Diabetic polyneuropathy. 3. Electroneurographic findings in diabetics and their relationships to age and duration of diabetes

Nerve conduction velocities were determined in patients with diabetes mellitus: motor conduction of the median nerve in 778 patients, sensory conduction of the median nerve in 680 patients and motor conduction of the tibial nerve in 745 patients. In 40.9% out of 778 patients at least one of the three nerve conduction velocities were found within pathological ranges. 30.4% of 227 patients below 19 years of age in whom the duration of the disease did not exceed four years exhibited at least one delayed nerve conduction velocity. Clinical signs of polyneuropathy in children and in adolescents below 19 years of age are rare (0.6%). In contrast delayed nerve conduction velocities were found in 29.4%. Metabolic disturbance of peripheral nerve function is assumed to be responsible in these patients, for angiopathy in children and adolescents is very rare too.     

Diabetic polyneuropathy. 4. Synopsis of electroneurographic findings in diabetics]

Sensory conduction velocity of the median nerve, motor conduction velocity of both median and tibial nerves, and corresponding distal laterncies are sufficient parameters to establish the diagnosis of polyneuropathy almost with certainty. Considering these six parameters yielded in detection of peripheral nerve dysfunction in 22% of diabetic patients who were free from clinical signs of polyneuropathy. Electroneurographical findings in 340 out of 677 patients with diabetes mellitus were interpreted as evidence of segmental demyelination. Within this group there was the majority of patients with clinical signs of polyneuropathy and with subclinical signs of peripheral nerve dysfunction. There existed a positive correlation between signs of nerve dysfunction with angiopathy, age and duration of the disease. A second group consisting of 243 diabetics with signs of incipient segmental demyelination with or without signs of axonaal degeneration mainly included juvenile patients with a short duration of the disease and with a low frequency of angiopathy.     

The diabetic polyneuropathy. I. Relation between impaired function in peripheral nerves and clinical findings

789 patients with diabetes mellitus were studied by clinical and electroneurographical investigation. Motor and sensory conduction velocities of the median nerve and motor conduction velocity of the tibial nerve were determined. 86.1% of the patients suffered from juvenile diabetes, and 13.9% from maturity onset diabetes. Average duration of the disease was 9.5 years, average age of the patients was 26.7 years. Clinical signs of polyneuropathy were found in 19.1%. In 40.9% of the patients at least one of 3 conduction velocities was found to be delayed. Patients with clinical signs of polyneuropathy exhibited delayed nerve conduction velocities and delayed distal latencies. Diagnosis of polyneuropathy almost with certainty is possible by determining the three nerve conduction velocities and the three corresponding distal latencies. 22% of patients without clinical signs of polyneuropathy exhibited electroneurographical signs of impaired peripheral nerve function. Heredity, body weight, lipid metabolism, actual metabolic balance, and treatment were found to be without any significant influence on nerve conduction velocity.     

Nerve conduction in childhood diabetes

Sixty-nine diabetic children were studied with respect to the motor nerve conduction velocities, duration of illness and adequacy of control.As a group there was a trend for children with diabetes to have slower MNCV than non-diabetic children, and for the slowing to become progressive as the duration of their disease increased. Poorer quality of diabetes control was also associated with progressive slowing of conduction but the exact relationship is uncertain, since no patient who had diabetes for more than four years was well controlled.Theories of causation of peripheral neuropathy in diabetic patients are reviewed; metabolic changes, rather than other factors, are thought most likely in children.     

A new prostaglandin E1 analogue (TFC-612) prevents a decrease in motor nerve conduction velocity in streptozocin-diabetic rats

A new prostaglandin E1 analogue (TFC-612) was orally given to streptozocin-diabetic rats for 4 weeks after the induction of diabetes and its effects on motor nerve conduction velocity were studied. The compound significantly prevented a decrease of the velocity but did not reverse abnormal sorbitol and myo-inositol contents of the sciatic nerve. The results suggest that TFC-612 has a potent effect on diabetic nerve dysfunction via other mechanism than the correction of sorbitol and myo-inositol metabolisms and could be a potential compound for therapy of diabetic polyneuropathy.     

