropathy (p < 0.05), when adjusted for age, sex, duration of diabetes, and HbA1c levels. DR was associated with reduced thickness in parafovea (p < 0.01). The RNFL was thinner in individuals with greater degrees of neuropathy (p < 0.04).Conclusions: DPN is associated with structural compromise involving several retinal layers. This compromise may represent a threat to visual integrity and therefore warrants examination of functional correlates.

Correlation between clinical neuropathy scores and nerve conduction studies in patients with diabetic peripheral neuropathy

Background Diabetic peripheral neuropathy (DPN) represents one of the most common complications of diabetes mellitus. Objective The aim of this study was to assess the correlation between clinical neuropathy scores and nerve conduction studies (NCS). Patients and methods This study included 30 (12 men and 18 women) Egyptian patients with type 2 diabetes mellitus complaining of symptoms suggestive of DPN. All patients underwent a clinical evaluation using three clinical scores: the Neuropathy Disability Score (NDS), the Neuropathy Impairment Score in the Lower Limbs (NIS-LLs), and the Diabetic Neuropathy Examination (DNE) score. Neurophysiological studies using NCS as well as measurement of glycated hemoglobin (HbA1C) were carried out. Results HbA1C was significantly correlated with NDS, NIS-LL, and DNE. The NDS was statistically correlated to median nerve sensory amplitude, sensory conduction velocity; ulnar nerve sensory amplitude, sensory conduction, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. NIS-LL was significantly correlated with median nerve sensory amplitude, sensory conduction velocity; motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. DNE was significantly correlated with median nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. Conclusion Clinical neuropathy scores represent a simple tool for evaluation and follow-up of patients with DPN in comparison with NCS, and we recommend the use of these scores in clinical practice on a routine basis.

Evaluation of sural nerve automated nerve conduction study in the diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus.

IntroductionNew tests for improved diagnosis of diabetic peripheral neuropathy (DPN) are useful.Material and methodsWe evaluated the utility of automated nerve conduction study (NCS) of the sural nerve with a new portable device for the diagnosis of DPN in patients with type 2 diabetes mellitus (T2DM). This study included 114 T2DM patients (58 men) with mean age 64.60 ±8.61 years. Exclusion criteria were B12 depletion, alcohol abuse and other causes of peripheral neuropathy. The reference method was the Neuropathy Disability Score (NDS) with a threshold NDS ≥ 3. Sural nerve automated NCS was carried out with the portable NC-stat DPNCheck device. Sensory nerve conduction velocity and sensory nerve action potential amplitude were measured bilaterally. Automated NCS was considered abnormal when ≥ 1 of the two aforementioned neurophysiological parameters was abnormal in at least one leg.ResultsExamination with NC-stat DPNCheck exhibited 90.48% sensitivity, 86.11% specificity, 79.17% positive predictive value (PPV) and 93.94% negative predictive value (NPV). The positive likelihood ratio (LR+) was 6.51 and the negative likelihood ratio (LR–) was 0.11.ConclusionsSural nerve automated NCS with the NC-stat DPNCheck device exhibits high sensitivity and specificity for the diagnosis of DPN in T2DM.

Quantitative sensory testing in type 1 diabetic patients with painful and painless diabetic neuropathy

The mechanism underlying the development of painful diabetic neuropathy (DN) is unknown. The aim of this study was to compare quantitative sensory testing (QST) characteristics of patients with painful and painless DN and to correlate QST measures with DN pain. Fifty type 1 diabetic patients with DN (30 with painful DN and 20 with painless DN) and 32 age-matched non-diabetic controls were included in this study. For all patients and controls, a detailed assessment of DN was performed which comprised McGill visual analogue scale (McGill VAS) for pain, neuropathy symptom profile and neuropathy disability score (NDS), quantitative sensory testing in form of cold, warm and vibration perception thresholds, nerve conduction studies (NCS), deep-breathing hear rate variability and Neuropad staining scores. Measures of QST, NCS and DB-HRV were correlated with McGill VAS for pain. There were no significant differences in cold, warm and vibration perception thresholds, NCS, DB-HRV and Neuropad scores between patients with painful and painless DN. Cold (r=-0.57, P=0.005), warm (r=0.47, P=0.026) and DB-HRV (r=0.50, P=0.023), however, correlated significantly with McGill VAS scores of pain. In conclusion, Quantitative sensory testing is a helpful tool to identify small nerve fibres damage of DN, correlates with pain intensity but cannot differentiate between painful and painless DN. Both central and peripheral neural injury could be implicated in the genesis of DN pain.

