The natural course of peripheral and autonomic neural function during the first two years after diagnosis of type 1 diabetes

Summary Motor and sensory nerve conduction velocities (MNCV, SNCV), beat-to-beat variation (BBV) at rest, speed of pupillary dilation (SPD), and pupillary latency time (PLT) were measured in 32 patients aged 12–36 years after 19±2 (mean±SEM) days and again after 3, 12, and 24 months of insulin treatment. Moreover, BBV under deep respiration was determined after 12 and 24 months, and thermal discrimination thresholds (TDT) as well as pain and vibration perception thresholds (PPT, VPT) were evaluated after 24 months. Mean HbA₁ levels during months 3–24 within the normal range (7.2±0.2%; mean±SEM) were observed in 20 patients (group 1), while in 12 patients (group 2) mean HbA₁ of months 3–24 was elevated (10.1±0.4%). There were no significant differences between both groups with regard to the nerve function tests at baseline and after 3 months. After 12 months mean median MNCV and median, ulnar, and sural SNCV were significantly lower in group 2 than in group 1 (p<0.05). After 24 months mean median MNCV, peroneal MNCV, median SNCV, and sural SNCV as well as both BBV tests and PLT were significantly impaired in group 2 as compared to group 1 (p<0.05). In addition, mean malleolar VPT and PPT to heat and cold stimuli on the thenar and the foot were significantly elevated in group 2 as compared to group 1 (p<0.05). These findings suggest that early deterioration of somatic nerve function after one year and of autonomic function after 2 years of diabetes may be prevented by effective glycemic control initiated immediately after diagnosis of the disease.Abbreviations BBV beat-to-beat variation - CSII continuous subcutaneous insulin infusion - IDDM insulin-dependent diabetes mellitus - MNCV motor nerve conduction velocity - NS not significant - PLT pupillary latency time - PPT pain perception threshold - SNCV sensory nerve conduction velocity - SPD speed of pupillary dilation - TDT thermal discrimination threshold - VPT vibration perception threshold     

电生理检查对伸指功能障碍的诊断价值

目的:探讨电生理检查对无明确外伤史出现伸指功能障碍的诊断价值。方法:对85例(92侧)无明确外伤史以伸指功能障碍为主诉的患者,桡浅神经、前臂内侧皮神经、尺神经、正中神经感觉神经传导速度(sensory nerve conduction velocity,SNCV)检测、运动神经传导速度(motor nerve conduction velocity,MNCV)检测;桡神经、正中神经、尺神经、肌皮神经、腋神经所支配肌的肌电图(electromyogram,EMG)检测。结果:外侧肌间隔卡压16例(16侧)、骨间后神经卡压41例(41侧)、胸廓出口14例(15侧)、运动神经元疾病4例(8侧)、平山病5例(7侧)、3例(侧)周围神经病变,2例(4侧)所检测指标均在正常范围,电生理检测所得结果阳性率为94.1%。结论:电生理检查可以对无明确外伤史出现伸指功能障碍提供客观的检测指标,对该病的病因诊断具有重要的价值。     

日韩健康人运动神经传导的比较

目的：检测健康的日本人和韩国人的末梢神经传导以研究不同国家的国民之间的传导差异,进而探讨各国民族生活习惯对末梢神经传导指标的影响。方法：以40名日本志愿者和30名韩国志愿者为对象,检测正中、尺、胫及腓神经的复合肌肉动作电位（CMAP）和F波,比较日本人和韩国人的神经传导检测结果。结果：经比较,正中、尺、胫及腓神经CMAP的远端波幅（DAmp）平均值,日本组高于韩国组（P〈0．05）;尺神经运动传导速度（MCV）日本组快于韩国组;F波最短潜伏期（F-Lat）日韩两组均有延长现象。腓神经D—Lat和F-Lat,日本组较韩国组延长;日本组中,腓神经DLat大于（x±s）的神经组的DAmp和F-Lat低下或延长。结论：正中、尺、胫及腓神经CMAP的DAmp,日本组高于韩国组;提示日韩两组均有腕肘部潜在性尺神经损伤;日本组中,可观察到踝前部的潜在性腓神经损伤。推测日常生活中的频繁而反复的轻微外伤以及日本人的正坐习惯是导致腕肘部及踝前部的潜在性神经损伤的根源。     