Electrophysiological changes in diabetic neuropathy: from subclinical alterations to disabling abnormalities

Clinical spectrum of diabetic neuropathy is variable; it may be asymptomatic, but once established as polyneuropathy, it is irreversible and may finally be disabling. To estimate the prevalence of subclinical diabetic polyneuropathy in the UAE, we undertook a pilot study by means of nerve conduction study (NCS) of peroneal motor and sural sensory studies in 60 diabetics with no symptoms of neuropathy. Neurological examination revealed clinical abnormalities suggesting polyneuropathy in 26 patients, 43% of the patients. NCS revealed abnormal values in 63% of the whole patients. Abnormal NCS was confirmed in 88% of the positive sign group. As to the negative sign group 44% had abnormalities in NCS. Prolonged F-wave latency was seen in 29% in no sign group and in 66% of the patients with positive signs. We found close association between neurological deficit score and abnormalities in NCS. Among various parameter of systemic nerve conduction study in subclinical patients, prolonged F-wave latency seems the commonest abnormality suggesting morphological changes in subclinical diabetic nerve. Decrease in amplitude of compound sensory action potential of sural nerve is another earlier abnormality, which is, then, accompanied by a fall in motor amplitude of peroneal nerve in advanced patients. Recently, our own group of Hirosaki has demonstrated that somatosensory central conduction time (CCT) between the spinal cord entry time and the arrival time to the sensory cortex is prolonged in diabetics. This abnormality might be partly responsible for the irreversible sensory deficits of diabetic neuropathy.     

Childhood diabetic neuropathy: functional impairment and non-invasive screening assessment

Aim Sensory diabetic neuropathy, determined by nerve conduction studies, is common in children with Type?1 diabetes. Diabetic neuropathy diagnoses are rarely made in paediatric daily care because they are asymptomatic, vibration detection is mostly normal and nerve-conduction testing is impractical. The present study aims to: (1) describe somatosensory dysfunction in children with diabetes, (2) test whether diabetes duration and HbA(1c) are related to somatosensory dysfunction and (3) identify the best screening test for large-fibre dysfunction, as indicated by nerve conduction studies. Methods Forty-five children (age 13.2?±?2.5?years) with Type?1 diabetes for 6.7?±?2.5?years and matched control subjects were assessed by neurological examinations, nerve conduction tests and quantitative sensory testing on the feet using the protocol of the German Research Network on Neuropathic Pain. Abnormal nerve conduction was used as gold standard to define neuropathies. Results We found a high prevalence of mechanical (38%) and thermal (24%) hypoesthesia often associated with hyperalgesia (47%). Tactile hypoesthesia (33%) was more frequent than pallhypaesthesia (11%). Only cold detection and mechanical pain thresholds were related to HbA(1c) . Tactile hypoesthesia had the highest sensitivity (75%), specificity (89%) and positive (75%) and negative (89%) predictive values for neuropathies defined by nerve conduction tests (31% abnormal). Conclusions Almost half of the children with diabetes have subclinical large- and small-fibre neuropathies. Tactile detection was better than vibration for neuropathy assessment. Quantitative sensory testing is a valuable tool for assessment of neuropathy as well as a target of interventional studies in children with diabetes.     

肌电图检查评估腕管综合征手术效果的临床分析

目的:探讨采用肌电图检查评估腕管综合征的手术治疗效果。方法:选取35例(患侧手共39侧)临床确诊为腕管综合征并接受腕管切开减压术治疗的患者,于手术前后分别行肌电图检查,应用正中神经传导检查和拇短展肌针极肌电图检查,分析患者手术前和手术后腕部正中神经功能的变化情况。结果:手术后,患者正中神经感觉传导潜伏期异常率(33%)、正中神经运动传导潜伏期异常率(36%)较手术前(72%、74%)明显下降(P0.05),正中神经感觉传导波幅(7.40±5.05)较手术前(4.86±3.60)显著降低(P0.001),拇短展肌静息状态下失神经电位的异常率(69%)、重收缩时募集电位异常率(13%)均较手术前(85%、26%)明显下降(P0.05)。患者手术前后正中神经感觉传导速度和运动传导速度对比差异无统计学意义(P0.05)。结论:腕管切开减压术可解除正中神经卡压状态,明显恢复正中神经功能,增强拇短展肌肌力,临床治疗效果好。肌电图检查可为腕管综合征患者手术治疗效果的评估提供客观的依据。     

