Sural Sensory Nerve Research Articles

A Comparative Study Analysis of Lower Limb and Upper Limb Conduction Velocity among Asymptomatic Patients of Type 2 Diabetes Mellitus

Objectives: Diabetes Mellitus is worldwide disease and diabetic peripheral neuropathy (DPN) is one of the most prevalent micro-vascular complication seen during the progress of disease. Frequently there is subclinical involvement seen for peripheral nerve functions which is revealed on nerve conduction study. Present study aims to assess nerve conduction velocity changes among asymptomatic patients with type 2 diabetes mellitus. Materials and Methods: Total 60 subjects were included for the study, 30 of them were of type 2 diabetes mellitus on regular treatment with disease duration of less than 5 years and asymptomatic for neuropathy and 30 were controls. All the participants were subjected to nerve conduction studies. Results: Nerve Conduction Velocity (NCV) of sural sensory nerve was found to be significantly decreased in diabetic patients as compared to controls. Conclusion: Sensory NCV was significantly decreased in the sural nerve compared to upper limb sensory nerves which suggests that long nerves are more prone to neuropathic changes even in asymptomatic diabetic patients.

Which combined nerve conduction study scores are best suited for polyneuropathy in diabetic patients?

Nerve conduction studies (NCS) are widely used in diagnosing diabetic polyneuropathy. Combining the Z scores of several measures (Z-compounds) may improve diagnostics by grading abnormality. We aimed to determine which combination of nerves and measures is best suited for studies of diabetic polyneuropathy. Sixty-eight patients with type 1 diabetes and 35 controls were included in this study. NCS measurements were taken from commonly investigated nerves in one arm and both legs. Different Z-compounds were calculated and compared with reference material to assess abnormality. A sensitivity proxy, the accuracy index (AI), and Cohen's d were calculated. Z-compounds with the highest AI consisted of the tibial and peroneal motor, and the sural, superficial peroneal, and tibial medial plantar sensory nerves in one or two legs. All Z-compounds were able to discriminate between diabetic subjects and nondiabetic controls (mean Cohen's d= 1.42 [range, 1.03-1.63]). The association between AI and number of measures was best explained logarithmically (R2 = 0.401), with diminishing returns above approximately 14 or 15 measures. F-wave inclusion may increase the AI of the Z compounds. Although often clinically useful among the non-elderly, the additional inclusion of medial plantar NCS into Z-compounds in general did not improve AI. Performing unilateral NCS in several motor and sensory lower extremity nerves is suited for the evaluation of polyneuropathy in diabetic patients. The use of Z-compounds may improve diagnostic accuracy in diabetic polyneuropathy and may be particularly useful for follow-up research studies as single summary measures of NCS abnormality development over time.

Correlation of nerve conduction study parameters with thyroid hormone in newly diagnosed hypothyroid patients

Background: Thyroid hormones act on many organs including central and peripheral nervous system for maintaining metabolic homeostasis. Entrapment neuropathies are most common in hypothyroidism. Nerve conduction parameters are impaired even in newly diagnosed cases of hypothyroid. Aims and Objectives: This study aims to study the correlation between thyroid hormone and nerve conduction study (NCS) parameters in newly diagnosed hypothyroid patients. Materials and Methods: This cross-sectional, descriptive study included newly diagnosed hypothyroid patients (n=30; age: 31.96±9.12). In all subjects, NCS was performed in median, ulnar, tibial motor nerve and median, ulnar, sural sensory nerve using Nihon Kohden machine in Neurophysiology lab 2, B. P. Koirala Institute of Health Science. Thyroid function test (TFT) was analyzed by ELISA. The association between thyroid hormone and NCS parameters was done using Pearson’s correlation. Results: In NCS sensory parameters; SNAP amplitude of the left sural nerve showed significant positive correlation with t3 (lt; r=0.451, P=0.012). Among motor parameters, distal latency of left median nerve showed significant negative correlation with t3 whereas nerve conduction velocity of the left median nerve showed positive correlation with t3. In rest of the nerve, the association between NCS parameters and TFT (t3, t4, and TSH) parameters did not show any significant changes. Conclusion: Our study reveals that in newly diagnosed cases of hypothyroidism, nerve impairment occurs in which the left side is affected much earlier than right side and further its severity can be correlated with level of T3 rather than TSH.

