Subclinical Peripheral Neuropathy Research Articles

Association of vitamin D deficiency and subclinical diabetic peripheral neuropathy in type 2 diabetes patients.

Diabetic peripheral neuropathy (DPN) contributes to disability and imposes heavy burdens, while subclinical DPN is lack of attention so far. We aimed to investigate the relationship between vitamin D and distinct subtypes of subclinical DPN in type 2 diabetes (T2DM) patients. This cross-sectional study included 3629 T2DM inpatients who undertook nerve conduction study to detect subclinical DPN in Zhongshan Hospital between March 2012 and December 2019. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) level < 50 nmol/L. 1620 (44.6%) patients had subclinical DPN and they were further divided into subgroups: distal symmetric polyneuropathy (DSPN) (n=685), mononeuropathy (n=679) and radiculopathy (n=256). Compared with non-DPN, DPN group had significantly lower level of 25(OH)D (P < 0.05). In DPN subtypes, only DSPN patients had significantly lower levels of 25(OH)D (36.18 ± 19.47 vs. 41.03 ± 18.47 nmol/L, P < 0.001) and higher proportion of vitamin D deficiency (78.54% vs. 72.18%, P < 0.001) than non-DPN. Vitamin D deficiency was associated with the increased prevalence of subclinical DPN [odds ratio (OR) 1.276, 95% confidence interval (CI) 1.086-1.501, P = 0.003] and DSPN [OR 1. 646, 95% CI 1.31-2.078, P < 0.001], independent of sex, age, weight, blood pressure, glycosylated hemoglobin, T2DM duration, calcium, phosphorus, parathyroid hormone, lipids and renal function. The association between vitamin D deficiency and mononeuropathy or radiculopathy was not statistically significant. A negative linear association was observed between 25(OH)D and subclinical DSPN. Vitamin D deficiency maintained its significant association with subclinical DSPN in all age groups. Vitamin D deficiency was independently associated with subclinical DSPN, rather than other DPN subtypes.

Risk Factors for Subclinical Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus.

To investigate the risk factors associated with subclinical diabetic peripheral neuropathy (sDPN) in patients with type 2 diabetes mellitus (T2DM). This cross-sectional, retrospective study involved 311 patients with T2DM who were successively admitted from January 2018 to December 2021 without any neurological symptoms. All participants underwent a nerve conduction study (NCS), and those asymptomatic patients with abnormal nerve conduction were diagnosed with sDPN. Differences between groups were evaluated by the chi-squared, Wilcoxon, or Fisher's exact test. Binary logistic regression analysis was performed to determine the independent risk factors for sDPN. Receiver operating characteristic (ROC) curves were constructed, and the areas under curves (AUCs) were detected. Among 311 asymptomatic patients with T2DM, 142 (45.7%) with abnormal nerve conduction were diagnosed with sDPN. Patients with sDPN significantly differed from those without diabetic peripheral neuropathy (DPN) in age, history of hypertension, duration of diabetes, anemia, neutrophil-to-lymphocyte ratio, fasting C-peptide level, serum creatinine level, and albuminuria (all p<0.05). Furthermore, the duration of diabetes (odds ratio [OR]: 1.062, 95% confidence interval [CI]: 1.016-1.110), fasting C-peptide level (OR: 2.427, 95% CI: 1.126-5.231), and presence of albuminuria (OR: 2.481, 95% CI: 1.406-4.380) were independently associated with the development of sDPN (all p<0.05). The AUCs for fasting C-peptide level, duration of diabetes, and the two factors combined were 0.6229 (95% CI: 0.5603-0.6855, p=0.0002), 0.6738 (95% CI: 0.6142-0.7333, p<0.0001), and 0.6808 (95% CI: 0.6212-0.7404, p<0.0001), respectively. For patients with T2DM and longer duration of diabetes, lower fasting C-peptide levels, and presence with albuminuria, the risk for developing DPN is higher even if they have no clinical signs or symptoms. Identifying potential risk factors for the development of sDPN and effectively controlling them early are critical for the successful management of DPN.

Mitochondrial myopathy without extraocular muscle involvement: a unique clinicopathologic profile.