State of lipid metabolism in children and adolescents with insulin-dependent diabetes. I. Evaluation of lipoprotein (A) behavior in children and adolescents with insulin-dependent diabetes]

The level of lipoprotein Lp(a), one of the risk factors of atherosclerosis, was determined in 91 children and adolescents of age ranging from 3.3 to 22 years suffering from insulin-dependent diabetes. The changes in Lp(a) were analyzed in relation to the group of patients, the duration of diabetes, possible genetic factors, other factors predisposing to early onset of atherosclerosis, and occurrence of obesity in the analyzed group. The relation between the level of Lp(a) and other parameters of lipid metabolism (total cholesterol, triglycerides, phospholipids, HDL-cholesterol and apolipoprotein B) as well as a degree of metabolic normalization of diabetes (as assessed by the determination of glycosylated hemoglobin and fructosamine) was studied in addition. No relation between Lp(a) and the factors mentioned above, with exception of glycosylated hemoglobin and fructosamine concentrations, could be demonstrated. The elevated level of Lp(a) in children and adolescents during the period of poor metabolic control of diabetes may constitute an additional risk factor for early onset of atherogenic changes.     

Neuropathy in latent hereditary hepatic porphyria.

Peripheral nerve conduction velocoties were measured in 20 patients with acute intermittent porphyria and five with variegate porphyria and in 25 controls matched for age and sex. None of the porphyric patients had acute symptoms on examination, and nine had never had symptoms. Compared with the controls, patients had a significantly slower conduction velocity of the slower motor fibres of the ulnar nerve (P less than 0-001) and a slower sensory conduction velocity of the ulnar and median nerves (P less than 0-05). There was no significant difference between the patients and controls in the maximum motor conductionvelocity of the median, ulnar, deep peroneal, or posterior tibial nerves. Slight peripheral neuropathy seems to be associated with latent hereditary hepatic porphyria, even in patients who have never had symptoms.     

Heterogeneity of antibody specificity in Taiwanese patients with polyneuropathy and IgM paraproteinemia

About half of the Caucasian patients with chronic polyneuropathy and IgM paraproteinemia show serum anti-myelin-associated glycoprotein (MAG) and anti-sulfoglucuronosyl glycosphingolipid (SGGLs) activities. These antibody activities have been demonstrated to react with a carbohydrate epitope known as the HNK-1 or sulfoglucuronic acid (SGA) epitope. However, in Asian populations the occurrence of serum anti-SGA activities has been reported to be relatively rare. We investigated 5 cases of chronic polyneuropathy with IgM paraproteinemia from Taiwan and found that 3 of them had high-titer serum anti-SGA (SGGL/MAG) antibody activities. The clinical symptoms of these 3 patients were consistent with sensory dominant polyneuropathy with a severer involvement of the lower limbs than of the upper limbs. Electromyography and nerve conduction studies revealed severe sensory nerve involvement (no response in 3 cases) and moderate slowing of motor conduction velocity (MCV) without conduction block. The decrease in MCV correlated well with anti-SGA antibody titer (less than 30 m/s with the titration of 1:12,800, normal 55–60 m/s). Pathological findings showed active demyelinating polyneuropathy with myelin ovoid and myelinated fiber loss. Our data suggest that anti-SGGL antibody activities may not be very rare among Asian populations. Additionally, there seems an intriguing possibility that the titer of this antibody correlates with the severity of peripheral nerve involvement in patients of demyelinating polyneuropathy with IgM paraproteinemia.     

An Electrophysiological Study of Acute Tetrodotoxin Poisoning

To evaluate the electrophysiological changes in patients with acute tetrodotoxin (TTX) poisoning from ingestion of globefish (Tetraodontidae) patients exposed to TTX were compared with age-matched controls. The cohort of TTX-poisoning cases was clinically subdivided into mild, moderate, or severe cases. The motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV), F-wave, H-reflex, and somatosensory-evoked potentials (SEP) of the median, ulnar, and common peroneal nerve (CPN) were determined using established techniques. Four of the 64 (6.3%) TTX-poisoning cases died and were omitted from the final analysis. The MCV and SCV of the median, ulnar, and CPN nerves in all the TTX-poisoning cases were significantly slower than the healthy controls. Severe cases of TTX poisoning had more significant reduction in nerve function. Thus, electroneurophysiological analysis could be used to determine the extent, course, and range of nerve system damage in patients with acute TTX poisoning.     