Tocotrienol-Rich Vitamin E (Tocovid) Improved Nerve Conduction Velocity in Type 2 Diabetes Mellitus Patients in a Phase II Double-Blind, Randomized Controlled Clinical Trial

Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes that affects approximately half of the diabetic population. Up to 53% of DPN patients experience neuropathic pain, which leads to a reduction in the quality of life and work productivity. Tocotrienols have been shown to possess antioxidant, anti-inflammatory, and neuroprotective properties in preclinical and clinical studies. This study aimed to investigate the effects of tocotrienol-rich vitamin E (Tocovid SuprabioTM) on nerve conduction parameters and serum biomarkers among patients with type 2 diabetes mellitus (T2DM). A total of 88 patients were randomized to receive 200 mg of Tocovid twice daily, or a matching placebo for 12 months. Fasting blood samples were collected for measurements of HbA1c, renal profile, lipid profile, and biomarkers. A nerve conduction study (NCS) was performed on all patients at baseline and subsequently at 2, 6, 12 months. Patients were reassessed after 6 months of washout. After 12 months of supplementation, patients in the Tocovid group exhibited highly significant improvements in conduction velocity (CV) of both median and sural sensory nerves as compared to those in the placebo group. The between-intervention-group differences (treatment effects) in CV were 1.60 m/s (95% CI: 0.70, 2.40) for the median nerve and 2.10 m/s (95% CI: 1.50, 2.90) for the sural nerve. A significant difference in peak velocity (PV) was also observed in the sural nerve (2.10 m/s; 95% CI: 1.00, 3.20) after 12 months. Significant improvements in CV were only observed up to 6 months in the tibial motor nerve, 1.30 m/s (95% CI: 0.60, 2.20). There were no significant changes in serum biomarkers, transforming growth factor beta-1 (TGFβ-1), or vascular endothelial growth factor A (VEGF-A). After 6 months of washout, there were no significant differences from baseline between groups in nerve conduction parameters of all three nerves. Tocovid at 400 mg/day significantly improve tibial motor nerve CV up to 6 months, but median and sural sensory nerve CV in up to 12 months of supplementation. All improvements diminished after 6 months of washout.

Differences in peripheral neuropathy in xeroderma pigmentosum complementation groups A and D as evaluated by nerve conduction studies

BackgroundXeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder with defective DNA nucleotide excision repair and associated with a high frequency of skin cancer. Approximately 25% of patients develop progressive neurological degeneration. Complementation groups XP-A and XP-D are most frequently associated with neurological disorders.Design/methodsThis is a retrospective review of patients with XP who were evaluated at NIH from 1986 to 2015 and had nerve conduction studies (NCS). In the complementation groups with peripheral neuropathy, further comparisons of the NCS were made with audiological, brain imaging, neuropsychological assessments that were also performed on most of the patients. Limited neuropathology of XP-A and XP-D patients were examined..ResultsThe 33 patients had NCS: XP-A (9 patients), XP-C (7 patients), XP-D (10 patients), XP-E (1 patient), XP-V (4 patients), and XP-unknown (2 patients). Peripheral neuropathy based on nerve conduction studies was documented only in two complementation groups: 78% (7/9) of XP-A patients had a sensorimotor neuropathy while 50% (5/10) of XP-D patients had a sensory neuropathy only. Analysis of sural sensory nerve amplitude in both complementation groups XP-A and XP-D correlated with sensorineural hearing loss (SNHL), MRI/CT severity, and Full-scale Intelligence Quotient (IQ). Analysis of fibular motor nerve amplitude in complementation XP-A correlated with SNHL and MRI/CT severity. Limited follow-up studies showed gradual loss of NCS responses compared to an earlier and more rapid progression of the hearing loss.ConclusionsDespite similar brain imaging and audiological findings patients, XP-A and XP-D complementation groups differ in the type of neuropathy, sensorimotor versus sensory alone. A few cases suggest that sensorineural hearing loss may precede abnormal NCS in XP and therefore serve as valuable clinical indicators of XP patients that will later develop peripheral neuropathy.

Critical illness neuropathy in severe COVID-19: a case series.