Mitochondrial myopathy without extraocular muscles involvement (MiMy) represents a distinct form of mitochondrial disorder predominantly affecting proximal/distal or axial muscles, with its phenotypic, genotypic features, and long-term prognosis poorly understood. A cross-sectional study conducted at a national diagnostic center for mitochondrial disease involved 47 MiMy patients, from a cohort of 643 mitochondrial disease cases followed up at Qilu Hospital from January 1, 2000, to January 1, 2021. We compared the clinical, pathological, and genetic features of MiMy to progressive external ophthalmoplegia (PEO) and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) patients. MiMy patients demonstrated a more pronounced muscle involvement syndrome, with lower 6MWT scores, higher FSS, and lower BMI compared to PEO and MELAS patients. Serum levels of creatinine kinase (CK), lactate, and growth and differentiation factor 15 (GDF15) were substantially elevated in MiMy patients. Nearly a third (31.9%) displayed signs of subclinical peripheral neuropathy, mostly axonal neuropathy. Muscle biopsies revealed that cytochrome c oxidase strong (COX-s) ragged-red fibers (RRFs) were a typical pathological feature in MiMy patients. Genetic analysis predominantly revealed mtDNA point pathogenic variants (59.6%) and less frequently single (12.8%) or multiple (4.2%) mtDNA deletions. During the follow-up, a majority (76.1%) of MiMy patients experienced stabilization or improvement after therapeutic intervention. This study provides a comprehensive profile of MiMy through a large patient cohort, elucidating its unique clinical, genetic, and pathological features. These findings offer significant insights into the diagnostic and therapeutic management of MiMy, ultimately aiming to ameliorate patient outcomes and enhance the quality of life.

Subclinical peripheral neuropathy is common in neuronal intranuclear inclusion disease with dominant encephalopathy.

Neuronal intranuclear inclusion disease (NIID) is associated with CGG repeat expansion in the NOTCH2NLC gene. Although pure or dominant peripheral neuropathy has been described as a subtype of NIID in a few patients, most NIID patients predominantly show involvements of the central nervous system (CNS). It is necessary to further explore whether these patients have subclinical peripheral neuropathy. Twenty-eight NIID patients, clinically characterized by CNS-dominant involvements, were recruited from two tertiary hospitals. Standard nerve conduction studies were performed in all patients. Skin and sural nerve biopsies were performed in 28 and 15 patients, respectively. Repeat-primed polymerase chain reaction and amplicon length polymerase chain reaction were used to screen the CGG repeat expansion in NOTCH2NLC. All 28 patients can be diagnosed with NIID based on skin pathological and genetic changes. All patients predominantly showed CNS symptoms mainly characterized by episodic encephalopathy and cognitive impairments, but no clinical symptoms of peripheral neuropathy could be observed initially. Electrophysiological abnormalities were found in 96.4% (27/28) of these patients, indicating that subclinical peripheral neuropathy is common in NIID patients with CNS-dominant type. Electrophysiological and neuropathological studies revealed that demyelinating degeneration was the main pathological pattern in these patients, although mild axonal degeneration was also observed in some patients. No significant association between CGG repeat size and the change of nerve conduction velocity was found in these patients. This study demonstrated that most patients with CNS-dominant NIID had subclinical peripheral neuropathy. Electrophysiological examination should be the routinely diagnostic workflow for every NIID patient.

Implementation of corneal confocal microscopy for screening and early detection of diabetic neuropathy in primary care alongside retinopathy screening: Results from a feasibility study.

ObjectiveScreening for diabetic peripheral neuropathy (DPN) is essential for early detection and timely intervention. Quantitative assessment of small nerve fiber damage is key to the early diagnosis and assessment of its progression. Corneal confocal microscopy (CCM) is a non-invasive, in-vivo diagnostic technique that provides an accurate surrogate biomarker for small-fiber neuropathy. In this novel study for the first time, we introduced CCM to primary care as a screening tool for DPN alongside retinopathy screening to assess the level of neuropathy in this novel cohort.Research design and methods450 consecutive subjects with type 1 or type 2 diabetes attending for annual eye screening in primary care optometry settings underwent assessment with CCM to establish the prevalence of sub-clinical diabetic peripheral neuropathy. Subjects underwent assessment for neurological and ocular symptoms of diabetes and a history of diabetic foot disease, neuropathy and diabetic retinopathy (DR).ResultsCCM examination was completed successfully in 427 (94.9%) subjects, 22% of whom had neuropathy according to Diabetic Neuropathy Symptom (DNS) score. The prevalence of sub-clinical neuropathy as defined by abnormal corneal nerve fiber length (CNFL) was 12.9%. In the subjects with a short duration of type 2 diabetes, 9.2% had abnormal CNFL. CCM showed significant abnormalities in corneal nerve parameters in this cohort of subjects with reduction of corneal nerve fiber density (CNFD, p<0.001), CNFL (p<0.001) and corneal nerve branch density (CNBD, p<0.001) compared to healthy subjects. In subjects who had no evidence of DR (67% of all subjects), 12.0% had abnormal CNFL.ConclusionsCCM may be a sensitive biomarker for early detection and screening of DPN in primary care alongside retinopathy screening.