显微手术治疗正中神经开放性损伤的临床效果分析

目的:分析显微手术治疗正中神经开放性损伤的临床效果。方法:选取2010年2月-2014年3月入住我院接受治疗的120例正中神经开放性损伤患者,随机分成观察组和对照组,每组60例。对照组行常规的手术治疗,观察组行显微手术进行治疗。术后随访6~48个月,比较两组患者正中神经的运动传导速度(MCV)、感觉传导速(SCV)以及正中神经功能优良率。结果:观察组正中神经功能优良率为93.33%,显著高于对照组70.00%(P0.05);两组患者治疗后正中神经MCV、SCV较治疗前均明显增加(P0.05);治疗后观察组MCV、SCV改善程度显著大于对照组(P0.01)。结论:显微手术治疗正中神经开放性损伤效果显著,为神经损伤修复奠定了理论基础,具有巨大的临床应用价值。     

Identification and Prediction of Diabetic Sensorimotor Polyneuropathy Using Individual and Simple Combinations of Nerve Conduction Study Parameters

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.     

TOCP对鸡迷走神经不同纤维成份传导速度和兴奋性的影响

对磷酸三邻甲苯醋(TOCP)染毒母鸡进行迷走神经不同纤维成份传导速度和兴奋性测定,发现实验组动物在染毒后14天迷走神经第5波(类似于C纤维)传导速度减慢30%,染毒后21天时减慢52%,并出现迷走神经各波兴奋性显著降低.实验结果说明,TOCP所致迟发性神经病可损害与内脏活动有关的迷走神经.     

Role of insulin signaling impairment,adiponectin and dyslipidemia in peripheral and central neuropathy in mice

One of the tissues or organs affected by diabetes is the nervous system, predominantly the peripheral system (peripheral polyneuropathy and/or painful peripheral neuropathy) but also the central system with impaired learning, memory and mental flexibility. The aim of this study was to test the hypothesis that the pre-diabetic or diabetic condition caused by a high-fat diet (HFD) can damage both the peripheral and central nervous systems. Groups of C57BL6 and Swiss Webster mice were fed a diet containing 60% fat for 8 months and compared to control and streptozotocin (STZ)-induced diabetic groups that were fed a standard diet containing 10% fat. Aspects of peripheral nerve function (conduction velocity, thermal sensitivity) and central nervous system function (learning ability, memory) were measured at assorted times during the study. Both strains of mice on HFD developed impaired glucose tolerance, indicative of insulin resistance, but only the C57BL6 mice showed statistically significant hyperglycemia. STZ-diabetic C57BL6 mice developed learning deficits in the Barnes maze after 8 weeks of diabetes, whereas neither C57BL6 nor Swiss Webster mice fed a HFD showed signs of defects at that time point. By 6 months on HFD, Swiss Webster mice developed learning and memory deficits in the Barnes maze test, whereas their peripheral nervous system remained normal. In contrast, C57BL6 mice fed the HFD developed peripheral nerve dysfunction, as indicated by nerve conduction slowing and thermal hyperalgesia, but showed normal learning and memory functions. Our data indicate that STZ-induced diabetes or a HFD can damage both peripheral and central nervous systems, but learning deficits develop more rapidly in insulin-deficient than in insulin-resistant conditions and only in Swiss Webster mice. In addition to insulin impairment, dyslipidemia or adiponectinemia might determine the neuropathy phenotype.KEY WORDS: Glucose, High-fat diet, Insulin, Neuropathy     

Pentoxifylline Effects on Nerve Conduction Velocity and Blood Flow in Diabetic Rats

