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Hayashi Y, Himeno T, Shibata Y, Hirai N, Asada‐Yamada Y, Sasajima S, Asano‐Hayami E, Motegi M, Asano S, Kato M, Nakai‐Shimoda H, Tani H, Miura‐Yura E, Morishita Y, Kondo M, Tsunekawa S, Nakayama T, Nakamura J, Kamiya H. Simplified electrophysiological approach combining a point-of-care nerve conduction device and an electrocardiogram produces an accurate diagnosis of diabetic polyneuropathy. J Diabetes Investig 2024; 15:736-742. [PMID: 38421109 PMCID: PMC11143421 DOI: 10.1111/jdi.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/11/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS/INTRODUCTION This study aimed to investigate the diagnostic potential of two simplified tests, a point-of-care nerve conduction device (DPNCheck™) and a coefficient of variation of R-R intervals (CVR-R), as an alternative to traditional nerve conduction studies for the diagnosis of diabetic polyneuropathy (DPN) in patients with diabetes. MATERIALS AND METHODS Inpatients with type 1 or type 2 diabetes (n = 167) were enrolled. The study population consisted of 101 men, with a mean age of 60.8 ± 14.8 years. DPN severity was assessed using traditional nerve conduction studies, and differentiated based on Baba's classification (BC). To examine the explanatory potential of variables in DPNCheck™ and CVR-R regarding the severity of DPN according to BC, a multiple regression analysis was carried out, followed by a receiver operating characteristic analysis. RESULTS Based on BC, 61 participants (36.5% of the total) were categorized as having DPN severity of stage 2 or more. The multiple regression analysis yielded a predictive formula with high predictive power for DPN diagnosis (estimated severity of DPN in BC = 2.258 - 0.026 × nerve conduction velocity [m/s] - 0.594 × ln[sensory nerve action potential amplitude (μV)] + 0.528In[age(years)] - 0.178 × ln[CVR-R], r = 0.657). The area under the curve in receiver operating characteristic analysis was 0.880. Using the optimal cutoff value for DPN with severer than stage 2, the predictive formula showed good diagnostic efficacy: sensitivity of 83.6%, specificity of 79.2%, positive predictive value of 51.7% and negative predictive value of 76.1%. CONCLUSIONS These findings suggest that DPN diagnosis using DPNCheck™ and CVR-R could improve diagnostic efficiency and accessibility for DPN assessment in patients with diabetes.
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Affiliation(s)
- Yusuke Hayashi
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Tatsuhito Himeno
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
- Department of Innovative Diabetes TherapyAichi Medical University School of MedicineNagakuteJapan
| | - Yuka Shibata
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
- Department of Clinical LaboratoryAichi Medical University HospitalNagakuteJapan
| | - Nobuhiro Hirai
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Yuriko Asada‐Yamada
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Sachiko Sasajima
- Department of Internal Medicine, School of DentistryAichi Gakuin UniversityNagoyaJapan
| | - Emi Asano‐Hayami
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Mikio Motegi
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Saeko Asano
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Makoto Kato
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Hiromi Nakai‐Shimoda
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Hiroya Tani
- Department of Clinical LaboratoryAichi Medical University HospitalNagakuteJapan
| | - Emiri Miura‐Yura
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Yoshiaki Morishita
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Masaki Kondo
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Shin Tsunekawa
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Takayuki Nakayama
- Department of Clinical LaboratoryAichi Medical University HospitalNagakuteJapan
| | - Jiro Nakamura
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
- Department of Innovative Diabetes TherapyAichi Medical University School of MedicineNagakuteJapan
| | - Hideki Kamiya
- Division of Diabetes, Department of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
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Bus SR, de Haan RJ, Vermeulen M, van Schaik IN, Eftimov F. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev 2024; 2:CD001797. [PMID: 38353301 PMCID: PMC10865446 DOI: 10.1002/14651858.cd001797.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) causes progressive or relapsing weakness and numbness of the limbs, which lasts for at least two months. Uncontrolled studies have suggested that intravenous immunoglobulin (IVIg) could help to reduce symptoms. This is an update of a review first published in 2002 and last updated in 2013. OBJECTIVES To assess the efficacy and safety of intravenous immunoglobulin in people with chronic inflammatory demyelinating polyradiculoneuropathy. SEARCH METHODS We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and two trials registers on 8 March 2023. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and quasi-RCTs that tested any dose of IVIg versus placebo, plasma exchange, or corticosteroids in people with definite or probable CIDP. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was significant improvement in disability within six weeks after the start of treatment, as determined and defined by the study authors. Our secondary outcomes were change in mean disability score within six weeks, change in muscle strength (Medical Research Council (MRC) sum score) within six weeks, change in mean disability score at 24 weeks or later, frequency of serious adverse events, and frequency of any adverse events. We used GRADE to assess the certainty of evidence for our main outcomes. MAIN RESULTS We included nine RCTs with 372 participants (235 male) from Europe, North America, South America, and Israel. There was low statistical heterogeneity between the trial results, and the overall risk of bias was low for all trials that contributed data to the analysis. Five trials (235 participants) compared IVIg with placebo, one trial (20 participants) compared IVIg with plasma exchange, two trials (72 participants) compared IVIg with prednisolone, and one trial (45 participants) compared IVIg with intravenous methylprednisolone (IVMP). We included one new trial in this update, though it contributed no data to any meta-analyses. IVIg compared with placebo increases the probability of significant improvement in disability within six weeks of the start of treatment (risk ratio (RR) 2.40, 95% confidence interval (CI) 1.72 to 3.36; number needed to treat for an additional beneficial outcome (NNTB) 4, 95% CI 3 to 5; 5 trials, 269 participants; high-certainty evidence). Since each trial used a different disability scale and definition of significant improvement, we were unable to evaluate the clinical relevance of the pooled effect. IVIg compared with placebo improves disability measured on the Rankin scale (0 to 6, lower is better) two to six weeks after the start of treatment (mean difference (MD) -0.26 points, 95% CI -0.48 to -0.05; 3 trials, 90 participants; high-certainty evidence). IVIg compared with placebo probably improves disability measured on the Inflammatory Neuropathy Cause and Treatment (INCAT) scale (1 to 10, lower is better) after 24 weeks (MD 0.80 points, 95% CI 0.23 to 1.37; 1 trial, 117 participants; moderate-certainty evidence). There is probably little or no difference between IVIg and placebo in the frequency of serious adverse events (RR 0.82, 95% CI 0.36 to 1.87; 3 trials, 315 participants; moderate-certainty evidence). The trial comparing IVIg with plasma exchange reported none of our main outcomes. IVIg compared with prednisolone probably has little or no effect on the probability of significant improvement in disability four weeks after the start of treatment (RR 0.91, 95% CI 0.50 to 1.68; 1 trial, 29 participants; moderate-certainty evidence), and little or no effect on change in mean disability measured on the Rankin scale (MD 0.21 points, 95% CI -0.19 to 0.61; 1 trial, 24 participants; moderate-certainty evidence). There is probably little or no difference between IVIg and prednisolone in the frequency of serious adverse events (RR 0.45, 95% CI 0.04 to 4.69; 1 cross-over trial, 32 participants; moderate-certainty evidence). IVIg compared with IVMP probably increases the likelihood of significant improvement in disability two weeks after starting treatment (RR 1.46, 95% CI 0.40 to 5.38; 1 trial, 45 participants; moderate-certainty evidence). IVIg compared with IVMP probably has little or no effect on change in disability measured on the Rankin scale two weeks after the start of treatment (MD 0.24 points, 95% CI -0.15 to 0.63; 1 trial, 45 participants; moderate-certainty evidence) or on change in mean disability measured with the Overall Neuropathy Limitation Scale (ONLS, 1 to 12, lower is better) 24 weeks after the start of treatment (MD 0.03 points, 95% CI -0.91 to 0.97; 1 trial, 45 participants; moderate-certainty evidence). The frequency of serious adverse events may be higher with IVIg compared with IVMP (RR 4.40, 95% CI 0.22 to 86.78; 1 trial, 45 participants, moderate-certainty evidence). AUTHORS' CONCLUSIONS Evidence from RCTs shows that IVIg improves disability for at least two to six weeks compared with placebo, with an NNTB of 4. During this period, IVIg probably has similar efficacy to oral prednisolone and IVMP. Further placebo-controlled trials are unlikely to change these conclusions. In one large trial, the benefit of IVIg compared with placebo in terms of improved disability score persisted for 24 weeks. Further research is needed to assess the long-term benefits and harms of IVIg relative to other treatments.
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Affiliation(s)
- Sander Rm Bus
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rob J de Haan
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marinus Vermeulen
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Crnošija L, Adamec I, Krbot Skorić M, Habek M. How to explore and explain autonomic changes in multiple sclerosis. Neurophysiol Clin 2023; 53:102854. [PMID: 36966707 DOI: 10.1016/j.neucli.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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Köhler G, Eichner M, Abrahamian H, Kofler M, Sturm W, Menzel A. [Diabetic neuropathy and diabetic foot syndrome (update 2023)]. Wien Klin Wochenschr 2023; 135:164-181. [PMID: 37101039 PMCID: PMC10133034 DOI: 10.1007/s00508-023-02167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
These are the guidelines for diagnosis and treatment of diabetic neuropathy and diabetic foot.The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy, including the complex situation of the diabetic foot syndrome. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided. The needs to prevent and treat diabetic foot syndrome are summarized.
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Affiliation(s)
- Gerd Köhler
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich.