Neurophysiological evaluation of juvenile systemic lupus erythematosus

BackgroundPeripheral nervous system and the central nervous system involvement in systemic lupus erythematosus (SLE) patients are one of the major causes of morbidity and mortality. The aim of this work was to study the nervous system clinically and electrophysiologically in children with systemic lupus erythematosus.ResultsThe study was carried out on thirty-eight children with SLE. Their age ranged from 5 to 16 years. The most encountered neurologic manifestations were tremors. It was observed in 47.4% of children, followed by headache in 39.5%, sensory manifestation as numbness in 23.7%, cerebrovascular stroke in 5.3%, and chorea in 2.6%, which was unilateral mostly in the upper limb, tics, and convulsion had the same percentage. Around 16% of children had positive findings in MRI, such as cerebrovascular disease, minimal hematoma, pseudotumorcerebri, vasculitis, and ectatic ventricles. Subclinical peripheral neuropathy was reported in nearly 52.6% of children, and clinical peripheral neuropathy was reported in 23.6%. Pure sensory subclinical peripheral neuropathy was detected in 13.1% of children, but mixed subclinical peripheral neuropathy was detected in 39.4%. Nearly 53% of studied children had an abnormal somatosensory-evoked potential study of posterior tibial and median nerves.ConclusionThe current study reported that the clinical neurological manifestations in juvenile SLE is common. Peripheral neuropathy is commonly detected, which could be either clinical or sub-clinical. Somatosensory evoked potential study is of value for early detection of central affection.So, we recommend more studies to determine the guidelines when to order these informative investigations for children with JSLE.

Frequency Of Peripheral Neuropathy in Chronic Hepatitis C Patients Presenting at Liaquat University Hospital, Hyderabad

Hepatitis C virus (HCV) and its infective pathogenic role leads to the psychiatric and neurological signs and symptoms. Therefore, close monitoring and regular follow-up is warranted. Objective: To find out the frequency of peripheral neuropathy among patients presenting at Liaquat University Hospital, Hyderabad, having Chronic Hepatitis C. Methods: The cross-sectional study included 359 patients with chronic HCV, aged 20 to 70 years, who presented to the Liaquat University Hospital's Hepatitis Clinic and Outpatient Department of General Medicine and Neurology. Non-probability - sequential sampling was used to choose patients. Patients were asked about demographic information and the duration of chronic HCV after giving informed written consent. The clinical examination was performed to see if there were any reduced tendon reflexes in all of the patient's extremities. To diagnose peripheral neuropathy based on nerve conduction velocity, all patients had an electrophysiological test using a simplified nerve conduction study (NCS) methodology (NCV). The research lasted six months, from June 2021 to December 2021. The information was examined via SPSS version 25.0. Results: There were 219 Men (61%) And 140 Females (39%) among the 359 Patients. The average age (SD) of the participants was 42.3 (8.7) years (range 22–70). HCV infection lasted 36 months on average (range 1–156). Out of 359 patients, 61 had clinical peripheral neuropathy (PN) (17%). Electrophysiological evidence of PN was present in all of these patients, electrophysiological investigation revealed subclinical PN in 19 more patients (5.3%). Conclusion: On the basis of the findings from this study, it can be concluded that a high prevalence of peripheral neuropathy is present among the patients with HCV in our locality. However, an electrophysiological examination should always be done to avoid underestimating PN, particularly in older HCV patients.

Comparison of Serum Holotranscobalamin with Serum Vitamin B12 in Population Prone to Megaloblastic Anemia and their Correlation with Nerve Conduction Study.