运动神经传导速度及H—反射测定在Ⅱ型糖尿病人周围神经损害中的诊断作用

本文通过68例Ⅱ型糠尿病人和30例对照组正常人空腹血糖、糖化血红蛋白和运动神经传导速度及H—反射的关系研究发现患者正中神经、尺神经、胫神经的运动神经传导速度明显减慢,胫神经的H—反射的时间明显延长,与对照组正常人有极显著性差异(P<0.001),在Ⅱ型糠尿病人周围神经病变的早期诊断中有一定价值。运动神经的传导速度减慢与病人年龄、病程无关,与糠化血红蛋白的升高有一定程度的负相关关系。     

Oral zinc therapy in diabetic neuropathy

The present double blind randomized study was conducted on 50 subjects; 20 age and sex matched healthy controls (Group--I); 15 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group--IIA); and 15 patients of diabetes mellitus with neuropathy who were given supplemental zinc sulphate (660 mg) for 6 weeks (Group--IIB). Serum zinc level, fasting blood sugar (FBS) and post prandial blood sugar (PPBS) levels and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p < 0.001) in group IIA and IIB as compared to healthy controls (Group--I) at baseline. After 6 weeks the change in pre and post therapy values of FBS, PPBS and MNCV (median and common peroneal nerve) were highly significant (P = < 0.001) for group IIB alone with insignificant change (P = > 0.05) in group IIA. No improvement (P = > 0.05) in autonomic dysfunction was observed in either groups. Therefore, oral zinc supplementation helps in achieving better glycemic control and improvement in severity of peripheral neuropathy as assessed by MNCV.     

Poly(ADP-ribose)polymerase inhibition counteracts renal hypertrophy and multiple manifestations of peripheral neuropathy in diabetic Akita mice

Poly(ADP-ribose) polymerase (PARP) activation has been implicated in the pathogenesis of diabetic complications, including nephropathy and peripheral neuropathy. This study aimed at evaluating the manifestations of both complications in diabetic Akita mice, a model of Type 1 (insulin-dependent) diabetes, and their amenability to treatment with the potent PARP inhibitor, 10-(4-methyl-piperazin-1-ylmethyl)-2H-7-oxa-1,2-diaza-benzo[de] anthracen-3-one (GPI-15427). Male non-diabetic C57Bl6/J and diabetic C57Bl/6-Ins2Akita/J (Akita) mice were maintained with or without treatment with GPI-15427, 30 mg/kg/day, for 4 weeks starting from 16 weeks of age. Sixteen week-old Akita mice displayed sensory nerve conduction velocity (SNCV) deficit, whereas the motor nerve conduction velocity (MNCV) tended to decrease, but the difference with controls did not achieve statistical significance. They also developed thermal and mechanical hypoalgesia and tactile allodynia. SNCV deficit, mechanical hypoalgesia, and tactile allodynia progressed with age whereas the severity of thermal hypoalgesia was similar in 16- and 20-week-old Akita mice. PARP inhibition alleviated, although it did not completely reverse, SNCV deficit, thermal and mechanical hypoalgesia and tactile allodynia. Sixteen-week-old Akita mice displayed MNCV deficit (41.3±2.5 vs. 51.0±1.2 m/sec in non-diabetic controls, P<0.01), axonal atrophy of myelinated fibers, kidney hypertrophy, and albuminuria. MNCV slowing, axonal atrophy, and kidney hypertrophy, but not albuminuria, were less severe in GPI-15427-treated age-matched Akita mice. Neuroprotective and nephroprotective effects of PARP inhibition were not due to alleviation of diabetic hyperglycemia, or peripheral nerve p38 mitogen-activated protein kinase activation. GPI-15427 did not affect any variables in control mice. In conclusion, the findings support an important role for PARP activation in diabetic peripheral neuropathy and kidney hypertrophy associated with Type 1 diabetes, and provide rationale for development and further studies of PARP inhibitors, for the prevention and treatment of these complications.     