- Rehabilitationszentrum Aflenz für Stoffwechselerkrankungen mit Schwerpunkt Diabetes mellitus und hochgradige Adipositas, Aflenz, Österreich.
| | | | | | - Markus Kofler
- Abteilung für Neurologie, Landeskrankenhaus Hochzirl, Hochzirl-Natters, Österreich
| | - Wolfgang Sturm
- Universitätsklinik für Innere Medizin I Innsbruck, Innsbruck, Österreich
| | - Anja Menzel
- Innere Medizin, Endokrinologie und Diabetologie, Deutschlandsberg, Österreich
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Kharitonova T, Shvarts YG, Verbovoy AF, Orlova NS, Puzyreva VP, Strokov IA. Efficacy and safety of the combined metabolic medication, containing inosine, nicotinamide, riboflavin and succinic acid, for the treatment of diabetic neuropathy: a multicenter randomized, double-blind, placebo-controlled parallel group clinical trial (CYLINDER). BMJ Open Diabetes Res Care 2022; 10:10/3/e002785. [PMID: 35680173 PMCID: PMC9185393 DOI: 10.1136/bmjdrc-2022-002785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Antioxidants may have positive impact on diabetic polyneuropathy (DPN), presumably due to alleviation of oxidative stress. We aimed to evaluate the efficacy and safety of combination of antioxidants: succinic acid, inosine, nicotinamide, and riboflavin (SINR) in the treatment of DPN. RESEARCH DESIGN AND METHODS In a double-blind, placebo-controlled clinical trial, men and women aged 45-74 years with type 2 diabetes and symptomatic DPN, with initial Total Symptom Score (TSS) ˃5, were randomized into experimental (n=109) or placebo (n=107) group. Patients received study medication/placebo intravenously for 10 days, followed by oral administration for 75 days. Statistical significance was defined as a two-tailed p<0.05. RESULTS In SINR group, mean TSS change after 12 weeks was -2.65 (±1.46) vs -1.73 (±1.51) in the placebo group (p<0.0001; t-test). Reduction of symptoms in the SINR group was achieved regardless of hemoglobin A1c levels, but better results were observed in patients with initial TSS <7.5. The analysis of TSS subscores revealed statistically significant between-group differences by dynamics of the intensity of paresthesia and of numbness starting from day 11 (p=0.035 and p=0.001, respectively; mixed model); by day 57, statistically significant between-group differences were detected also by dynamics of burning intensity (p=0.005; mixed model). Study limitations are small effect size, moderate proportion of patients with severe DPN symptoms, subjective assessment of outcomes, exclusion of participants who received injectable glucose-lowering medications other than insulins, and patients with uncontrolled and type 1 diabetes. CONCLUSIONS The combination of SINR effectively alleviates DPN symptoms in patients with type 2 diabetes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04649203; Unique Protocol ID: CTF-III-DM-2019).
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Affiliation(s)
- Tatiana Kharitonova
- Department of Acute Cerebrovascular Pathology and Emergency Neurology, Sankt-Peterburgskij naucno-issledovatel'skij institut skoroj pomosi imeni I I Dzanelidze, Sankt Peterburg, Russian Federation
| | - Yury G Shvarts
- Department of Faculty Therapy, City Clinical Hospital, Saratov, Russian Federation
| | - Andrey F Verbovoy
- Department of Endocrinilogy, Limited Liability Company 'Center Diabetes', Samara, Russian Federation
| | - Natalia S Orlova
- Endocrinologist, 'Eco-Safety' Medical Center, St Petersburg, Russian Federation
| | - Valentina P Puzyreva
- City Endocrinology Center, City Hospital No 4, Rostov-on-Don, Russian Federation
| | - Igor A Strokov
- Department of Nervous Diseases and Neurosurgery, Sechenov University, Moskva, Russian Federation
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Zhang M, Yan J, Huang J, Ye K, Zhou P, Liu X. Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China. Endocr J 2022; 69:155-163. [PMID: 34526425 DOI: 10.1507/endocrj.ej21-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral arterialdisease (PAD) can result in diabetic foot ulcers, gangrene, and even amputation. Since most cases of PAD in diabetic patients are associated with peripheral neuropathy, the symptoms of vascular disease are easily concealed by the symptoms of neuropathy and are ignored by people, so it is critical for health care providers to screen PAD for the diabetes patients. This study was carried out to identify theprevalence and related factors of PAD in diabetes mellitus inpatients. This was a cross-sectional observational study. A total of 855 patients were enrolled in the study from December 2018 to December 2019. The patients were divided into a non-PAD group (ABI = 0.9-1.3) and a PAD group (ABI <0.9). Logistic multivariate regression analysis showed that age, LDL-C, dorsalis pedis artery pulsation (left foot), and sensory-current threshold (right foot) were related factors for peripheral arterial disease. Patients who are older and have a higher LDL-C level, abnormal dorsal foot pulse, and abnormal sensory-current threshold must be vigilant, and receive early screening for PAD diagnosis and treatment to avoid a malignant outcome. In clinical work, medical staff should actively apply PAD screening to diabetic patients, identify risk factors as early as possible, conduct early interventions, reduce the risk of PAD in patients, and avoid the occurrence of adverse outcomes.
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Affiliation(s)
- Minna Zhang
- Nursing Institute, Jinan University, Guangzhou 51000, China
| | - Junlan Yan
- Nursing Institute, Jinan University, Guangzhou 51000, China
| | - Jiewei Huang
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
| | - Kaiming Ye
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
| | - Peiru Zhou
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
| | - Xueyan Liu
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
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Rasmussen VF, Jensen TS, Tankisi H, Karlsson P, Vestergaard ET, Kristensen K, Nyengaard JR, Terkelsen AJ. Large fibre, small fibre and autonomic neuropathy in adolescents with type 1 diabetes: A systematic review. J Diabetes Complications 2021; 35:108027. [PMID: 34429229 DOI: 10.1016/j.jdiacomp.2021.108027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 08/14/2021] [Indexed: 01/23/2023]
Abstract
AIMS To estimate the prevalence of neuropathy in adolescents with type 1 diabetes. METHODS Systematic collection of published studies exploring the prevalence of large fibre neuropathy (LFN), small fibre neuropathy (SFN), and autonomic neuropathy in adolescents with type 1 diabetes. Following prospective registration (Prospero CRD42020206093), PubMed, EMBASE, and Cochrane Library were searched for studies from 2000 to 2020. PICO framework was used in the selection process (Population: adolescents aged 10-19 years with type 1 diabetes; Intervention: diagnostic methods for neuropathy; Comparison: reference data; Outcome: data on prevalence or comparison). Data were extracted concerning study quality based on available data and established methods for determining and diagnosing various neuropathy types. RESULTS From 2,017 initial citations, 27 studies (7589 participants) fulfilled eligibility criteria. The study population (47% males) had a diabetes duration between 4.0 and 10.6 years, and HbA1c level between 7.3 and 10.8%, 56-95 mmol/mol. The prevalence of LFN, based on nerve conduction studies, was 10-57%. Based on other tests for neuropathy, the prevalence of LFN and SFN was 12-62%, and that of cardiac autonomic neuropathy was 12-75%. CONCLUSION The described prevalence of neuropathy in adolescents with type 1 diabetes varied, which can be methodological due to different screening methods and classifications of neuropathy.
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Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Paediatrics, Randers Regional Hospital, Randers, Denmark.
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; International Diabetic Neuropathy Consortium, Aarhus University, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Department of Clinical Medicine, Aarhus University, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Esben Thyssen Vestergaard
- Department of Paediatrics, Randers Regional Hospital, Randers, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Jens Randel Nyengaard
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Shin KJ, Kang JW, Sung KH, Park SH, Kim SE, Park KM, Ha SY, Kim SE, In Lee B, Park J. Quantitative gait and postural analyses in patients with diabetic polyneuropathy. J Diabetes Complications 2021; 35:107857. [PMID: 33610435 DOI: 10.1016/j.jdiacomp.2021.107857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although gait disturbances are relatively common symptoms in diabetic polyneuropathy (DPN), few studies have quantitatively analyzed gait and posture in DPN patients. This study aimed to analyze gait and posture quantitatively in DPN patients and to determine the association between clinical and electrophysiological parameters and gait and posture parameters. METHODS Sixty-four DPN patients were enrolled in this study. DPN was clinically assessed using the Toronto clinical neuropathy score (TCNS). All participants underwent nerve conduction study (NCS), three-dimensional motion analysis, and static posturography. We evaluate the correlation of gait and posture parameters with electrophysiological and clinical parameters. RESULTS Foot height, step length, and stride length among gait parameters were inversely correlated with the TCNS. Anteroposterior range during eyes-closed and mediolateral distance and range during eyes-open and eyes-closed were inversely correlated with the sensory nerve action potential amplitude in the sural nerve. Mediolateral distance during eyes-open and eyes-closed was correlated with the compound muscle action potential amplitude in the peroneal nerve. CONCLUSIONS Gait parameters are associated with clinical parameters, and postural parameters are associated with electrophysiological parameters, particularly sensory NCS. Gait and postural analysis can be a useful tool for assessing the neurological status in DPN patients.
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Affiliation(s)
- Kyong Jin Shin
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Jong Woo Kang
- Department of Orthopaedic Surgery, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Kwon Hyuk Sung
- Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Sung Ho Park
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Sam Yeol Ha
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Byoung In Lee
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Jinse Park
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea.