Early detection of megaloblastic anemia and associated neurological complications is crucial for management. This study was conducted to compare serum holotranscobalamin level with serum vitamin B12 level as early biomarker in people prone to megaloblastic anemia and to evaluate co-relation between these biomarkers and nerve conduction study in study patients. 83 adult patients (Hb > 12 gm/dl) prone to megaloblastic anemia were studied for basic haematological investigations, random blood sugar, thyroid function test, liver function test, kidney function test, serum vitamin B12, serum holotranscobalamin and serum folic acid levels. 45 patients among them underwent nerve conduction studies. All study patients were classified in 6 groups on the basis of risk factors for megaloblastic anemia. 29 patients (34.9%) were on antiepileptic drugs, 26 (31.3%) were chronic alcoholic, 10 patients (12%) each, had malabsorption and ileal tuberculosis, 6 (7.22%) had chronic pancreatitis and 2 (2.4%) had ileal resection. 30 patients (36.14%) had low serum holotranscobalamin, including 7 patients (8.43%) with low serum vitamin B12 level also, unmasking vitamin B12 deficiency in 23 patients (27.7%). 7 patients (8.43%) had mean corpuscular volume (MCV) > 100fL and 8 patients (9.63%) had vitamin B12 deficiency related changes on peripheral smear. Serum vitamin B12 and holotranscobalamin levels were significantly low in patients with peripheral smear changes, with p value 0.039 and 0.041 respectively, while no such association seen with MCV. Subclinical peripheral neuropathy was detected in 18 (40%) out of 45 patients on nerve conduction study. Serum holotranscobalamin levels were significantly lower (p = 0.031) than serum vitamin B12 levels (p = 0.2) in patients with neuropathic changes. Rest investigations and serum folic acid levels were normal in all patients. Holotranscobalamin levels can be considered early and reliable marker for vitamin B12 deficiency and deficiency associated peripheral neuropathy, even in patients who are prone to megaloblastic anemia, and not yet anemic or symptomatic for neuropathy.

Prevention of Bortezomib-Induced Peripheral Neuropathy in Newly Multiple Myeloma Patients Using Nervonic Acid, Curcuma Rizoma, and L-Arginine Compound: A Pilot Study.

Introduction:This is a phase II pilot study to evaluate the efficacy of a nutraceutical compound composed of nervonic acid, curcuma rizoma, and l-Arginine to prevent the onset of bortezomib-induced peripheral neuropathy (BIPN) in 16 newly diagnosed multiple myeloma (MM) patients treated with bortezomib (BTZ) over 6 months.Materials and methods:Assessments included neurological examination and electroneurography, Common Terminology Criteria for Adverse Events (NCI-CTCAE), reduced version of Total Neuropathic Score (TNSr), pain evaluation, functional autonomy scales, self-perceived symptoms and quality of life questionnaires at baseline and after 6 months.Results:No patients were symptomatic at baseline, despite neurophysiological data and TNSr evidence of peripheral neuropathy (PN) in 11 of them. After 6 months, only 9 patients completed the study. All had modifications in neurological examination with 8 out of 9 showing neurophysiological data of PN (2 of which had a NCI-CTCAE grade of neurotoxicity ≥2); 4 patients dropped out due to BIPN, 2 because of MM progression, 1 for scarce compliance.Discussion:In our study, the compound was not adequate to prevent BIPN. The incidence of subclinical PN in MM patients is a risk factor for the development of severe neurotoxicity during BTZ treatment. For this reason to evaluate the efficacy of any preventive compound, as well as to manage MM patients, it should be mandatory to include neurophysiological study as a standard procedure.

Electrophysiological estimation of subclinical neuropathy and its types in diabetes mellitus patients

Diabetes mellitus is the leading cause for peripheral neuropathy in India. It is a devastating complication which leads to amputation of limbs affecting the physical and social quality of life. Subclinical peripheral neuropathy is one which doesn’t have any symptoms or signs, but positive electrophysiological findings.: 1): To estimate the prevalence of subclinical peripheral neuropathy and its types among the diabetes mellitus patients. 2): To determine the various risk factors influencing them. 51 patients with diabetes mellitus without symptoms and signs of peripheral neuropathy were selected based on inclusion criteria and after assessing the screening scores. Necessary blood investigations was done and nerve conduction test was carried out in both upper and lower limbs for motor and sensory study.22(43%) out of the 51 diabetic patients had subclinical peripheral neuropathy. Lower limb(29.5%) predmominates than upper limb, sensory(23.5%) more common than motor neuropathy. Axonal neuropathy was the predominant (29%). Statistical significance was observed between the duration of diabetes mellitus, high triglyceride levels, high blood sugar profile and high HbA1C values with the presence of subclinical peripheral neuropathy.Nerve conduction study is the best for diagnosing subclinical neuropathy in diabetes mellitus patients. By early diagnosis and control of diabetes we can prevent dreadful complications.

Point Prevalence of Peripheral Neuropathy in Children and Adolescents with Type 1 Diabetes Mellitus.