Quantitative sensory testing in type 1 diabetic patients with mild to severe diabetic neuropathy

Background: Small nerve fibre damage has been shown to precede large fibre damage and represents the early stage for diabetic neuropathy (DPN). Aims: To assess small nerve fibre deficit in patients with mild to severe DPN using quantitative sensory testing (QST) and to correlate QST findings with other neuropathy assessment measures in patients with DPN. Materials and Methods: Seventy-nine diabetic patients (49 with and 30 without diabetic neuropathy) and 35 healthy volunteers underwent neuropathy assessment. The evaluation comprised neuropathy symptoms profile, modified neuropathy disability score (NDS), quantitative sensory testing (QST) in form of cold and warm thresholds, vibration pressure threshold (VPT), nerve conduction studies (NCS), deep breathing heart rate variability (DB-HRV), and Neuropad staining scores. Patients were also stratified by their NDS scores into mild, moderate and severe DPN. Measures of QST were compared among various grades of DPN severity and correlated with other clinical and neurophysiological tests. Results: Patients with DPN demonstrated higher vibration perception (P<0.001) and warm (P<0.001) thresholds and lower cold threshold (P<0.001) and these QST abnormalities related directly to the grade of DPN severity. Measures of QST also correlated with those of nerve conduction studies (r range 0.54-0.68) and autonomic function assessment(r range 0.33-0.48). Conclusion: Quantitative sensory testing can identify small nerve fibres impairment which could represent the early stage of diabetic neuropathy and hence the optimal period for intervention.

Electrochemical skin conductance to detect sudomotor dysfunction, peripheral neuropathy and the risk of foot ulceration among Saudi patients with diabetes mellitus.

BackgroundSudomotor dysfunction is manifested clinically as abnormal sweating leading to dryness of feet skin and increased risk of foot ulceration. The aim of this study was to test the performance of foot electrochemical skin conductance (ESC) to detect diabetic peripheral neuropathy and the risk of foot ulceration against traditional methods in Saudi patients with diabetes mellitus.MethodsThis cross-sectional study was conducted on 296 Saudi patients with diabetes mellitus. Painful neuropathic symptoms were evaluated using the neuropathy symptom score (NSS). The risk of foot ulceration and diabetic peripheral neuropathy were determined using the neuropathy disability score (NDS). Vibration perception threshold (VPT) was assessed using neurothesiometer. Neurophysiological assessment of the right and left sural, peroneal and tibial nerves was performed in 222 participants. Diabetic peripheral neuropathy was defined according to the definition of the American Academy of Neurology. ESC was measured with Sudoscan.ResultsFeet-ESC decreased as the scores of sensory and motor function tests increased. Feet-ESC decreased as the NSS, NDS and severity of diabetic peripheral neuropathy increased. Sensitivity of feet-ESC < 50μS to detect diabetic peripheral neuropathy assessed by VPT ≥ 25 V, NDS ≥ 3, NDS ≥ 6 was 90.1, 61 and 63.8 % respectively and specificity 77, 85 and 81.9 % respectively. Sensitivity of feet-ESC < 70μS to detect diabetic peripheral neuropathy assessed by VPT ≥ 25 V, NDS ≥ 3, NDS ≥ 6 was 100, 80.6 and 80.9 % respectively. Sensitivity and specificity of feet-ESC < 70μS to detect confirmed-diabetic peripheral neuropathy were 67.5 and 58.9 % respectively.ConclusionSudoscan a simple and objective tool can be used to detect diabetic peripheral neuropathy and the risk of foot ulceration among patients with diabetes mellitus. Prospective studies to confirm our results are warranted.

Serum levels of TGF-β1 in patients of diabetic peripheral neuropathy and its correlation with nerve conduction velocity in type 2 diabetes mellitus

To correlate serum levels of TGF-β1 with motor and sensory nerve conduction velocities in patients of type 2 diabetes mellitus The study was conducted in diagnosed type 2 diabetes mellitus patients which were divided in patients with clinically detectable peripheral neuropathy of shorter duration (n=37) and longer duration (n=27). They were compared with patients without clinical neuropathy (n=22). Clinical diagnosis was based on neuropathy symptom score (NSS) and Neuropathy disability score (NDS) for signs. Blood samples were collected for baseline investigations and estimation of serum TGF-β1. Nerve conduction velocity was measured in both upper and lower limbs. Median, Ulnar, Common Peroneal and Posterior Tibial nerves were selected for motor nerve conduction study and Median and Sural nerves were selected for sensory nerve conduction study In patients of type 2 diabetes mellitus with clinically detectable and serum TGF-β1 showed positive correlation with nerve conduction velocities High level of TGF-β1 in serum of T2DM patients with neuropathy show possible contribution in development of neuropathy. Due to its independent association this cytokine might be used as biomarker for diabetic peripheral neuropathy.