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Cheshire WP, Freeman R, Gibbons CH, Cortelli P, Wenning GK, Hilz MJ, Spies JM, Lipp A, Sandroni P, Wada N, Mano A, Ah Kim H, Kimpinski K, Iodice V, Idiáquez J, Thaisetthawatkul P, Coon EA, Low PA, Singer W. Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology. Clin Neurophysiol 2020; 132:666-682. [PMID: 33419664 DOI: 10.1016/j.clinph.2020.11.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 11/02/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
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Affiliation(s)
- William P Cheshire
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, Florida 32224, USA
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215-5400, USA
| | - Christopher H Gibbons
- Department of Neurology, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215-5400, USA
| | - Pietro Cortelli
- DIBINEM - University of Bologna, Bologna, Italy; IRCCS Istituto di Scienze Neurologiche, Bologna, Italy
| | - Gregor K Wenning
- Section of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, Erlangen 91054, Germany
| | - Judith M Spies
- Department of Neurology, Level 8 East, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - Axel Lipp
- Park-Klinik Weißensee, Schönstraße 80, Berlin 13086, Germany
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa 078-8510, Japan
| | - Akiko Mano
- Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-Cho Itabashi-ku, Tokyo 173-0015, Japan
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University Dongsan Hospital, 2800 Dalgubeol Daero, Dalseo-gu, Daegu, South Korea
| | - Kurt Kimpinski
- School of Kinesiology, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, Division of Clinical Neurology, Institute of Neurology, University College London, WC1N 3BG London, United Kingdom
| | - Juan Idiáquez
- Department of Neurologia, Facultad de Medicina, University of Valparaíso, 7 Norte 1122, Valparaíso, 2531094, Chile
| | - Pariwat Thaisetthawatkul
- Department of Neurological Sciences, 988435 University of Nebraska Medical Center, Omaha, Nebraska 68198-8435, USA
| | - Elizabeth A Coon
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
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10
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Kamiya H, Shibata Y, Himeno T, Tani H, Nakayama T, Murotani K, Hirai N, Kawai M, Asada-Yamada Y, Asano-Hayami E, Nakai-Shimoda H, Yamada Y, Ishikawa T, Morishita Y, Kondo M, Tsunekawa S, Kato Y, Baba M, Nakamura J. Point-of-care nerve conduction device predicts the severity of diabetic polyneuropathy: A quantitative, but easy-to-use, prediction model. J Diabetes Investig 2020; 12:583-591. [PMID: 32799422 PMCID: PMC8015817 DOI: 10.1111/jdi.13386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 01/18/2023] Open
Abstract
Aims/Introduction A gold standard in the diagnosis of diabetic polyneuropathy (DPN) is a nerve conduction study. However, as a nerve conduction study requires expensive equipment and well‐trained technicians, it is largely avoided when diagnosing DPN in clinical settings. Here, we validated a novel diagnostic method for DPN using a point‐of‐care nerve conduction device as an alternative way of diagnosis using a standard electromyography system. Materials and Methods We used a multiple regression analysis to examine associations of nerve conduction parameters obtained from the device, DPNCheck™, with the severity of DPN categorized by the Baba classification among 375 participants with type 2 diabetes. A nerve conduction study using a conventional electromyography system was implemented to differentiate the severity in the Baba classification. The diagnostic properties of the device were evaluated using a receiver operating characteristic curve. Results A multiple regression model to predict the severity of DPN was generated using sural nerve conduction data obtained from the device as follows: the severity of DPN = 2.046 + 0.509 × ln(age [years]) − 0.033 × (nerve conduction velocity [m/s]) − 0.622 × ln(amplitude of sensory nerve action potential [µV]), r = 0.649. Using a cut‐off value of 1.3065 in the model, moderate‐to‐severe DPN was effectively diagnosed (area under the receiver operating characteristic curve 0.871, sensitivity 70.1%, specificity 87.7%, positive predictive value 83.0%, negative predictive value 77.3%, positive likelihood ratio 5.67, negative likelihood ratio 0.34). Conclusions Nerve conduction parameters in the sural nerve acquired by the handheld device successfully predict the severity of DPN.
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Affiliation(s)
- Hideki Kamiya
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuka Shibata
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.,Department of Laboratory, The Medical Clinic of Aichi Medical University, Nagoya, Japan
| | - Tatsuhito Himeno
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroya Tani
- Department of Clinical Laboratory, Aichi Medical University Hospital, Nagakute, Japan
| | - Takayuki Nakayama
- Department of Clinical Laboratory, Aichi Medical University Hospital, Nagakute, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University Graduate School of Medicine, Kurume, Japan
| | - Nobuhiro Hirai
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Miyuka Kawai
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuriko Asada-Yamada
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Emi Asano-Hayami
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiromi Nakai-Shimoda
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuichiro Yamada
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takahiro Ishikawa
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshiaki Morishita
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masaki Kondo
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shin Tsunekawa
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshiro Kato
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masayuki Baba
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Jiro Nakamura
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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11
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Hashemi-Soteh MB, Ahmadzadeh Amiri A, Sheikh Rezaee MR, Ahmadzadeh Amiri A, Olfat S, Ahmadzadeh Amiri A. Aldose reductase (AC)n gene polymorphism in Iranian patients with type 2 diabetic microangiopathy; a case-control study. Diabetol Int 2020; 12:101-107. [PMID: 33479585 DOI: 10.1007/s13340-020-00446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
Aim (AC)n promoter region of the aldose reductase (ALR) genes polymorphism has been associated with diabetic microvascular complications (MVCs). The aim of this study was to find the relationship between dinucleotide repeat (AC)n polymorphisms of the ALR gene and the occurrence of MVCs, such as diabetic retinopathy, neuropathy, and nephropathy in Iranian type 2 diabetic (T2D) patients. Methods This prospective case-control study was performed on T2D patients who were categorized into two groups based on the presence or absence of diabetic microangiopathy. All patients were provided informed consent. After extracting genomic DNA, the (AC)n of the ALR gene was determined using Polymerase chain reaction (PCR). Results Thirteen alleles of the (AC)n gene polymorphism were detected including Z + 16, Z + 14, Z + 8, Z + 6, Z + 4, Z + 2, Z, Z - 2, Z - 4, Z - 6, Z - 8, Z - 10, and Z - 12. The frequency of the Z - 4 allele was significantly higher in patients with retinopathy, nephropathy, and autonomic neuropathy compared with those with long-term uncomplicated diabetes (P < 0.001, P < 0.001, P = 0.031, respectively). After controlling for baseline risk factors, we found that the carrier of the Z - 4 allele of ALR (AC)n polymorphism had a higher risk of diabetic retinopathy and diabetic nephropathy (P < 0.001). The homozygosity for the Z - 4 allele was found to be associated with diabetic microangiopathy. Conclusion Our results showed that ALR (AC)n gene polymorphism in Iranian patients with type 2 diabetes independently, predispose retinal, renal and neural microvascular to diabetic complications.
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Affiliation(s)
| | | | - Majid Reza Sheikh Rezaee
- Department of Ophthalmology, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Ahmad Ahmadzadeh Amiri
- Department of Ophthalmology, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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12
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13
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Sasaki H, Kawamura N, Dyck PJ, Dyck PJB, Kihara M, Low PA. Spectrum of diabetic neuropathies. Diabetol Int 2020; 11:87-96. [PMID: 32206478 PMCID: PMC7082443 DOI: 10.1007/s13340-019-00424-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/29/2019] [Indexed: 02/06/2023]
Abstract
The diabetic state results in neuropathy. The main causative mechanism is hyperglycemia, although microvascular involvement, hypertriglyceridemia, as well as genetic and immune mechanisms may be contributory. There is a growing spectrum of types of diabetic neuropathies that differ based on the type of fibers involved (e.g. myelinated, unmyelinated, autonomic, somatic), distribution of nerves involved, and mechanisms of neuropathy. The most common type is distal sensory neuropathy (DSN), which affects the distal ends of large myelinated fibers, more often sensory than motor, and is often asymptomatic. The next-most common is distal small fiber neuropathy (DSFN), which largely affects the unmyelinated fibers and carries the phenotype of burning feet syndrome. Diabetic autonomic neuropathy (DAN) occurs when widespread involvement of autonomic unmyelinated fibers occurs, and patients can be incapacitated with orthostatic hypotension as well as neurogenic bladder and bowel involvement. Radiculoplexus diabetic neuropathy causes proximal weakness and pain, usually in the lower extremity, and has a combination of immune, inflammatory, and vascular mechanisms. The nerve roots and plexus are involved. These patients present with proximal weakness of a subacute onset, often with severe pain and some autonomic failure. Finally, rapid and sustained reduction of blood glucose can result in treatment-induced diabetic neuropathy (TIND), which largely affects the sensory and autonomic fibers. This occurs if HbA1c is rapidly reduced within 3 months, and the likelihood is proportional to the original A1c and the size of the reduction.
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Affiliation(s)
| | | | - Peter J. Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - P. James B. Dyck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | | | - Phillip A. Low
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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14
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Rosenberger DC, Blechschmidt V, Timmerman H, Wolff A, Treede RD. Challenges of neuropathic pain: focus on diabetic neuropathy. J Neural Transm (Vienna) 2020; 127:589-624. [PMID: 32036431 PMCID: PMC7148276 DOI: 10.1007/s00702-020-02145-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
Neuropathic pain is a frequent condition caused by a lesion or disease of the central or peripheral somatosensory nervous system. A frequent cause of peripheral neuropathic pain is diabetic neuropathy. Its complex pathophysiology is not yet fully elucidated, which contributes to underassessment and undertreatment. A mechanism-based treatment of painful diabetic neuropathy is challenging but phenotype-based stratification might be a way to develop individualized therapeutic concepts. Our goal is to review current knowledge of the pathophysiology of peripheral neuropathic pain, particularly painful diabetic neuropathy. We discuss state-of-the-art clinical assessment, validity of diagnostic and screening tools, and recommendations for the management of diabetic neuropathic pain including approaches towards personalized pain management. We also propose a research agenda for translational research including patient stratification for clinical trials and improved preclinical models in relation to current knowledge of underlying mechanisms.