IntroductionNeurological complications of SARS-CoV-2 disease have received growing attention, but only few studies have described to date clinical and neurophysiological findings in COVID patients during their stay in intensive care units (ICUs). Here, we neurophysiologically assessed the presence of either critical illness neuropathy (CIP) or myopathy (CIM) in ICU patients.Materials and MethodsPatients underwent a neurophysiological assessment, including bilateral examination of the median, ulnar, deep peroneal and tibial motor nerves and of the median, ulnar, radial and sural sensory nerves. Needle electromyography (EMG) was performed for both distal and proximal muscles of the lower and upper limbs. In order to differentiate CIP from CIM, Direct Muscle Stimulation (DMS) was applied either to the deltoid or tibialis anterior muscles. Peak to peak amplitudes and onset latencies of the responses evoked by DMS (DMSamp, DMSlat) or by motor nerve stimulation (MNSamp, MNSlat) were compared. The ratio MNSamp to DMSamp (NMR) and the MNSlat to DMSlat difference (NMD: MNSlat − DMSlat) were also evaluated.ResultsNerve conduction studies showed a sensory-motor polyneuropathy with axonal neurogenic pattern, as confirmed by needle EMG. Both MNSamp and NMR were significantly reduced when compared to controls (p < 0.0001), whereas MNSlat and NMD were markedly increased (p = 0.0049).ConclusionsWe have described COVID patients in the ICU with critical illness neuropathy (CIP). COVID-related CIP could have implications for the functional recovery and rehabilitation strategies.

Subclinical myopathic changes in COVID-19.

IntroductionCoronavirus disease 2019 (COVID-19) is associated to neuromuscular symptoms in up to 10.7% of hospitalized patients. Nevertheless, the extent of muscular involvement in infected subjects with no signs of myopathy has never been assessed with neurophysiological investigations.MethodsOver a 3-week period — from April 30 through May 20, 2020 — a total of 70 patients were hospitalized in the Internal Medicine Ward of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy. After excluding patients who underwent invasive ventilation and steroid treatment, 12 patients were evaluated. Nerve conduction studies (NCS) included the analysis of conduction velocity, amplitude, and latency for bilateral motor tibial, ulnar nerves, and sensory sural and radial nerves. Unilateral concentric-needle electromyography (EMG) was performed evaluating at least 4 areas of 8 selected muscles. For each muscle, spontaneous activity at rest, morphology, and recruitment of motor unit action potentials (MUAPs) were evaluated.ResultsWhile nerve conduction studies were unremarkable, needle electromyography showed myopathic changes in 6 out of 12 subjects. All patients were asymptomatic for muscular involvement. Clinical features and laboratory findings did not show relevant differences between patients with and without myopathic changes.ConclusionOur data show that in SARS-CoV-2 infection muscular involvement can occur despite the absence of clinical signs or symptoms and should be considered part of the disease spectrum. The application of muscle biopsy to unravel the mechanisms of myofiber damage on tissue specimens could help to clarify the pathogenesis and the treatment response of coronavirus-mediated injury.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10072-021-05469-8.

Nerve Conduction Studies (NCS) and Electromyography (EMG) P-NE002. The differences of vitamin D supplementation in nerve conduction studies based on diabetic duration and glycemic control in diabetic neuropathy

Introduction. Diabetic neuropathy (DN) is the most common form of neuropathy in developed countries. Diabetic duration and glycemic control are risk factors for DN. Evidence that vitamin D can improve glycemic control is still uncertain. In some literatures, there are conflicting reports on the effect of vitamin D on nerve conduction studies (NCSs). Aim: To assess the differences of vitamin D supplementation in NCSs based on diabetic duration and glycemic control in type 2 diabetes mellitus (T2DM) Indonesian patients. Methods. Twenty-five subjects with T2DM in Haji Adam Malik General Hospital Medan were studied. They were treated for 10 weeks with vitamin D (D3) supplementation of 50,000 IU/week. They were evaluated by HbA1c level and routine NCSs in the upper and lower limbs, before and 10 weeks after vitamin D supplementation. The differences of vitamin D supplementation in NCSs were based on diabetic duration and glycemic control. This was analyzed with dependent t-test. Results. There were significant differences of vitamin D supplementation in distal latency (DL) of all nerves, and amplitude (A) of motor median, ulnar, peroneal, and tibial nerves and sensory sural nerve based on diabetic duration. There were significant differences in A of motor and sensory median and ulnar nerves and motor peroneal and tibial nerves, and nerve conduction velocity (NCV) of all nerves. Conclusion. There were differences in vitamin D supplementation in NCSs based on diabetic duration and glycemic control in T2DM Indonesian patients.