Pentoxifylline has several actions that improve blood rheology and tissue perfusion and may therefore potentially be applicable to diabetic neuropathy. The aims of this study were to ascertain whether 2 weeks of treatment with pentoxifylline could correct nerve conduction velocity and blood flow deficits in 6-week streptozotocin-diabetic rats and to examine whether the effects were blocked by co-treatment with the cyclooxygenase inhibitor, flurbiprofen, or the nitric oxide synthase inhibitor, N^G-nitro-ʟ-arginine. Diabetic deficits in sciatic motor and saphenous sensory nerve conduction velocity were 56.5% and 69.8% corrected, respectively, with pentoxifylline treatment. Sciatic endoneurial blood flow was approximately halved by diabetes and this deficit was 50.4% corrected by pentoxifylline. Flurbiprofen co-treatment markedly attenuated these actions of pentoxifylline on nerve conduction and blood flow whereas N^G-nitro-ʟ-arginine was without effect. Thus, pentoxifylline treatment confers neurovascular benefits in experimental diabetic neuropathy, which are linked at least in part to cyclooxygenasemediated metabolism.     

补阳还五汤联合针灸对糖尿病周围神经病变患者血糖代谢、神经传导速度和血液流变学的影响

摘要 目的：探讨补阳还五汤联合针灸对糖尿病周围神经病变（DPN）患者血糖代谢、神经传导速度和血液流变学的影响。方法：选取我院2018年4月-2021年4月期间收治的100例DPN患者,按照双色球法将患者分为对照组（50例,常规西医治疗）和研究组（50例,对照组基础上接受补阳还五汤联合针灸治疗）。均治疗4周,对比两组临床疗效、血糖代谢水平、神经传导速度和血液流变学。结果：治疗后研究组临床总有效率（94.00%）,高于对照组（72.00%）（P<0.05）。治疗后研究组的空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）水平均低于对照组（P<0.05）。治疗后研究组的腓总神经和正中神经感觉神经传导速度（SNCV）、运动神经传导速度（MNCV）均较对照组高（P<0.05）。治疗后研究组的红细胞比积、纤维蛋白原、全血粘度（高切）及全血粘度（低切）水平均低于对照组（P<0.05）。结论：补阳还五汤联合针灸治疗DPN患者疗效显著,有效提高其神经传导速度,改善其血糖代谢和血液流变学。     

Parameters of action potentials of motor units in diabetic patients as determined by electromyography using skin surface leads

Motor units were studied in children by means of electromyography using skin surface leads. In the control group of healthy children, 295 action potentials typical of the age dynamics were recorded from motor units. In the group of children with type I diabetes mellitus and diabetic polyneuropathy, a higher amplitude and a longer duration of motor unit action potentials than in the control group, which are typical of diabetic polyneuropathy, were observed.     

湿润烧伤膏联合封闭负压引流术对糖尿病足溃疡患者神经传导速度、溃疡创面血管新生及氧化应激水平的影响

摘要 目的：探讨湿润烧伤膏联合封闭负压引流术（VSD）对糖尿病足溃疡（DFU）患者神经传导速度、溃疡创面血管新生及氧化应激水平的影响。方法：选取我院2021年1月~2022年5月间收治的80例DFU患者,根据信封抽签法分为对照组（n=40）和研究组（n=40）。两组患者在住院期间均接受基础治疗,在此基础上,对照组接受VSD治疗,研究组在对照组的基础上接受湿润烧伤膏治疗。观察两组临床指标、生活质量、神经传导速度、溃疡创面血管新生及氧化应激水平的变化情况。结果：研究组的创面愈合率高于对照组,创面愈合时间短于对照组（P<0.05）。研究组治疗后踝肱指数（ABI）高于对照组（P<0.05）。研究组治疗后简明健康调查量表（SF-36）各维度评分高于对照组（P<0.05）。研究组治疗后腓总神经感觉神经传导速度（SCV）、腓总神经运动神经传导速度（MCV）、正中神经MCV、正中神经SCV高于对照组（P<0.05）。研究组治疗后内皮抑素（ES）低于对照组,血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）高于对照组（P<0.05）。研究组治疗后丙二醛（MDA）、晚期蛋白氧化产物（AOPP）低于对照组,超氧化物歧化酶 （SOD）高于对照组（P<0.05）。结论：湿润烧伤膏联合VSD应用于DFU患者,可促进其创面愈合,提高神经传导速度和生活质量,可能与调节氧化应激水平、促进溃疡创面血管新生相关。