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Affiliation(s)
- Daniela C Rosenberger
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Vivian Blechschmidt
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Hans Timmerman
- Department of Anesthesiology, Pain Center, University Medical Center of Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - André Wolff
- Department of Anesthesiology, Pain Center, University Medical Center of Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
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15
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Zhang C, Tang M, Lu X, Zhou Y, Zhao W, Liu Y, Liu Y, Guo X. Relationship of ankle-brachial index, vibration perception threshold, and current perception threshold to glycemic variability in type 2 diabetes. Medicine (Baltimore) 2020; 99:e19374. [PMID: 32195933 PMCID: PMC7220673 DOI: 10.1097/md.0000000000019374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To explore the relationship of glycemic variability with lower extremity arterial disease (LEAD) and diabetic peripheral neuropathy (DPN).Seventy-eight patients with type 2 diabetes were enrolled. All patients underwent 72-hour dynamic blood glucose monitoring and obtained mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), standard deviation of blood glucose (SD), largest amplitude of glycemic excursion (LAGE), mean blood glucose (MBG), T≥10.0 (percentage of time for blood glucose levels ≥10.0 mmol/L), T≤3.9 (percentage of time for blood glucose levels ≤3.9 mmol/L), and other glycemic variability parameters. In the meanwhile, in order to explore the correlation of glycemic variability parameters with ankle-brachial index (ABI), vibration perception threshold (VPT), and current perception threshold (CPT), all patients underwent quantitative diabetic foot screening, including ABI for quantitative assessment of lower extremity arterial lesions and VPT and CPT for quantitative assessment of peripheral neuropathy.Patients were divided into abnormal CPT group (n = 21) and normal CPT group (n = 57) according to the CPT values. Compared with the normal CPT group, abnormal CPT group showed significantly higher levels of HbA1c, longer duration of diabetes, and higher levels of T≤3.9 (P < .05). However, there was no significant difference of MAGE, SD, LAGE, MODD, and other glycemic variability parameters between abnormal CPT group and normal CPT group (P > .05). Pearson correlation analysis or Spearman correlation analysis showed that ABI negatively correlated with MBG, T≥10.0, SD, LAGE, and MAGE (P < .05), but no correlation of ABI with T≤3.9 and MODD (P > .05) was shown. VPT showed a positive correlation with T≥10.0 (P < .05), but no correlation with other glycemic variability parameters (P > .05). There was no correlation between the other CPT values and the glycemic variability parameters (P > .05), except that the left and right 250 Hz CPT values were positively correlated with T≤3.9 (P > .05).The higher the blood glucose levels, the severer the degree of LEAD and DPN lesions; the higher the incidence of hypoglycemia, the severer the degree of DPN lesions; the greater the fluctuation of blood glucose, the severer the degree of LEAD lesions. However, the glycemic variability was not significantly correlated with DPN.
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Affiliation(s)
- Chuangbiao Zhang
- Department of Endocrinology, First Affiliated Hospital of Jinan University
| | - Meili Tang
- Department of Endocrinology, First Affiliated Hospital of Jinan University
| | - Xiaohua Lu
- Department of Endocrinology, First Affiliated Hospital of Jinan University
| | - Yan Zhou
- Department of Endocrinology, First Affiliated Hospital of Jinan University
- College of Nursing, Jinan University, Guangzhou
| | - Wane Zhao
- Department of Endocrinology, First Affiliated Hospital of Jinan University
- College of Nursing, Jinan University, Guangzhou
| | - Yu Liu
- Department of Endocrinology, First Affiliated Hospital of Jinan University
- College of Nursing, Jinan University, Guangzhou
| | - Yan Liu
- Department of Endocrinology, First Affiliated Hospital of Jinan University
- College of Nursing, Jinan University, Guangzhou
| | - Xiujie Guo
- Department of Endocrinology, Qingyuan People's Hospital, Qingyuan, Guangdong Province, China
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16
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Apostolou T, Gokal R. Neuropathy and Quality of Life in Diabetic Continuous Ambulatory Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s41] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Oiabetes mellitus is the commonest cause of end-stage renal failure and is associated with considerable morbidity. Neuropathy is one of the most serious complications of diabetes, linked to the incidence of nephropathy and retinopathy. The prevalence of neuropathy increases with age and duration of diabetes. Peripheral sensorimotor neuropathy is the main manifestation of neurological dam -age in diabetes, while autonomic neuropathy, a devastating complication, is also present in a large number of patients with long-term diabetes. Clinical features of autonomic neuropathy are mainly cardiovascular disorders and abnormal visceral function. One of the most important sequelae of neuropathy is the development of the insensitive foot at risk of ulceration, deformation, Charcot neuroarthropathy, and amputation. Prevention, education, and identification of the at-risk patient are the key elements in managing these severe complications. Oialysis, and mainly peritoneal dialysis, still remains the main renal replacement therapy for end-stage renal disease (ESRO) diabetic patients. It is obvious from many studies that diabetes and its complications are major risk factors associated with poorer survival rates, increased morbidity, and decreased quality of life. Few, if any, data are available specifically evaluating quality of life in continuous ambulatory peritoneal dialysis (CAPO) diabetic patients. Fewer data are available estimating the impact of neuropathy on the quality of life of such patients. Specific studies must be carried out to further investigate quality-of-life issues and neuropathy in this vulnerable group of patients.
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Affiliation(s)
| | - Ram Gokal
- Manchester Royal Infirmary, Renal Unit, Manchester, U.K
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17
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Jeannin AC, Salem JE, Massy Z, Aubert CE, Vemeer C, Amouyal C, Phan F, Halbron M, Funck-Brentano C, Hartemann A, Bourron O. Inactive matrix gla protein plasma levels are associated with peripheral neuropathy in Type 2 diabetes. PLoS One 2020; 15:e0229145. [PMID: 32092076 PMCID: PMC7039520 DOI: 10.1371/journal.pone.0229145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS/HYPOTHESIS Diabetic peripheral neuropathy is a frequent and severe complication of diabetes. As Matrix-gla-protein (MGP) is expressed in several components of the nervous system and is involved in some neurological disease, MGP could play a role in peripheral nervous system homeostasis. The aim of this study was to evaluate factors associated with sensitive diabetic neuropathy in Type 2 Diabetes, and, in particular, dephospho-uncarboxylated MGP (dp-ucMGP), the inactive form of MGP. METHODS 198 patients with Type 2 Diabetes were included. Presence of sensitive diabetic neuropathy was defined by a neuropathy disability score (NDS) ≥6. Plasma levels of dp-ucMGP were measured by ELISA. RESULTS In this cohort, the mean age was 64+/-8.4 years old, and 80% of patients were men. Peripheral neuropathy was present in 15.7% of the patients and was significantly associated (r = 0.51, p<0.0001) with dp-ucMGP levels (β = -0.26, p = 0.045) after integrating effects of height (β = -0.38, p = 0.01), insulin treatment (β = 0.42, p = 0.002), retinopathy treated by laser (β = 0.26, p = 0.02), and total cholesterol levels (β = 0.3, p = 0.03) by multivariable analysis. CONCLUSIONS The association between diabetic neuropathy and the inactive form of MGP suggests the existence of new pathophysiological pathways to explore. Further studies are needed to determine if dp-ucMGP may be used as a biomarker of sensitive neuropathy. Since dp-ucMGP is a marker of poor vitamin K status, clinical studies are warranted to explore the potential protective effect of high vitamin K intake on diabetic peripheral neuropathy.
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Affiliation(s)
- Anne-Caroline Jeannin
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Ziad Massy
- Division of Nephrology, Ambroise Paré Hospital, AP-HP, Pitié-Salpêtrière Hospital, Université Paris-Saclay, Paris, France
| | - Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cees Vemeer
- Cardiovascular Research Institute CARIM, Maastricht University, Maastricht, The Netherlands
| | - Chloé Amouyal
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Franck Phan
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Marine Halbron
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Agnès Hartemann
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
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Wang X, Liu C, Wei X, Zheng Y, Li F, Fang Y, Zhou J. Acupuncture versus sham acupuncture in the treatment of diabetic distal symmetric polyneuropathy (DSPN): Study protocol for a randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Chicharro-Luna E, Pomares-Gómez FJ, Ortega-Ávila AB, Coheña-Jiménez M, Gijon-Nogueron G. Variability in the clinical diagnosis of diabetic peripheral neuropathy. Prim Care Diabetes 2020; 14:53-60. [PMID: 31208891 DOI: 10.1016/j.pcd.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
AIMS The aims of this study are to assess the variability in the prevalence of diabetic peripheral neuropathy (DPN), according to the diagnostic and clinical guidelines used. METHODS A cross-sectional observational study was conducted of 111 patients with diabetes mellitus. The presence/absence of DPN was determined according to 12 different criteria stipulated in various clinical guidelines (ADA 2018, IWGDF 2016, IDF 2012 and CONUEI 2018). The Cohen's kappa coefficient (κ) was performed to determine the degree of agreement for DPN diagnosis among the different criteria. RESULTS The recorded prevalence of DPN ranged from 13.1% (criterion ADA 2018) to 68.5% (criterion IDF 2012). The sensory parameter that was most commonly affected was the non-perception of vibration (68.5%) and the absence of Achilles reflexes (59.4%). IWGDF, based on the use of a monofilament, cotton wisp and tuning fork, was the test with more agreements, presenting good agreement with 2 criteria from ADA 2018 (k=0.845), 1b2 (k=0.817), 2 criteria from IWGDF 2016 (k=0.933), (k=0.817), 1 criteria from IDF 2012 (k=0.845) and 1 criteria from CONUEI 2018 (k=0.860), all p<0.001. CONCLUSION The IWGDF criterion based on the use of a monofilament, cotton wisp and tuning fork for the diagnosis presented the highest level of concordance with the other criteria (>0.8).
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Affiliation(s)
- Esther Chicharro-Luna
- Departament of Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain.
| | | | - Ana Belén Ortega-Ávila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain.
| | | | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain; Instituto de Investigación Biomedica de Malaga (IBIMA), Spain.
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Lechleitner M, Abrahamian H, Francesconi C, Kofler M, Sturm W, Köhler G. [Diabetic neuropathy and diabetic foot syndrome (Update 2019)]. Wien Klin Wochenschr 2019; 131:141-150. [PMID: 30980143 DOI: 10.1007/s00508-019-1487-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
These are the guidelines for diagnosis and treatment of diabetic neuropathy and diabetic foot. Diabetic neuropathy comprises a number of mono- and polyneuropathies, plexopathies, radiculopathies and autonomic neuropathy.The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy, including the complex situation of the diabetic foot syndrome. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided. The needs to prevent and treat diabetic foot syndrome are summarized.