To assess the point prevalence of peripheral neuropathy (PN) in children with type 1 diabetes mellitus (T1DM) and to determine their predictors. In this cross-sectional study, children aged 8-18 y with T1DM on insulin therapy for > 2 y and free from acute complications were enrolled. All participants were evaluated for symptoms of PN with diabetic neuropathy symptom (DNS) score and underwent a detailed neurological examination. Assessment of nerve dysfunction was done using nerve conduction studies (NCS). The disease-related factors that increase the risk of PN were determined. Fifty children (52% boys) were enrolled with mean age of 12.2 ± 2.8 y and duration of diabetes 5.1 ± 2.1 y. No subject had clinical evidence or DNS score suggestive of PN. Twenty-eight (56%) children demonstrated subclinical neuropathy on NCS. Proportion of children with pure motor, pure sensory, and mixed motor-sensory neuropathy was 40%, 2%, and 14%, respectively. The peroneal nerve was the most common motor nerve affected. Poor glycemic control (HbA1c > 9%) and longer duration of diabetes (> 5 y) were significantly associated with the risk of PN (p value < 0.05). A large proportion of children with T1DM have subclinical PN. Poor glycemic control and longer duration of diabetes are risk factors for nerve dysfunction. Neurophysiological studies should be performed in these children to facilitate early detection.

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.

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.

Corneal confocal microscopy demonstrates minimal evidence of distal neuropathy in children with celiac disease.

The aim of this study was to utilise corneal confocal microscopy to quantify corneal nerve morphology and establish the presence of sub-clinical small fibre damage and peripheral neuropathy in children with celiac disease. This is a cross-sectional cohort study of twenty children with celiac disease and 20 healthy controls who underwent clinical and laboratory assessments and corneal confocal microscopy. Corneal nerve fiber density (no.mm2), corneal nerve branch density (no.mm2), corneal nerve fiber length (mm.mm2), corneal nerve fiber tortuosity and inferior whorl length (mm.mm2) were quantified manually. Corneal nerve fiber density (34.7±8.6 vs. 32.9±8.6; P = 0.5), corneal nerve branch density (47.2±24.5 vs. 47.3±20.0; P = 0.1) and corneal nerve fiber length (20.0±5.1 vs. 19.5±4.5; P = 0.8) did not differ between children with celiac disease and healthy controls. Corneal nerve fiber tortuosity (11.4±1.9 vs 13.5±3.0; P = 0.01) was significantly lower and inferior whorl length (20.0±5.5 vs 23.0±3.8; P = 0.06) showed a non-significant reduction in children with celiac disease compared to healthy controls. Inferior whorl length correlated significantly with corneal nerve fiber density (P = 0.005), corneal nerve branch density (P = 0.04), and corneal nerve fiber length (P = 0.002). Corneal confocal microscopy demonstrates minimal evidence of neuropathy in children with celiac disease.

The pattern of nerve involvement in type 1 diabetic patients with subclinical peripheral neuropathy

The pattern of nerve involvement in type 1 diabetic patients with subclinical peripheral neuropathy

Subclinical peripheral neuropathy in patients with chronic obstructive pulmonary disease without hypoxemia

AIM: The aim of the study was to determine the prevalence of subclinical peripheral neuropathy (PNP) in stable chronic obstructive pulmonary disease (COPD) patients without severe hypoxemia. MATERIALS AND METHODS: Fifty-six (52 men and 4 women) patients with COPD without severe hypoxemia, 25 healthy smokers, and 24 healthy nonsmokers were included in the study. The latency, amplitude, and velocity measurements of right and left median motor nerve, tibial motor nerve, peroneal motor nerve, median sensory nerve, sural sensory nerve, right ulnar motor nerve, and right ulnar sensory nerve were performed. RESULTS: A high proportion of PNP was detected in the COPD group compared to the smoker and nonsmoker control groups (41.1%, 36.0%, and 33.3%, respectively). However, the difference between the groups was not statistically significant (P = 0.784). However, some of the electrophysiological measurements were statistically significantly worse in the COPD group (P 0.05). CONCLUSION: The present study demonstrates that the PNP may be an extrapulmonary manifestation of COPD. The physician should be aware of the possibility of PNP in COPD patients without severe hypoxemia.