Analysis of Electrophysiological Parameters as an Early Indicator for Nerve Root Involvement among the Patients with Acute Lumbar Radiculopathy

Electrophysiological parameters especially the late responses which include H reflex analysis are of great significance and importance in diagnosing and predicting the level of nerve root involvement radiculopathy patients. The main objective of the present study was to analyse the electrophysiological parameters like amplitude and latency for prediction of nerve root involvement in lumbar radiculopathy patients. The present research project study was undertaken on 50 diagnosed patients of lumbar radiculopathy. The study participants were between the age group of 30-60 years and were having the low back pain ranging from 30-60 days. The bilateral nerve conduction studies were performed for posterior tibial nerve, sural nerve, and late responses like H waves were studied and analysed for amplitude and latency for all the patients. Patients with radiculopathy showed significant reduction in the amplitude of sural sensory nerve, the latencies were prolonged among the patients with L5-S1 root involvement based on the MRI findings. H wave’s amplitude asymmetry was significantly noted among the patients with L5-S1 root involvement suggesting the axonal compression at nerve root level earlier than the changes in the latencies for H waves. Prolonged latencies is reduction in the amplitude of sural nerve as well as, the amplitude asymmetry for late responses like H waves can be considered as one of the earlier signs of compression of the nerve roots in lumbosacral radiculopathy.

A Prospective Study of Taxane-Induced Neuropathy with Breast Cancer: Proper Assessment Tool for Taxane-Induced Neuropathy.

Background Many chemotherapeutic agents, especially taxanes, can induce peripheral neuropathy. Aim To evaluate the clinical characteristics of taxane-induced neuropathy (TIN) and determine the proper assessment tool for TIN in patients with breast cancer. Setting and Design Single-center, observational, prospective study. Methods and Material Forty-three patients with breast cancer treated with taxanes were prospectively enrolled. The reduced version of the Total Neuropathy Score (TNSr) was performed at baseline and 3 months after enrollment. TIN was diagnosed if the difference between the baseline and 3-month TNSr was greater than 1. In patients with TIN, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire— Chemotherapy-Induced Peripheral Neuropathy (20-item scale (EORTC-CIPN20) was also assessed 3 months after enrollment. Results Thirty-seven out of 43 (86.0%) patients were diagnosed with TIN. Sensory symptoms (64.9%) were the most frequent abnormality, followed by autonomic symptoms (54.1%). No patients reported motor symptoms or motor weakness. The TNSr sensory symptom score positively correlated with that of the EORTC-CIPN20. Nerve conduction studies showed reduced nerve conduction velocities and amplitudes after taxane treatment compared to those before chemotherapy in all tested nerves; however, only three (8.1%) patients had sural sensory nerve action potential amplitude outside normal limits. Conclusions TIN was predominantly sensory with normal nerve conduction studies which is the main feature of small fiber neuropathy. A combination scale comprising of a clinician-based scale and a patient-reported questionnaire and specialized tests for small nerve fibers should be considered as proper assessment tools to evaluate TIN.

The silent occurrence of cerebral small vessel disease in nonelderly patients with type 2 diabetes mellitus.