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Affiliation(s)
- Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl-Natters, Hochzirl, 6170, Zirl, Österreich.
| | | | | | - Markus Kofler
- Abteilung für Neurologie, Landeskrankenhaus Hochzirl-Natters, Zirl, Österreich
| | - Wolfgang Sturm
- Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Gerd Köhler
- Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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Shabeeb D, Najafi M, Hasanzadeh G, Hadian MR, Musa AE, Shirazi A. Electrophysiological measurements of diabetic peripheral neuropathy: A systematic review. Diabetes Metab Syndr 2018; 12:591-600. [PMID: 29610062 DOI: 10.1016/j.dsx.2018.03.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/26/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Peripheral neuropathy is one of the main complications of diabetes mellitus. One of the features of diabetic nerve damage is abnormality of sensory and motor nerve conduction study. An electrophysiological examination can be reproduced and is also a non-invasive approach in the assessment of peripheral nerve function. Population-based and clinical studies have been conducted to validate the sensitivity of these methods. When the diagnosis was based on clinical electrophysiological examination, abnormalities were observed in all patients. METHOD In this research, using a review design, we reviewed the issue of clinical electrophysiological examination of diabetic peripheral neuropathy in articles from 2008 to 2017. For this purpose, PubMed, Scopus and Embase databases of journals were used for searching articles. RESULTS/FINDINGS The researchers indicated that diabetes (both types) is a very disturbing health issue in the modern world and should be given serious attention. Based on conducted studies, it was demonstrated that there are different procedures for prevention and treatment of diabetes-related health problems such as diabetic polyneuropathy (DPN). The first objective quantitative indication of the peripheral neuropathy is abnormality of sensory and motor nerve conduction tests. Electrophysiology is accurate, reliable and sensitive. It can be reproduced and also is a noninvasive approach in the assessment of peripheral nerve function. CONCLUSION The methodological review has found that the best method for quantitative indication of the peripheral neuropathy compared with all other methods is clinical electrophysiological examination. For best results, standard protocols such as temperature control and equipment calibration are recommended.
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Affiliation(s)
- Dheyauldeen Shabeeb
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran; Department of Physiology, College of Medicine, University of Misan, Iraq; Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Gholamreza Hasanzadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mohammed Reza Hadian
- Brain and Spinal Injury Repair Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ahmed Eleojio Musa
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran; Research Center for Molecular and Cellular Imaging, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran; Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran.
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22
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Meyer-Hamme G, Friedemann T, Greten HJ, Plaetke R, Gerloff C, Schroeder S. ACUDIN - ACUpuncture and laser acupuncture for treatment of DIabetic peripheral Neuropathy: a randomized, placebo-controlled, partially double-blinded trial. BMC Neurol 2018; 18:40. [PMID: 29653569 PMCID: PMC5898043 DOI: 10.1186/s12883-018-1037-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus with significant clinical sequelae that can affect a patient's quality of life. Metabolic and microvascular factors are responsible for nerve damage, causing loss of nerve function, numbness, painful sensory symptoms, and muscle weakness. Therapy is limited to anti-convulsant or anti-depressant drugs for neuropathic pain and paresthesia. However, reduced sensation, balance and gait problems are insufficiently covered by this treatment. Previous data suggests that acupuncture, which has been in use in Traditional Chinese Medicine for many years, may potentially complement the treatment options for peripheral neuropathy. Nevertheless, more objective data on clinical outcome is necessary to generally recommend acupuncture to the public. METHODS We developed a study design for a prospective, randomized (RCT), placebo-controlled, partially double-blinded trial for investigating the effect of acupuncture on DPN as determined by nerve conduction studies (NCS) with the sural sensory nerve action potential amplitude as the primary outcome. The sural sensory nerve conduction velocity, tibial motor nerve action potential amplitude, tibial motor nerve conduction velocity, the neuropathy deficit score, neuropathy symptom score, and numeric rating scale questionnaires are defined as secondary outcomes. One hundred and eighty patients with type 2 diabetes mellitus will be randomized into three groups (needle acupuncture, verum laser acupuncture, and placebo laser acupuncture). We hypothesize that needle and laser acupuncture have beneficial effects on electrophysiological parameters and clinical and subjective symptoms in relation to DPN in comparison with placebo. DISCUSSION The ACUDIN trial aims at investigating whether classical needle acupuncture and/or laser acupuncture are efficacious in the treatment of DPN. For the purpose of an objective parameter, NCS were chosen as outcome measures. Acupuncture treatment may potentially improve patients' quality of life and reduce the socio-economic burden caused by DPN. TRIAL REGISTRATION German Clinical Trial Register (DRKS), No. DRKS00008562 , trial search portal of the WHO ( http://apps.who.int/trialsearch/ ).
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Affiliation(s)
- Gesa Meyer-Hamme
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Martinistrasse 52, House O55, 20246 Hamburg, Germany
| | - Thomas Friedemann
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Martinistrasse 52, House O55, 20246 Hamburg, Germany
| | - Henry Johannes Greten
- Heidelberg School of Chinese Medicine, Karlsruher Str. 12, 69126 Heidelberg, Germany
- Department of Neurophysiology, Instituto di Ciencias Biomedicas Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050, –313 Porto, Portugal
| | - Rosemarie Plaetke
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sven Schroeder
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Martinistrasse 52, House O55, 20246 Hamburg, Germany
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Yang CJ, Hsu HY, Lu CH, Chao YL, Chiu HY, Kuo LC. Do we underestimate influences of diabetic mononeuropathy or polyneuropathy on hand functional performance and life quality? J Diabetes Investig 2017; 9:179-185. [PMID: 28267271 PMCID: PMC5754520 DOI: 10.1111/jdi.12649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/23/2017] [Accepted: 02/28/2017] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction The purpose of the present study was to identify whether there are differences in hand dexterity, hand functional performance and quality of life between diabetes patients with mononeuropathy and polyneuropathy of their hands to further present the importance regarding the impacts of diabetic neuropathic deficits on patients’ functional capacity. Materials and Methods The neurological deficits of 127 patients with type 2 diabetes were examined by electrophysiological tests for the median and ulnar nerves, and were stratified into the diabetic mononeuropathy, diabetic polyneuropathy and non‐diabetic neuropathy groups by sensory amplitude of these nerves. The Purdue pegboard test, Michigan Hand Outcomes Questionnaire, and Diabetes‐39 were carried out to understand patients’ hand dexterity, functional hand performance and quality of life, respectively. Results The results showed significant differences in all subtests of the Purdue pegboard test among the three groups. Furthermore, aesthetics, patient's satisfaction of the Michigan Hand Outcomes Questionnaire and diabetes control, sexual functioning, energy, and mobility of the Diabetes‐39 also showed significant differences among the three groups. Conclusions The present study shows the patients with polyneuropathy suffer from more negative impacts on hand functional performance and quality of life than those with mononeuropathy and without neuropathy. These findings might assist both patients and clinicians in better realizing the impacts of neuropathic hands, and planning suitable strategies of intervention or health education to prevent declines in hand functions.
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Affiliation(s)
- Chien-Ju Yang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Hsiang Lu
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yen-Li Chao
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Haw-Yen Chiu
- Section of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Li-Chieh Kuo
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
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Kobori M, Yagihashi S, Shiina N, Shiozawa N, Haginoya A, Ojima M, Douguchi S, Tamasawa A, Saitou M, Baba M, Osonoi T. Four-year sequential nerve conduction changes since first visit in Japanese patients with early type 2 diabetes. J Diabetes Investig 2016; 8:369-376. [PMID: 27736033 PMCID: PMC5415466 DOI: 10.1111/jdi.12583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/08/2016] [Accepted: 09/19/2016] [Indexed: 01/24/2023] Open
Abstract
Aims/Introduction Despite being the most common complication of diabetes, the pattern of clinical development of diabetic neuropathy is not well‐known. In the present study, we retrospectively examined sequential changes in nerve conduction studies (NCS) for 4 years to characterize the way neuropathic changes develop in patients with type 2 diabetes. Materials and Methods We randomly selected 158 patients with type 2 diabetes who newly visited Naka Memorial Clinic, Ibaraki, Japan, and underwent serial 4‐year NCS. Records of clinical profile, signs and symptoms of neuropathy, and NCS data from median and tibial nerves were extracted to determine the progression of neuropathy. NCS data were represented by motor nerve conduction velocities, amplitudes of compound muscle action potentials (CMAPs) and minimal latencies of F‐wave. Results The prevalence of clinical neuropathy in 158 cases was 30% at baseline and 29% at the end of the study, with improvement of glycated hemoglobin (8.6–6.9%). Over 4 years, there were no changes of the signs and symptoms of neuropathy. Motor nerve conduction velocities were slightly improved or consistent at the fourth year compared with those at the beginning (+1.5% in median nerve, P < 0.05; +0.8%, not significant in the tibial nerve). The extent of the glycated hemoglobin correction correlated with the improvement of motor nerve conduction velocity. In contrast, CMAPs of both median and tibial nerves were decreased (−11.6%, P < 0.01; −3.7%, P < 0.05, respectively). For the decrease in CMAPs, no specific risk factors were identified by logistic regression analysis. Conclusions The present study showed progressive decline of CMAPs despite improved glycemic controls or the lack of NCV slowing in patients with early type 2 diabetes.
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Affiliation(s)
- Mariko Kobori
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Soroku Yagihashi
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan.,Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Norie Shiina
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Nana Shiozawa
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Akiko Haginoya
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Misato Ojima
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | | | | | - Miyoko Saitou
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
| | - Masayuki Baba
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Takeshi Osonoi
- Kensei-kai Naka Memorial Clinic, Naka-city, Ibaraki, Japan
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D'Amato C, Morganti R, Greco C, Di Gennaro F, Cacciotti L, Longo S, Mataluni G, Lauro D, Marfia GA, Spallone V. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res 2016; 13:418-428. [PMID: 27334483 DOI: 10.1177/1479164116653240] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. METHODS In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. RESULTS In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). CONCLUSION Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity.