Electrophysiological analysis of subclinical peripheral neuropathy in cases with diabetes mellitus type I

Electrophysiological analysis of subclinical peripheral neuropathy in cases with diabetes mellitus type I

PERIPHERAL NEUROPATHY IN BEHÇET'S DISEASE: CLINICAL AND NEUROPHYSIOLOGICAL STUDY

Background: Behcet’s disease (BD) is a chronic idiopathic relapsing condition, whereas multiple organs are affected as a sequential effect of the vascular and inflammatory process. Based on the neurophysiological studies, 20-40% of BD patients may have silent neurological involvement (SNI) with no or very mild clinical manifestations. Objectives: Assessing clinically and electro physiologically the prevalence of symptomatic and asymptomatic peripheral neuropathy (PN) among BD patients along with the potential predictors of PN among BD patients. Patients and Methods: All patients with clinically established BD according to the International Criteria for Behcet's Disease (ICBD) were involved in the current study. All patients were submitted to clinical evaluation, neuropathy symptom score (NSS) along with electrophysiological nerve conduction studies including sensory and motor nerve conduction assessment. Results:  An overall 30 participants who fulfilled the inclusion criteria were enrolled in the study. There were 22 (73.3%) males and 8 (26.7%) females with a mean age of 37.9±8.31 years. Based on the electrophysiological studies, 16 (53.3%) patients had the evidence of peripheral neuropathy in the terms of mixed (23.3%), motor (6.6%), and sensory (23.3%) nerve affection. The most affected peripheral nerve was sural nerve (46.6%) succeeded by peroneal (43.3%) and ulnar (20%) nerves. The univariate regression model showed that the age of the patients and the duration of the disease were independent predictors of peripheral neuropathy. Conclusion: PN is a considerable complication of BD, whereby health care providers should employ a routine follow up protocol for early detection of even the subclinical PN.

PERIPHERAL NEUROPATHY IN BEHÇET'S DISEASE: CLINICAL AND NEUROPHYSIOLOGICAL STUDY

Background: Behcet’s disease (BD) is a chronic idiopathic relapsing condition, whereas multiple organs are affected as a sequential effect of the vascular and inflammatory process. Based on the neurophysiological studies, 20-40% of BD patients may have silent neurological involvement (SNI) with no or very mild clinical manifestations. Objectives: Assessing clinically and electro physiologically the prevalence of symptomatic and asymptomatic peripheral neuropathy (PN) among BD patients along with the potential predictors of PN among BD patients. Patients and Methods: All patients with clinically established BD according to the International Criteria for Behcet's Disease (ICBD) were involved in the current study. All patients were submitted to clinical evaluation, neuropathy symptom score (NSS) along with electrophysiological nerve conduction studies including sensory and motor nerve conduction assessment. Results:  An overall 30 participants who fulfilled the inclusion criteria were enrolled in the study. There were 22 (73.3%) males and 8 (26.7%) females with a mean age of 37.9±8.31 years. Based on the electrophysiological studies, 16 (53.3%) patients had the evidence of peripheral neuropathy in the terms of mixed (23.3%), motor (6.6%), and sensory (23.3%) nerve affection. The most affected peripheral nerve was sural nerve (46.6%) succeeded by peroneal (43.3%) and ulnar (20%) nerves. The univariate regression model showed that the age of the patients and the duration of the disease were independent predictors of peripheral neuropathy. Conclusion: PN is a considerable complication of BD, whereby health care providers should employ a routine follow up protocol for early detection of even the subclinical PN.

Use of graded Semmes Weinstein monofilament testing for ascertaining peripheral neuropathy in people with and without diabetes

AimsTo assess peripheral neuropathy (PN) using graded Semmes Weinstein monofilaments (SWMs) and determine factors associated with PN among adult volunteers with and without diabetes. MethodsAdult volunteers were assessed for distal sensory PN using three graded SWMs. Four PN levels were defined: 0 (no PN; felt all three filaments), 1 (subclinical PN; insensate to 1-g filament), 2 (insensate to 10-g), or 3 (insensate to 75-g). Levels 2–3 were considered clinical PN. Associations with PN were determined using ordinal logistic regression. ResultsIn 1564 subjects (median age 41.9 years, 50.1% women), PN was subclinical or worse in 68.9% and clinical in 11.2%. Age-sex-race-adjusted prevalence of clinical PN was greater in people with diabetes (15.3%) than without (6.1%; P < 0.001). Associated factors included older age, male sex, greater BMI, greater heart rate, lower mean arterial pressure, and family history of diabetes or cardiovascular diseases. Higher PN levels associated with worse albuminuria and retinopathy. Only older age and male sex associated with PN both in people with and without diabetes. ConclusionsPN is common in our sample, notably in those without diabetes, although diabetes greatly increases its risk. Using graded SWMs may have a prognostic value as it permits the identification of subclinical PN.