The prevalence of cerebral small vessel disease (SVD) increases in elderly patients with type 2 diabetes (T2DM), exacerbating cognitive decline. However, the prevalence and the severity of SVD in dementia-free nonelderly T2DM patients were largely unknown. Our primary aim is to investigate SVD in such patients, with a specific focus on the correlation between SVD and diabetic peripheral sensorimotor polyneuropathy (DSP). We recruited 180 young and middle-aged subjects without cognitive impairment (106 with T2DM, 74 controls). Signs of cerebral SVD on magnetic resonance image were investigated, and the overall SVD burden was evaluated by a combined score. Patients with T2DM underwent further detailed DSP assessment. Regression models were used to investigate the association of SVD with the presence of T2DM, and the associations of the prevalence and severity of SVD and DSP were also explored in patients with T2DM. The prevalence of microbleeds and overall burden of SVD were significantly higher in T2DM patients than in the controls. Further, the presence of DSP related to an increased risk of SVD after adjustment in diabetic group. Moreover, Toronto Clinical Scoring System values were positively associated with the increased SVD scores, and bilateral sural sensory nerve conduction velocities were negatively associated with increasingly severity of SVD scores. The current findings extended the increasing prevalence of SVD to dementia-free nonelderly patients with T2DM, suggesting that the time for cognitive screening and prevention might be moved forward in T2DM patients, especially for those with DSP.

Impact of occupational lead exposure on nerve conduction study data

Introduction To investigate nerve conduction data of lead exposed workers. Methods A total of 287 subjects, consisting of 197 lead exposed workers and 90 healthy controls were included. Nerve conduction study of motor (median, ulnar, peroneal and tibial) and sensory (median, ulnar and sural) nerves were performed. The data were analyzed as two and three groups. Results The median blood lead level was 40.90 µg/dl. Median sensory, ulnar motor, and ulnar sensory conduction velocity were lower; distal latency of median motor, median sensory and sural sensory were longer than the controls (p < 0.05). There was no difference between the groups in terms of amplitudes. Discussion This study was indicated the neurotoxic effect of lead exposure may occur in the peripheral nerves, while the mean blood lead level is 40 µg/dl.

Normal neurophysiologic parameters of the sural nerve among adult healthy Sudanese population

Background: Nerve conduction studies (NCSs) are of central importance for the assessment of peripheral nervous system disorders. They help in the diagnosis, extent distribution of neural lesion as well as the prognosis of a disease process. The aim of this study is to establish normative NCS reference data of the sural nerve in Sudanese population for our EMG electrodiagnostic center; and to survey the effects of age, gender, height, weight and temperature on conduction Parameters. Methods: The study was conducted in Elmagzoub Neuroscience Electrodiagnostic Centre; supported by the Faculty of Medicine, National Ribat University, Khartoum, Sudan. NCSs were performed in 210 sural nerves of 105 adult healthy Sudanese subjects using standardized techniques. Results: The Right sural nerve SNAP parameters in the whole subjects were set as (mean ±standard deviation) for onset latency. peak latency, amplitude and conduction velocity. The values were 2.73±0.42 ms, 3.32±0.46 ms, 8.39±3.49 uV and 52.05±8.47 m/s, respectively. The Left sural nerve SNAP parameters in the whole study group were 2.71±0.50 ms, 3.29 ±0.52 ms, 8.54±4.56 uV and 52.66 ±8.95, respectively. Conclusion: The sural sensory nerve conduction parameters compared favorably with the existing literature. Age showed a positive correlation with latencies, and negative correlation with amplitude and velocity. Gender has conspicuous effect on all sural nerve conduction parameters. Height showed an effect on latency and conduction velocity whereas BMI revealed a negative correlation with amplitude and conduction velocity of sural nerve.

A cross-sectional study on nerve conduction velocity in stable chronic obstructive pulmonary disease

Objectives: This study was undertaken with the aim to find out possible presence of subclinical peripheral neuropathy in patients of chronic obstructive pulmonary disease (COPD) and its association with advancing severity of disease. Changes in nerve conduction parameter values in these patients have been presented. Materials and Methods: Median, ulnar, peroneal motor, and sural sensory nerve conduction latency, amplitude, and velocity were recorded in 100 known cases of COPD in the age group of 25–65 years as per the standard protocol. Results: On analysis, statistically significant lowering of sural nerve conduction velocity (P = 0.002) and amplitude (P = 0.003) was found with decreasing FEV1% in the three stages of COPD. Decrease in ulnar sensory conduction amplitude and velocity was also noted but it was not significant. Fall in sural nerve conduction velocity was found to be strongly and positively correlated (P = 0.029, r = 0.444) with decrease in FEV1%. Conclusion: These findings suggest that with increasing severity of disease, airflow limitation enhances polyneuropathy in COPD patients. It is predominantly axonal and mainly involving sensory nerve.