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Affiliation(s)
- Cinzia D'Amato
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Morganti
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federica Di Gennaro
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Laura Cacciotti
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Longo
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgia Mataluni
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Girolama A Marfia
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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26
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Rota E, Morelli N. Entrapment neuropathies in diabetes mellitus. World J Diabetes 2016; 7:342-353. [PMID: 27660694 PMCID: PMC5027001 DOI: 10.4239/wjd.v7.i17.342] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/18/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.
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Abstract
Electrophysiologic studies provide objective data concerning nerve and muscle function. This information enables the diagnosis of disease states and monitoring of disease progression. This chapter describes the changes in electrophysiologic function in both prediabetes and diabetes and discusses the utility of this testing in patients with diabetes. Both the strengths and limitations of electrophysiology are discussed.
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29
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Cheshire WP. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 2016; 196:91-104. [DOI: 10.1016/j.autneu.2016.01.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 01/22/2023]
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Shimkina NF, Nad’ YG, Barantsevich ER. Neurological complications in patients with diabetes mellitus type 1 treated with different methods of insulinotherapy. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:13-17. [DOI: 10.17116/jnevro20161169113-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Waddington Cruz M, Benson MD. A Review of Tafamidis for the Treatment of Transthyretin-Related Amyloidosis. Neurol Ther 2015; 4:61-79. [PMID: 26662359 PMCID: PMC4685869 DOI: 10.1007/s40120-015-0031-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Indexed: 12/24/2022] Open
Abstract
Transthyretin (TTR)-related amyloidosis (ATTR) is a devastating disease which affects a combination of organs including the heart and the peripheral nerves, and which has a fatal outcome if not treated within a average of 10 years. Tafamidis, or 2-(3,5-dichloro-phenyl)-benzoxazole-6-carboxylic acid, selectively binds to TTR with negative cooperativity and kinetically stabilizes wild-type native TTR and mutant TTR; tafamidis therefore has the potential to halt the amyloidogenic cascade initiated by TTR tetramer dissociation, monomer misfolding, and aggregation. The first tafamidis trial, Fx-005, evaluated the effect of 18 months of tafamidis treatment (20 mg once daily) on disease progression, as well as assessing its safety in TTR-FAP Val30Met patients. The secondary objective of this trial was to study the pharmacodynamic stabilization of mutated TTR. Tafamidis proved effective in reducing the progress of neuropathy, and in maintaining the nutritional status and quality of life of stage 1 (able to walk without support) Val3OMet TTR-FAP patients. Furthermore, TTR stabilization was achieved in more than 90% of patients. An extension study, Fx-006, was conducted to determine the long-term safety and tolerability of tafamidis and to assess the efficacy of the drug on slowing disease progression. No significant safety or tolerability issues were noticed. Taken together, the results from both trials indicated that the beneficial effects of tafamidis were sustained over a 30-month period and that starting treatment early is desirable. Results are expected from an extended open-label study but data that have already been presented show that long-term use of tafamidis in Val30Met patients is associated with reduced progression in polyneuropathy. Tafamidis was initially approved for commercial use in Europe in 2011 and has since been approved for use in Japan, Mexico, and Argentina where it is used as a first-line treatment option for patients with early-stage TTR-FAP. Patients should be carefully followed at referral centers to ascertain the individual response to treatment. In cases of discontinuation, liver transplantation and enrollment in clinical trials of novel drugs aimed mostly toward suppression of TTR production are options.
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Affiliation(s)
- Márcia Waddington Cruz
- Amyloidosis Research and Treatment Center (CEPARM), University Hospital (HUCFF), Federal University of Rio de Janeiro, Rio De Janeiro, Brazil.
| | - Merril D Benson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Draak THP, Vanhoutte EK, van Nes SI, Gorson KC, Van der Pol WL, Notermans NC, Nobile-Orazio E, Lewis RA, Léger JM, Van den Bergh PYK, Lauria G, Bril V, Katzberg H, Lunn MPT, Pouget J, van der Kooi AJ, Hahn AF, van den Berg LH, van Doorn PA, Cornblath DR, Faber CG, Merkies ISJ. Comparing the NIS vs. MRC and INCAT sensory scale through Rasch analyses. J Peripher Nerv Syst 2015; 20:277-88. [DOI: 10.1111/jns.12127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas H. P. Draak
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Els K. Vanhoutte
- Department of Clinical Genetics; Maastricht University Medical Center; Maastricht The Netherlands
| | - Sonja I. van Nes
- Department of Neurology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Kenneth C. Gorson
- Department of Neurology, St. Elizabeth's Medical Center; Tufts University School of Medicine; Boston MA USA
| | - W.-Ludo Van der Pol
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - Nicolette C. Notermans
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - Eduardo Nobile-Orazio
- Department of Neurological Sciences, Milan University; Humanitas Clinical Institute; Rozzano Milan Italy
| | - Richard A. Lewis
- Department of Neurology; Cedars-Sinai Medical Center; Los Angeles, California USA
| | - Jean-Marc Léger
- Department of Neurology; Hôpital de la Salpêtrière; Paris France
| | | | - Giuseppe Lauria
- Department of Clinical Neurosciences; Neuromuscular Diseases Unit National Neurological Institute “Carlo Besta”; 3rd Neurology Unit Milan Italy
| | - Vera Bril
- Department of Neurology; Toronto General Hospital; Toronto ON Canada
| | - Hans Katzberg
- Department of Neurology; Toronto General Hospital; Toronto ON Canada
| | - Michael P. T. Lunn
- Department of Neurology, Centre for Neuromuscular Disease; National Hospital for Neurology and Neurosurgery; Queen Square London UK
| | - Jean Pouget
- Department of Neurology; Centre de Référence des Maladies Neuromusculaires et de la SLA; Hôpital de La Timone Marseille France
| | | | - Angelika F. Hahn
- Department of Neurology; London Health Science Center; London ON Canada
| | - Leonard H. van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - Pieter A. van Doorn
- Department of Neurology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - David R. Cornblath
- Department of Neurology; Johns Hopkins School of Medicine; Baltimore MD USA
| | - Catharina G. Faber
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Ingemar S. J. Merkies
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
- Department of Neurology; Spaarne Hospital; Hoofddorp The Netherlands
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Kamel SR, Hamdy M, Abo Omar HAS, Kamal A, Ali LH, Abd Elkarim AH. Clinical diagnosis of distal diabetic polyneuropathy using neurological examination scores: correlation with nerve conduction studies. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2015. [DOI: 10.4103/1110-161x.163945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Van den Bergh PYK, Lunn MP. Future needs in peripheral neuropathy outcome measures. J Peripher Nerv Syst 2015; 20:341-6. [PMID: 26306616 DOI: 10.1111/jns.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
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Hsu HY, Chiu HY, Lin HT, Su FC, Lu CH, Kuo LC. Impacts of elevated glycaemic haemoglobin and disease duration on the sensorimotor control of hands in diabetes patients. Diabetes Metab Res Rev 2015; 31:385-94. [PMID: 25417846 DOI: 10.1002/dmrr.2623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/07/2014] [Accepted: 11/09/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND To understand the impacts of disease chronicity and hyperglycaemia on sensorimotor control of hands of diabetic patients, this study investigated the differences in hand sensation, strength and motor control by applying the pinch-holding-up activity test for patients with diabetes mellitus (DM) with different levels of glycaemic control and disease chronicity. METHODS One hundred and fifty-nine patients with clinically defined DM were included. Semmes-Weinstein monofilament, static two-point discrimination and moving two-point discrimination, maximal pinch strength precision pinch performance tests and nerve conduction studies (NCS) of the subjects were carried out. Forty-seven (29.6%) patients were in the HbA(1c) < 7% category, and 112 (70.4%) patients were in the >7% group. There were 87 (54.7%) patients with the disease duration <10 years, and 72 (45.3%) patients with disease duration ≧10 years. RESULTS The severity of hyperglycaemia significantly impacts the results for Semmes-Weinstein monofilament, precision pinch force control, sensory and motor NCS tests (p < 0.05). In addition, the chronicity of disease influences the motor control of precision pinch performance and the amplitude of motor NCS (p < 0.05) for the diabetes patients. CONCLUSIONS The evidence suggests that disease chronicity and hyperglycaemia have impacts on sensorimotor control in the hands of DM patients. In addition, the efficiency of prehensile forces of hand-to-object interactions in the pinch-holding-up activity test could be significant for identifying hand function, as well as pathologic changes in median nerve function, for patients with DM.
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Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lopergolo D, Isak B, Gabriele M, Onesti E, Ceccanti M, Capua G, Fionda L, Biasiotta A, Di Stefano G, La Cesa S, Frasca V, Inghilleri M. Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 2014; 126:1780-9. [PMID: 25497713 DOI: 10.1016/j.clinph.2014.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP), a spinal inhibitory reflex mainly mediated by A-delta fibres, in demyelinating and axonal polyneuropathy (PNP) and evaluate whether CSP parameters differ between patients with and without neuropathic pain. METHODS Eighty-four patients with demyelinating PNP, 178 patients with axonal PNP and 265 controls underwent clinical examination, DN4 questionnaire, standard nerve conduction study, motor-root stimulation and CSP recordings from abductor digiti minimi. We calculated the afferent conduction time of CSP (a-CSP time) with the formula: CSP latency-root motor evoked potential latency. RESULTS In the demyelinating PNP group the a-CSP time was significantly longer; in the axonal PNP group, CSP duration was shorter than the demyelinating group (p=0.010) and controls (p=0.001). CSP parameters were not different between patients with and without neuropathic pain. CONCLUSIONS The abnormality of a-CSP time in the demyelinating PNP group suggests the crucial role of A-delta fibres in the mechanism of CSP; the shorter CSP duration in the axonal PNP group supports the strong influence of the number of axons on this parameter. Our study suggests that neuropathic pain could be related to pathophysiological mechanisms differing from mere A-delta fibre loss. SIGNIFICANCE CSP evaluation is effective in detecting A-delta fibre dysfunction in axonal as well as demyelinating PNP.
