Top

Journal of Neurology

Published in:

01-01-2007 | ORIGINAL COMMUNICATION

Subclinical diabetic neuropathy with normal conventional electrophysiological study

Authors: Jong Seok Bae, Byoung Joon Kim, MD

Published in: Journal of Neurology | Issue 1/2007

Abstract

Background

For early detection and prevention of diabetic neuropathy, it is important to identify subclinical diabetic neuropathy. Routine nerve conduction study often fails to detect early stage of neuropathy.

Objectives

The purpose of this study is to evaluate the clinical usefulness of electrophysiological indexes in detecting early diabetic neuropathy with no objective clinical or electrophysiological abnormalities.

Materials and Methods

Nerve conduction study of upper/lower limbs was investigated in 31 subclinical diabetic neuropathy patients with normal nerve conduction studies(group I), 38 clinical diabetic neuropathy patients with normal nerve conduction studies(group II) and 31 normal controls. Residual latency (RL), terminal latency index (TLI) and modified F raito (MFR) were calculated and compared among groups.

Results

Compared with controls, MFR of lower limbs and TLI of both upper/lower limbs were significantly decreased in both group I and II (p<0.05). RL was increased in both groups, but the difference was not statistically significant. Comparing the indexes between group I and II, there was no significant difference.

Conclusions

RL, TLI and MFR, which reflect distal conduction slowing, may be useful indexes to identify subclinical diabetic neuropathy. The results also suggest that electrophysiological changes that are obscured in routine nerve conduction study are present before the clinical manifestation.

(1988) Report and recommendations of the San Antonio conference on diabetic neuropathy. Neurology 38:1161–1165

Attarian S, Azulay JP, Boucraut J, Escande N, Pouget J (2001) Terminal latency index and modified F ratio in distinction of chronic demyelinating neuropathies. Clin Neurophysiol 112:457–463PubMedCrossRef

Barohn RJ, Kissel JT, Warmolts JR, Mendell JR (1989) Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. Arch Neurol 46:878–884PubMed

Bril V (1999) NIS-LL: the primary measurement scale for clinical trial endpoints in diabetic peripheral neuropathy. Eur Neurol 41(Suppl 1):8–13PubMedCrossRef

Bril V, Werb MR, Greene DA, Sima AA (1996) Single-fiber electromyography in diabetic peripheral polyneuropathy. Muscle Nerve 19:2–9PubMedCrossRef

Bromberg MB (1991) Comparison of electrodiagnostic criteria for primary demyelination in chronic polyneuropathy. Muscle Nerve 14:968–976PubMedCrossRef

Brown MJ, Asbury AK (1984) Diabetic neuropathy. Ann Neurol 15:2–12PubMedCrossRef

Chang CW, Chuang LM (1996) Correlation of HbA1c concentration and single-fiber EMG findings in diabetic neuropathy. Electromyogr Clin Neurophysiol 36:425–432PubMed

Cocito D, Isoardo G, Ciaramitaro P, Migliaretti G, Pipieri A, Barbero P, Cucci A, Durelli L (2001) Terminal latency index in polyneuropathy with IgM paraproteinemia and anti-MAG antibody. Muscle Nerve 24:1278–1282PubMedCrossRef

10.

Daube J (1996) Compound muscle action potentials. In: Daube J (eds) Clinical neurophysiology. FA Davis Company, Philadelphia, pp 199–324

11.

Dyck PJ (1992) New understanding and treatment of diabetic neuropathy. N Engl J Med 326:1287–1288PubMedCrossRef

12.

Dyck PJ, Kratz KM, Lehman KA, Karnes JL, Melton LJ, 3rd, O’Brien PC, Litchy WJ, Windebank AJ, Smith BE, Low PA, et al. (1991) The Rochester Diabetic Neuropathy Study: design, criteria for types of neuropathy, selection bias, and reproducibility of neuropathic tests. Neurology 41:799–807PubMed

13.