New electrophysiological assessments for the early diagnosis of encephalopathy and peripheral neuropathy in chronic uraemia

The clinical manifestations of neuropathy in chronic uraemia are late in occurring. However, at an early stage it is possible to detect damage to either the central or peripheral nervous system by means of modern electrophysiological investigation methods. We examined 29 patients with CRF (plasma creatinine 7.0 +/- 4.0 mg%) on conservative diet. The following electrophysiological tests were carried out at least once: Electroencephalogram (EEG), Electromyogram (EMG), Motor Nerve Conduction Velocity (MNCV), Sensory Nerve Conduction Velocity (SNCV), Visual Evoked Potentials (VEPs) using the pattern reversal transient stimulation method. At the same time the following blood tests were performed: BUN, creatinine, uric acid, glucose, cholesterol, triglycerides, lipid electrophoresis, total protein (electrophoretic method), Na, K, Ca, P, red cells blood count and PTH. MNCV, SNCV and VEPs appeared to slow down early, sometimes even where there were no clinical symptoms. In addition, there is a direct correlation with decreasing renal function. MNCV and SNCV were correlated directly, reciprocally although the compromise of SNCV appeared an earlier phenomenon. The significant direct correlation between MNCV, SNCV and serum PTH suggests that the latter has an important peripheral neurotoxic role. VEP recording permits detection of early abnormalities in the central nervous system with residual renal function values around 40%.     

补阳还五汤化裁方联合穴位注射治疗糖尿病周围神经病变的临床研究

目的 观察补阳还五汤化裁方内服联合VB12注射液穴位注射治疗糖尿病周围神经病变的临床疗效。方法 选择2016年8月~2018年8月我院内分泌科40例辨证为气虚血瘀型的DPN患者,随机分为对照组和治疗组,各20例。两组均接受血糖控制治疗,对照组予硫辛酸注射液静滴,治疗组在其基础上采用补阳还五汤化裁方内服联合VB12注射液穴位注射治疗。观察治疗前后患者临床疗效,肌电图检测腓总神经和正中神经的运动神经、感觉神经传导速度。结果 治疗组有效率为90.00%,高于对照组的60.00%,差异有统计学意义（P＜0.05）;治疗后,两组患者腓总神经、正中神经MCV及SCV均较治疗前提高,差异有统计学意义（P＜0.05）;且治疗组腓总神经、正中神经MCV及SCV高于对照组,差异有统计学意义（P＜0.05）。结论 补阳还五汤化裁方内服联合VB12注射液穴位注射治疗糖尿病周围神经病变可有效改善患者腓总神经、正中神经的运动神经传导速度及感觉神经传导速度,提高临床疗效。     

Asymptomatic electrophysiologic carpal tunnel syndrome in diabetics: entrapment or polyneuropathy

Electrophysiologic carpal tunnel syndrome (CTS) is common and is frequently asymptomatic in diabetics. In order to evaluate the clinical significance of asymptomatic electrophysiologic CTS, the nerve conduction studies (NCS) of 48 diabetics with asymptomatic electrophysiologic CTS were compared with those of 56 age and gender-matched controls, as well as 50 patients with symptomatic CTS without diabetes. Nerve conduction velocities of the ulnar, peroneal, and posterior tibial nerves were significantly slower in diabetics with asymptomatic electrophysiologic CTS than in normal controls. Compared to symptomatic non-diabetic CTS, there was also significant slowing of the median and ulnar nerve conduction velocities in asymptomatic diabetic CTS. However, in diabetics with asymptomatic CTS, abnormalities of the distal segment of the median NCS were more prominent compared with those of all the other tested nerves. These findings suggested that asymptomatic electrophysiologic CTS in diabetics is a manifestation of increased vulnerability to the entrapment of the peripheral nerve.     