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Affiliation(s)
- Diego Lopergolo
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Baris Isak
- Marmara University Hospital School of Medicine, Department of Neurology, Fevzi Cakmak Mah. Mimar Sinan Cad. No: 41, 34899 Ust Kaynarca/Pendik, Istanbul, Turkey; Department of Clinical Neurophysiology, Aarhus Universitets hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Maria Gabriele
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Gelsomina Capua
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Laura Fionda
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Antonella Biasiotta
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Giulia Di Stefano
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy.
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Chon KH, Yang B, Posada-Quintero HF, Siu KL, Rolle M, Brink P, Birzgalis A, Moore LC. A novel quantitative method for diabetic cardiac autonomic neuropathy assessment in type 1 diabetic mice. J Diabetes Sci Technol 2014; 8:1157-67. [PMID: 25097056 PMCID: PMC4455481 DOI: 10.1177/1932296814545669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this work, we used a sensitive and noninvasive computational method to assess diabetic cardiovascular autonomic neuropathy (DCAN) from pulse oximeter (photoplethysmographic; PPG) recordings from mice. The method, which could be easily applied to humans, is based on principal dynamic mode (PDM) analysis of heart rate variability (HRV). Unlike the power spectral density, PDM has been shown to be able to separately identify the activities of the parasympathetic and sympathetic nervous systems without pharmacological intervention. HRV parameters were measured by processing PPG signals from conscious 1.5- to 5-month-old C57/BL6 control mice and in Akita mice, a model of insulin-dependent type 1 diabetes, and compared with the gold-standard Western blot and immunohistochemical analyses. The PDM results indicate significant cardiac autonomic impairment in the diabetic mice in comparison to the controls. When tail-cuff PPG recordings were collected and analyzed starting from 1.5 months of age in both C57/Bl6 controls and Akita mice, onset of DCAN was seen at 3 months in the Akita mice, which persisted up to the termination of the recording at 5 months. Western blot and immunohistochemical analyses also showed a reduction in nerve density in Akita mice at 3 and 4 months as compared to the control mice, thus, corroborating our PDM data analysis of HRV records. Western blot analysis of autonomic nerve proteins corroborated the PPG-based HRV analysis via the PDM approach. In contrast, traditional HRV analysis (based on either the power spectral density or time-domain measures) failed to detect the nerve rarefaction.
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Affiliation(s)
- Ki H Chon
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Bufan Yang
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Hugo F Posada-Quintero
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Kin L Siu
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Marsha Rolle
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Peter Brink
- Department of Physiology & Biophysics, Stony Brook University, Stony Brook, NY, USA
| | - Aija Birzgalis
- Department of Physiology & Biophysics, Stony Brook University, Stony Brook, NY, USA
| | - Leon C Moore
- Department of Physiology & Biophysics, Stony Brook University, Stony Brook, NY, USA
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Lysy Z, Lovblom LE, Halpern EM, Ngo M, Ng E, Orszag A, Breiner A, Bril V, Perkins BA. Measurement of cooling detection thresholds for identification of diabetic sensorimotor polyneuropathy in type 1 diabetes. PLoS One 2014; 9:e106995. [PMID: 25216179 PMCID: PMC4162569 DOI: 10.1371/journal.pone.0106995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022] Open
Abstract
Objective Compared to recently-studied novel morphological measures, conventional small nerve fiber functional tests have not been systematically studied for identification of diabetic sensorimotor polyneuropathy (DSP). We aimed to determine and compare the diagnostic performance of cooling detection thresholds (CDT) in a cross-sectional type 1 diabetes cohort. Research Design and Methods 136 subjects with type 1 diabetes and 52 healthy volunteers underwent clinical and electrophysiological examination for DSP classification concomitantly with the Toronto Clinical Neuropathy Score (TCNS) and three small fiber function tests: CDT, heart rate variability (HRV), and laser doppler imaging of axon-mediated neurogenic flare responses to cutaneous heating (LDIFLARE). Area under the curve (AUC) and optimal thresholds were determined by receiver operating characteristic (ROC) curves in the type 1 diabetes cohort. Results Type 1 diabetes subjects were 42±17 years of age with mean HbA1c 7.9±1.7%. Fifty-nine (45%) met the case definition for DSP. CDT values were lowest in cases with DSP (18.3±8.4°C) compared to controls without DSP (28.4±3.5°C) and to healthy volunteers (29.6±1.8°C; p-value for both comparisons<0.0001). AUCCDT was 0.863 which was similar to AUCTCNS (0.858, p = 0.24) and AUCHRV (0.788, p = 0.05), but exceeded AUCLDIFLARE (0.750, p = 0.001). The threshold of <25.1°C was equivalent to the lower bound of the healthy volunteer 95% distribution [25.1, 30.8°C] and performed with 83% sensitivity and 82% specificity. Conclusions Akin to novel small fiber morphological measures, CDT is a functional test that identifies DSP with very good diagnostic performance. These findings support further research that revisits the role of CDT in early DSP detection.
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Affiliation(s)
- Zoe Lysy
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elise M Halpern
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mylan Ngo
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Ng
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hoffman W, Donovan K. Traumatic digital amputations of the foot inflicted by pet cat upon individual with diabetic peripheral neuropathy. J Am Podiatr Med Assoc 2014; 103:441-4. [PMID: 24072375 DOI: 10.7547/1030441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetic peripheral neuropathy (DPN) is a common cause of many lower-extremity complications. This case study illustrates the potential perils of pet ownership associated with diabetes and neuropathy. The case describes an incident resulting in traumatic digital amputations inflicted by a patient's pet feline while she was sleeping. In presenting this case, the potential risks of pet ownership for patients with DPN are discussed along with a review of the relevant literature.
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Affiliation(s)
- William Hoffman
- Saint Barnabas Medical Center, Podiatric Surgery, Livingston, NJ. Dr. Hoffman is now in private practice, Ocean County Foot and Ankle Surgical Associates, Toms River, NJ. Dr. Donovan is also in private practice, Innovative Foot and Ankle, Kenilworth, NJ
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Charnogursky GA, Emanuele NV, Emanuele MA. Neurologic Complications of Diabetes. Curr Neurol Neurosci Rep 2014; 14:457. [DOI: 10.1007/s11910-014-0457-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Neuropathies related to diabetes mellitus can affect 60-70% of patients with diabetes. These can include peripheral polyneuropathies, mononeuropathies, and autonomic neuropathies. Control of glucose, lipids, and hypertension and cessation of smoking can limit onset and progression of these neuropathies. Besides control of the above listed risk factors, we do not have effective medications to treat the pathophysiologic mechanisms of diabetic neuropathies. Treatment is limited to ameliorating pain and correcting the end organ consequences of the neuropathic processes.
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Affiliation(s)
- Gerald Charnogursky
- Division of Endocrinology and Metabolism, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
| | - Hong Lee
- Division of Endocrinology and Metabolism, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Norma Lopez
- Division of Endocrinology and Metabolism, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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Abstract
Diabetic peripheral and autonomic neuropathies are common complications of diabetes with broad spectrums of clinical manifestations and high morbidity. Studies using various agents to target the pathways implicated in the development and progression of diabetic neuropathy were promising in animal models. In humans, however, randomized controlled studies have failed to show efficacy on objective measures of neuropathy. The complex anatomy of the peripheral and autonomic nervous systems, the multitude of pathogenic mechanisms involved, and the lack of uniformity of neuropathy measures have likely contributed to these failures. To date, tight glycemic control is the only strategy convincingly shown to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow the progression of neuropathy in some patients with type 2 diabetes. Lessons learned about the role of glycemic control on distal symmetrical polyneuropathy and cardiovascular autonomic neuropathy are discussed in this review.
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Affiliation(s)
- Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, 5329 Brehm Tower 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Mamta Jaiswal
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Catherine Martin
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, 5329 Brehm Tower 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, 5329 Brehm Tower 1000 Wall Street, Ann Arbor, MI 48105, USA
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Eftimov F, Winer JB, Vermeulen M, de Haan R, van Schaik IN. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev 2013:CD001797. [PMID: 24379104 DOI: 10.1002/14651858.cd001797.pub3] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) causes progressive or relapsing weakness and numbness of the limbs, developing over at least two months. Uncontrolled studies suggest that intravenous immunoglobulin (IVIg) helps. This review was first published in 2002 and has since been updated, most recently in 2013. OBJECTIVES To review systematically the evidence from randomised controlled trials (RCTs) concerning the efficacy and safety of IVIg in CIDP. SEARCH METHODS On 4 December 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2012, issue 11 in the Cochrane Library), MEDLINE and EMBASE to December 2012 and ISI from January 1985 to May 2008. We searched for ongoing trials through two metaRegistries (World Health Organization International Clinical Trials Registry Platform Search Portal and Current Controlled Trials). SELECTION CRITERIA We selected RCTs testing any dose of IVIg versus placebo, plasma exchange or corticosteroids in definite or probable CIDP. DATA COLLECTION AND ANALYSIS Two authors reviewed literature searches to identify potentially relevant RCTs, scored their quality and extracted data independently. We contacted authors for additional information. MAIN RESULTS We considered eight RCTs, including 332 participants, to be eligible for inclusion in the review. These trials were homogeneous and the overall risk of bias low. Five studies, in a total of 235 participants compared IVIg against placebo. One trial with 20 participants compared IVIg with plasma exchange, one trial compared IVIg with prednisolone in 32 participants, and one trial, newly included at this update, compared IVIg with intravenous methylprednisolone in 46 participants.A significantly higher proportion of participants improved in disability within one month after IVIg treatment as compared with placebo (risk ratio (RR) 2.40, 95% confidence interval (CI) 1.72 to 3.36; number needed to treat for an additional beneficial outcome 3.03 (95% CI 2.33 to 4.55), high quality evidence). Whether all these improvements are equally clinically relevant cannot be deduced from this analysis because each trial used different disability scales and definitions of significant improvement. In three trials, including 84 participants, the disability score could be transformed to the modified Rankin score, on which improvement of one point after IVIg treatment compared to placebo was barely significant (RR 2.40, 95% CI 0.98 to 5.83) (moderate quality evidence). Only one placebo-controlled study included in this review had a long-term follow-up. The results of this study suggest that IVIg improves disability more than placebo over 24 and 48 weeks.The mean disability score revealed no significant difference between IVIg and plasma exchange at six weeks (moderate quality evidence). There was no significant difference in improvement in disability on prednisolone compared with IVIg after two or six weeks, or on methylprednisolone compared to IVIg after two weeks or six months (moderate quality evidence).There were no statistically significant differences in frequencies of side effects between the three types of treatment for which data were available (IVg versus placebo or steroids). (moderate or high quality evidence) Mild and transient adverse events were found in 49% of participants treated with IVIg, while serious adverse events were found in six per cent. AUTHORS' CONCLUSIONS The evidence from RCTs shows that IVIg improves disability for at least two to six weeks compared with placebo, with an NNTB of three. During this period it has similar efficacy to plasma exchange, oral prednisolone and intravenous methylprednisolone. In one large trial, the benefit of IVIg persisted for 24 and possibly 48 weeks. Further research is needed to compare the long-term benefits as well as side effects of IVIg with other treatments.