Dyck PJ, O’Brien PC (1989) Meaningful degrees of prevention or improvement of nerve conduction in controlled clinical trials of diabetic neuropathy. Diabetes Care 12:649–652PubMed

14.

Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA (1994) A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 17:1281–1289PubMed

15.

Kaku DA, England JD, Sumner AJ (1994) Distal accentuation of conduction slowing in polyneuropathy associated with antibodies to myelin-associated glycoprotein and sulphated glucuronyl paragloboside. Brain 117(Pt 5):941–947PubMedCrossRef

16.

Kaplan P, Sahgal V (1978) Residual latency: new applications of an old technique. Arch Phys Med Rehabil 59:24–27PubMed

17.

Kaplan PE (1976) Sensory and motor residual latency measurements in helathy patients and patients with neuropathy-part 1. J Neurol Neurosurg Psychiatry 39:338–340PubMedCrossRef

18.

Kimura J, Yamada T, Stevland NP (1979) Distal slowing of motor nerve conduction velocity in diabetic polyneuropathy. J Neurol Sci 42:291–302PubMedCrossRef

19.

Olaleye D, Perkins BA, Bril V (2001) Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract 54:115–128PubMedCrossRef

20.

Pastore C, Izura V, Geijo-Barrientos E, Dominguez JR (1999) A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy. Muscle Nerve 22:1667–1673PubMedCrossRef

21.

Perkins BA, Olaleye D, Zinman B, Bril V (2001) Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care 24:250–256PubMed

22.

Radziwill AJ, Steck AJ, Renaud S, Fuhr P (2003) Distal motor latency and residual latency as sensitive markers of anti-MAG polyneuropathy. J Neurol 250:962–966PubMedCrossRef

23.

Rith-Najarian SJ, Stolusky T, Gohdes DM (1992) Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria. Diabetes Care 15:1386–1389PubMed

24.

Sander HW, Latov N (2003) Research criteria for defining patients with CIDP. Neurology 60:S8-S15PubMed

25.

Shahani BT, Young RR, Potts F, Maccabee P (1979) Terminal latency index(TLI) and late response studies in motor neuron disease(MND), peripheral neuropathies and entrapment syndromes (abstract). Acta Neurol Scand Supp. 73:118

26.

Shimada H, Kihara M, Kosaka S, Ikeda H, Kawabata K, Tsutada T, Miki T (2001) Comparison of SSR and QSART in early diabetic neuropathy–the value of length-dependent pattern in QSART. Auton Neurosci 92:72–75PubMedCrossRef

27.

Simovic D, Weinberg DH (1999) The median nerve terminal latency index in carpal tunnel syndrome: a clinical case selection study. Muscle Nerve 22:573–577PubMedCrossRef

28.

Simovic D, Weinberg DH (1997) Terminal latency index in the carpal tunnel syndrome. Muscle Nerve 20:1178–1180PubMedCrossRef

29.

Trojaborg W, Hays AP, van den Berg L, Younger DS, Latov N (1995) Motor conduction parameters in neuropathies associated with anti-MAG antibodies and other types of demyelinating and axonal neuropathies. Muscle Nerve 18:730–735PubMedCrossRef

Title: Subclinical diabetic neuropathy with normal conventional electrophysiological study
Authors: Jong Seok Bae
Byoung Joon Kim, MD
Publication date: 01-01-2007
Publisher: Steinkopff-Verlag
Published in: Journal of Neurology / Issue 1/2007
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-006-0261-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Subclinical diabetic neuropathy with normal conventional electrophysiological study

Abstract

Background

Objectives

Materials and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Materials and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2007

Psychosocial interventions in people with multiple sclerosis

Measuring cognitive change in older adults: reliable change indices for the SIDAM

Ischemic cerebral attacks due to a pseudo-aneurysm of the internal carotid artery with Listeria monocytogenes

Upbeat nystagmus due to a caudal medullary lesion and influenced by gravity

News on Parkinson’s disease: from parkin mutations and limb-kinetic apraxia to valvular heart disease

Quality Assessment in Multiple Sclerosis Therapy (QUASIMS)