Associations of cells from both innate and adaptive immunity with lower nerve conduction velocity: the Maastricht Study

IntroductionDistal sensorimotor polyneuropathy (DSPN) is common in people with diabetes but is also found in pre-diabetes. Peripheral nerve myelin damage, which can be assessed by reduced nerve conduction velocity (NCV),...

The effect of hormone replacement therapy on nerve conduction studies in newly diagnosed hypothyroid patients

Background: Deficiency of thyroid hormone has been associated with mononeuropathy, myopathy, sensory neuropathies, and sensorimotor polyneuropathy. Nerve conduction studies (NCSs) are useful to evaluate the electric conduction in motor and sensory nerves and differentiate between axonal neuropathy or demyelination as well as localization of disorder. Hormone replacement therapy (HRT) might restore the nerve function by reversing the biochemical abnormalities. Aims and Objectives: This study was conducted to observe the effects of hypothyroidism on peripheral nerves by NCS in newly diagnosed patients and effect of short-term (3 months) treatment with hormonal replacement therapy (thyroxine [T4]) on clinical features of peripheral nerve dysfunction and NCS. Materials and Methods: In this study, 40 patients with newly diagnosed hypothyroidism underwent complete neurological and nerve electrodiagnostic examination. After examination, the patients were provided HRT (T4) for 3 months. Then, neurological and nerve electrodiagnostic examinations were repeated in all the patients. Results: After 3 months of treatment, free triiodothyronine (FT3) and free T4 (FT4) were increased while thyroid-stimulating hormone was decreased and the results obtained were statistically significant. On diagnosis, carpal tunnel syndrome (CTS) was found in 42.5% of patients and neuropathy in 25% of subjects. After treatment, improvement was seen in 77% of patients with CTS and 70% of patients with neuropathy. Latency of median, tibial, and peroneal motor nerve as well as latency of median and sural sensory nerve were decreased on treatment. Again, amplitude of curve and nerve conduction velocity (NCV) increased in median, tibial, and peroneal nerve on treatment. No significant effects were seen in latency, amplitude of curve, or NCV in ulnar motor and sensory nerve. Conclusion: The study suggests that abnormalities such as polyneuropathy and entrapment mononeuropathies can be reversed with appropriate treatment in many newly diagnosed hypothyroidism patients.

Relation of glycated hemoglobin with nerve conduction study and proprioception in patients with type 2 diabetes mellitus

Background and Aim: Diabetic peripheral neuropathy is a major complication of type 2 diabetes mellitus (T2DM). Association of elevated glycated hemoglobin (HbA1c) and nerve function is known, but its relationship with proprioception is still unknown. This study was conducted to find the correlation of HbA1c with nerve conduction study (NCS) and proprioception in T2DM patients.Materials and Methods: 88 patients of T2DM of <5 years duration, between the age group 30 and 60 years, participated in the study. NCS of tibial motor, peroneal motor, and sural sensory nerves was done. Proprioception was assessed by testing the absolute error scores of knee joint position sense (JPS) with a digital inclinometer. Pearson correlation coefficient was used to analyze the relation of HbA1c with NCS parameters and the knee JPS errors.Results: HbA1c showed a positive correlation with distal latency and a negative correlation with amplitude and conduction velocity. JPS errors showed a moderate positive correlation with HbA1c.Conclusion: HbA1c values have a significant relation with the development of peripheral neuropathy in T2DM patients. This effect was observed on both nerve conduction studies as well as on proprioception test.

Reference values of dorsal sural sensory nerve action potential: A useful tool to diagnose peripheral neuropathy