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Affiliation(s)
- Filip Eftimov
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, PO Box 22700, Amsterdam, Netherlands, 1100 DE
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Merlini G, Planté-Bordeneuve V, Judge DP, Schmidt H, Obici L, Perlini S, Packman J, Tripp T, Grogan DR. Effects of tafamidis on transthyretin stabilization and clinical outcomes in patients with non-Val30Met transthyretin amyloidosis. J Cardiovasc Transl Res 2013; 6:1011-20. [PMID: 24101373 PMCID: PMC3838581 DOI: 10.1007/s12265-013-9512-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/11/2013] [Indexed: 11/01/2022]
Abstract
This phase II, open-label, single-treatment arm study evaluated the pharmacodynamics, efficacy, and safety of tafamidis in patients with non-Val30Met transthyretin (TTR) amyloidosis. Twenty-one patients with eight different non-Val30Met mutations received 20 mg QD of tafamidis meglumine for 12 months. The primary outcome, TTR stabilization at Week 6, was achieved in 18 (94.7%) of 19 patients with evaluable data. TTR was stabilized in 100% of patients with non-missing data at Months 6 (n = 18) and 12 (n = 17). Exploratory efficacy measures demonstrated some worsening of neurological function. However, health-related quality of life, cardiac biomarker N-terminal pro-hormone brain natriuretic peptide, echocardiographic parameters, and modified body mass index did not demonstrate clinically relevant worsening during the 12 months of treatment. Tafamidis was well tolerated. In conclusion, our findings suggest that tafamidis 20 mg QD effectively stabilized TTR associated with several non-Val30Met variants.
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Affiliation(s)
- Giampaolo Merlini
- Amyloid Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Via Golgi 19, 27100, Pavia, Italy,
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How to explore a patient with a chronic axonal polyneuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 23931784 DOI: 10.1016/b978-0-444-52902-2.00014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Chronic axonal polyneuropathies are very frequently encountered by physicians. It is important to take a systematic approach when evaluating these patients. In this chapter we present such an approach. We present the diagnostic recommendations based on previously published evidence-based reviews and guidelines.
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Xu Q, Pan J, Yu J, Liu X, Liu L, Zuo X, Wu P, Deng H, Zhang J, Ji A. Meta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy. Diabetes Res Clin Pract 2013; 101:99-105. [PMID: 23664235 DOI: 10.1016/j.diabres.2013.03.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/12/2013] [Accepted: 03/25/2013] [Indexed: 11/24/2022]
Abstract
AIMS To compare the efficacy and safety of daily lipoic acid (300-600 mg i.v.) plus methylcobalamin (500-1000 mg i.v. or im.) (LA-MC) with that of methylcobalamin alone (MC) on diabetic peripheral neuropathy (DPN). METHODS Electronic database were searched for studies published up to November 1, 2012 and study quality was assessed in duplicate. A random or a fixed effect model was used to analyse outcomes which were expressed as risk ratios (RRs) or mean difference (MD). I(2) statistic was used to assess heterogeneity. RESULTS Seventeen studies were included. Combined data from all studies showed that the LA-MC combination therapy was significantly superior to MC monotherapy (RR=1.47; 95% CI: 1.37-1.58). Superiority of the LA-MC combination was shown in nerve conduction velocity (NCV) with WMDs of 6.89 (95% CI: 4.24-9.73) for median motor nerve conduction velocity (MNCV), 5.24 (4.14-6.34) for median sensory nerve conduction velocity (SNCV), 4.34 (3.03-5.64) for peroneal MNCV, and 4.53 (3.2-5.85) for peroneal SNCV. There were no serious adverse events associated with treatment. CONCLUSIONS The results of the meta-analysis show that treatment with LA-MC for 2-4 weeks is associated with better outcomes in NCV and neuropathic symptoms relative to MC treatment. However larger well-designed studies are required to confirm this conclusion.
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Affiliation(s)
- Qian Xu
- Department of Pharmacy, Zhu-Jiang Hospital, Southern Medical University, Guangzhou, China.
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Weisman A, Bril V, Ngo M, Lovblom LE, Halpern EM, Orszag A, Perkins BA. Identification and prediction of diabetic sensorimotor polyneuropathy using individual and simple combinations of nerve conduction study parameters. PLoS One 2013; 8:e58783. [PMID: 23533591 PMCID: PMC3606395 DOI: 10.1371/journal.pone.0058783] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 02/08/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Evaluation of diabetic sensorimotor polyneuropathy (DSP) is hindered by the need for complex nerve conduction study (NCS) protocols and lack of predictive biomarkers. We aimed to determine the performance of single and simple combinations of NCS parameters for identification and future prediction of DSP. MATERIALS AND METHODS 406 participants (61 with type 1 diabetes and 345 with type 2 diabetes) with a broad spectrum of neuropathy, from none to severe, underwent NCS to determine presence or absence of DSP for cross-sectional (concurrent validity) analysis. The 109 participants without baseline DSP were re-evaluated for its future onset (predictive validity). Performance of NCS parameters was compared by area under the receiver operating characteristic curve (AROC). RESULTS At baseline there were 246 (60%) Prevalent Cases. After 3.9 years mean follow-up, 25 (23%) of the 109 Prevalent Controls that were followed became Incident DSP Cases. Threshold values for peroneal conduction velocity and sural amplitude potential best identified Prevalent Cases (AROC 0.90 and 0.83, sensitivity 80 and 83%, specificity 89 and 72%, respectively). Baseline tibial F-wave latency, peroneal conduction velocity and the sum of three lower limb nerve conduction velocities (sural, peroneal, and tibial) best predicted 4-year incidence (AROC 0.79, 0.79, and 0.85; sensitivity 79, 70, and 81%; specificity 63, 74 and 77%, respectively). DISCUSSION Individual NCS parameters or their simple combinations are valid measures for identification and future prediction of DSP. Further research into the predictive roles of tibial F-wave latencies, peroneal conduction velocity, and sum of conduction velocities as markers of incipient nerve injury is needed to risk-stratify individuals for clinical and research protocols.
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Affiliation(s)
- Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mylan Ngo
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leif E. Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elise M. Halpern
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A. Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Abstract
Diabetes is the most common cause of neuropathy in United States and neuropathies are the most common complication of diabetes mellitus, affecting up to 50% of patients with type 1 and type 2 diabetes mellitus. Symptoms usually include numbness, tingling, pain, and weakness. Dizziness with postural changes can be seen with autonomic neuropathy. Metabolic, vascular, and immune theories have been proposed for the pathogenesis of diabetic neuropathy. Axonal damage and segmental demyelination can be seen with diabetic neuropathies. Management of diabetic neuropathy should begin at the initial diagnosis of diabetes and mainly requires tight and stable glycemic control.
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Arimura A, Deguchi T, Sugimoto K, Uto T, Nakamura T, Arimura Y, Arimura K, Yagihashi S, Nishio Y, Takashima H. Intraepidermal nerve fiber density and nerve conduction study parameters correlate with clinical staging of diabetic polyneuropathy. Diabetes Res Clin Pract 2013; 99:24-9. [PMID: 23006635 DOI: 10.1016/j.diabres.2012.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/09/2012] [Accepted: 09/04/2012] [Indexed: 01/02/2023]
Abstract
AIM AND METHODS To assess the usefulness of the diagnostic and staging criteria for diabetic polyneuropathy (DP) by the Diabetic Neuropathy Study Group in Japan (DNSGJ) we examined clinical features, intraepidermal nerve fiber densities (IENFD) and nerve conduction studies (NCS) and coefficient of variation of the R-R intervals (CVR-R) in 44 patients with diabetes. RESULTS The patients were classified into stage I (n=20), II (n=6), III+IV (n=12), and V (n=6) according to the staging criteria by DNSGJ. IENFD decreased as stages progressed (13.8±7.1 fiber/mm in stage I to 0.8±1.3 fiber/mm in stage V). Compound motor and sensory action potential and motor and sensory nerve conduction velocity decreased with progressing stage. F-wave latency prolonged as stages progressed. CVR-R decreased with progressing stage (4.41%±2.65% in stage I to 1.33%±0.57% in stage V). IENFD correlated with the various parameters of NCS (r=0.378-0.636, p<0.05) and CVR-R (r=0.399, p=0.007). CONCLUSIONS Clinical staging for DP by DNSGJ reflects the results of small and large fiber neuropathy.
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Affiliation(s)
- Aiko Arimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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[Diabetic neuropathy]. Wien Klin Wochenschr 2012; 124 Suppl 2:33-8. [PMID: 23250455 DOI: 10.1007/s00508-012-0267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
These are the guidelines for diagnosis and treatment of diabetic neuropathy. This diabetic late complication comprises a number of mono- and polyneuropathies, plexopathies, radiculopathies and autonomic neuropathy. The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensomotoric neuropathy, are provided.
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