Background: Dorsal sural sensory nerve is the most distal nerve of the lower limb for which its sensory nerve action potential (SNAP) could be helpful for the diagnosis of early and subclinical peripheral neuropathy. The objective of this study was to estimate the age and sex reference data of amplitude (Amp), onset latency (OL), and conduction velocity (CV) of SNAP. Materials and Methods: A prospective cross-sectional study was conducted among 50 healthy subjects (28 male and 22 female). Participants were stratified into Group A (≤50 years) and Group B (>50 years) according to their age. Student's t-test was used to compare the data between Group A and B, between male and female and Pearson correlation was used to analyze the correlation between age and SNAP parameters. Results: OL of Group A and Group B was 2.80 ± 0.36 ms and 3.11 ± 0.55 ms, respectively (P = 0.037). CV of Group A and Group B was 45.6 ± 3.33 m/sec and 39.5 ± 1.17 m/sec, respectively (P = 0.000). Amp of Group A and Group B was 6.63 ± 0.73 μV 4.99 ± 0.47 μV, respectively (P = 0.000). OL of male and female was 2.59 ± 0.28 ms 3.34 ± 0.25 ms, respectively (P = 0.000). Pearson correlation coefficient “r” between “age– OL,” “age– CV,” and “age– Amp” was 0.135 (P = 0.351), −0.759 (P = 0.000), 0.953 (P = 0.000), respectively. Conclusion: This study provides age and sex reference values of dorsal sural SNAP in the eastern part of the Indian population.

Electrophysiologically verified effects of acupuncture on diabetic peripheral neuropathy in type 2 diabetes: The randomized, partially double-blinded, controlled ACUDIN trial.

Acupuncture is commonly used in Traditional Chinese Medicine for treatment of diabetic peripheral neuropathy (DPN), but data from randomized controlled trials are rare. This randomized, placebo-controlled, partially double-blinded clinical trial randomly assigned adults with confirmed type 2 diabetes-induced DPN to receive 10 sessions of needle acupuncture, laser acupuncture, or placebo laser acupuncture for 10 consecutive weeks. Treatment was provided at bilateral acupoints Ex-LE-10 (Bafeng), Ex-LE-12 (Qiduan), and ST-34 (Lianqiu). Neurological assessments, including nerve conduction studies (NCS) of sural and tibial nerves, were performed at baseline and weeks 6 and 15. Primary outcome was delta of sural sensory nerve action potential (SNAP). Secondary outcomes included further NCS values, clinical scores, and patient-reported outcome measures (PROMs). Of 180 participants, 172 completed the study. Sural SNAP and sural and tibial nerve conduction velocities improved significantly after 10 treatments when comparing needle acupuncture to placebo. Needle acupuncture showed earlier onset of action than laser acupuncture. PROMs showed larger improvements following needle and laser acupuncture than placebo, reaching significant differences for hyperesthesia and cramps following needle acupuncture and for heat sensation following laser acupuncture. Classical needle acupuncture had significant effects on DPN. Improvement in NCS values presumably indicates structural neuroregeneration following acupuncture.

Acupuncture for diabetic peripheral neuropathy: study protocol for a randomized, placebo-controlled trial

BackgroundDiabetic peripheral neuropathy (DPN) is the most common chronic complication of diabetes mellitus that has a considerable impact on quality of life, but there are few effective therapeutic strategies. The aim of this trial is to determine the efficacy and safety of manual acupuncture (MA) versus sham acupuncture (SA) for DPN.Methods/designThis is a study protocol for a randomized, placebo-controlled clinical trial. A total of 118 patients with DPN will be recruited and randomly assigned in a 1:1 ratio to either the MA group or SA group. All patients will receive 24 sessions over 12 weeks. Participants will complete the trial by visiting the research center at month 6 for a follow-up assessment. The primary outcome is peroneal motor nerve conduction velocity (peroneal MNCV) at week 12 compared with baseline. Secondary outcomes include peroneal motor nerve action potential amplitude (peroneal MNAP) and latent period (peroneal MNLP), sural sensory nerve conduction velocity (sural SNCV), action potential amplitude (sural SNAP) and latent period (sural SNLP), fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), glycated hemoglobin (HbAlc) at week 12 compared with baseline, Michigan Neuropathy Screening Instrument (MNSI) score and Diabetes Specific Quality of Life scale (DSQL) at week 12 and month 6 compared with baseline. Safety will be assessed during the whole trial. Masking effectiveness will be assessed by patients.DiscussionThis trial may provide high-quality evidence for evaluating the efficacy and safety of MA treatment for DPN compared with SA treatment. Results of this study will be published in peer-reviewed journals.Trial registrationChinese Clinical Trials Registry ChiCTR1800020444. First registered on 29 December 2018, retrospectively registered, http://www.chictr.org.cn/showproj.aspx?Proj=31063.