Neuromuscular status of thyroid diseases: a prospective clinical and electrodiagnostic study

With this study, it has been intended to evaluate the neuromuscular symptoms and findings observed in patients with the diagnoses of hyperthyroidism and hypothyroidism. This study included 21 patients with hyperthyroidism, 19 patients with hypothyroidism and a control group comprised of 29 healthy persons. In the patient group with hypothyroidism, the increase in the median motor distal latency and the median sensorial distal latency (p < 0.0001), the reduction in the median sensory action potential amplitude (p < 0.01) and the slowing in the velocity of nerve conduction (p < 0.01) were found significantly different when compared to the control group. H-reflex latencies were determined to be significantly longer bilaterally (p < 0.01). In the patient group with hyperthyroidism, only the reduction in the median sensory action potential amplitude and the prolongation in the distal latency (p < 0.05) were significant. As for the lower extremities, the slowing in the velocity of the nerve conduction of bilateral peroneal (p < 0.0001), the prolongation in the peroneal F-wave latency (p < 0.01), the slowing in the velocity of the nerve conduction of bilateral tibial nerve (p < 0.05), the prolongation in the tibial F-wave latency (p < 0.01), the prolongation in the sural nerve distal latency (p < 0.0001) and the reduction in the sensory action potential amplitude (p < 0.05) were determined to be significantly different compared to the control group. Among the thyroid patients, 17 (42.5%) patients were diagnosed with mononeuropathy and polyneuropathy. Entrapment neuropathy was observed in 30% and diffuse neuropathy in 10% of the patients. Mypopathy findings were observed in 2 patients.     

Electroneuromyographic sequelae of tetanus, a controlled study of 40 patients

To assess the peripheral nervous system involvement caused by tetanus 40 patients recovered from tetanus and their sex and age matched referents were submitted to electroneuromyography (ENMG). Clinical symptoms and signs of peripheral neuropathy were found in 6 patients, 3 of whom had other obvious aetiology than tetanus. EMG was examined of the masseters and three muscles in the extremities. Motor conduction velocities (MCVs) were examined of the median, ulnar and peroneal nerves, distal sensory conduction velocity (dSCV) of the median, ulnar and radial nerves and the sensory conduction velocity (SCV) of the median nerve. Repetitive stimulation was done to study the neuromuscular transmission. The patients had significantly longer motor distal latencies (DLs) and slower dSCVs and more frequent ENMG findings compatible with mono- or polyneuropathy than their referents. There was no systematical difference in the MCVs. These findings suggest that tetanus may cause toxic axonal polyneuropathy, sequels of which appear to be slight or subclinical and can be seen at a group level.     

正常儿童的神经电图检测报告

目的:利用神经电图检测技术,获取不同年龄期正常儿童的有关神经电生理数据,以便在儿科临床应用中提供其详细、有效的判断依据。方法:采用肌电图／诱发电位仪检测405名儿童的正中神经、尺神经、腓神经、胫神经的运动传导速度(MCV)和感觉传导速度(SCV)、F波及股神经运动潜伏期(FML)。此405名正常儿童按年龄分15组,每组25-40人,分别检测双侧肢体,取单肢结果统计制表。结果:各年龄期各检查项目波形引出率100％。MCV、SCV随年龄增加而增快,潜伏期随年龄增加而延长。除胫后神经感觉神经动作电位(SNAP)随年龄增加而降低外,其余神经复合肌肉动作电位(CMAP)、SNAP波幅均随年龄增加而增高。F波潜伏期随年龄增加而延长,F波响应率无明显年龄规律,但各神经中以胫神经响应率最高,腓总神经响应率最低。结论:不同年龄儿童MCV、SCV、F波、FML的测值与年龄的增长相关,在临床应用中,应参照相应年龄期正常值作出判断。     

Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients

It is unknown to what extent chronic intermittent hypoxaemia in obstructive sleep apnea causes damage to the motor and sensory peripheral nerves. It was hypothesized that patients with obstructive sleep apnea would have bilaterally significantly impaired amplitudes of both motor and sensory peripheral nerve‐evoked potentials of both lower and upper limbs. An observational study was conducted on 43 patients with obstructive sleep apnea confirmed by the whole‐night polysomnography, and 40 controls to assess the relationship between obstructive sleep apnea and peripheral neuropathy. All obstructive sleep apnea subjects underwent standardized electroneurographic testing, with full assessment of amplitudes of evoked compound muscle action potentials, sensory neural action potentials, motor and sensory nerve conduction velocities, and distal motor and sensory latencies of the median, ulnar, peroneal and sural nerves, bilaterally. All nerve measurements were compared with reference values, as well as between the untreated patients with obstructive sleep apnea and control subjects. Averaged compound muscle action potential and sensory nerve action potential amplitudes were significantly reduced in the nerves of both upper and lower limbs in patients with obstructive sleep apnea compared with controls (P < 0.001). These results confirmed that patients with obstructive sleep apnea had significantly lower amplitudes of evoked action potentials of both motor and sensory peripheral nerves. Clinical/subclinical axonal damage exists in patients with obstructive sleep apnea to a greater extent than previously thought.     

健康青年人四肢远端神经F波特征

目的:观察健康青年志愿者的正中、尺、腓、胫神经F波最短潜伏期以及出现率与年龄、性别的关系.方法:选择延边大学医学院健康志愿者996名为研究对象,采用美国NICOLET公司出产的Portabook肌电图诱发电位仪,检测正中神经、尺神经、腓神经和胫神经F波,比较分析男18～21岁组、女18～21岁组与男22～25岁组、女2...     

Evaluation of the peroxynitrite decomposition catalyst Fe(III) tetra-mesitylporphyrin octasulfonate on peripheral neuropathy in a mouse model of type 1 diabetes

Whereas the important role of free radicals in diabetes-associated complications is well established, the contributions of the highly reactive oxidant peroxynitrite have not been properly explored. The present study used a pharmacological approach to evaluate the role of peroxynitrite in peripheral diabetic neuropathy. Control and STZ-diabetic mice were maintained with or without treatment with the potent peroxynitrite decomposition catalyst Fe(III) tetramesitylporphyrin octasulfonate (FeTMPS), at doses of 5 or 10 mg/kg/day in the drinking water for 3 weeks after an initial 3 weeks without treatment. Mice with a 6-week duration of diabetes developed clearly manifest motor (MNCV) and sensory nerve conduction velocity (SNCV) deficits, thermal hypoalgesia (paw withdrawal, tail-flick, and hot plate tests), mechanical hypoalgesia (tail pressure Randall-Sellito test), tactile allodynia (flexible von Frey filament test), and approximately 44% loss of intraepidermal nerve fibers. They also had increased nitrotyrosine and poly(ADP-ribose) immunofluorescence in sciatic nerve, grey matter of the spinal cord, and dorsal root ganglion neurons. FeTMPS treatment alleviated or essentially corrected (at a dose of 10 mg/kg/day) MNCV and SNCV deficits, and was associated with less severe small sensory nerve fiber dysfunction and degeneration. Nitrotyrosine and poly(ADP-ribose) immunofluorescence in sciatic nerve, spinal cord, and dorsal root ganglion neurons in peroxynitrite decomposition catalyst-treated diabetic mice was markedly reduced. In conclusion, peroxynitrite contributes to large motor, large sensory, and small sensory fiber neuropathy in streptozotocin-diabetic mice. The findings provide rationale for development of potent peroxynitrite decomposition catalysts for the treatment of diabetic neuropathy.     

The usefulness of minimal F-wave latency and sural/radial amplitude ratio in diabetic polyneuropathy

The possibility of whether minimal F-wave latency and a simple ratio between the sural and superficial radial sensory response amplitudes may provide a useful electrodiagnostic test in diabetic patients was investigated in this report. To evaluate the diagnostic sensitivity of minimal F-wave latency, the Z-scores of the minimal F-wave latency, motor nerve conduction velocity (MCV), amplitude of compound muscle action potentials (CMAP), and distal latency (DL) of the median, ulnar, tibial, and peroneal nerve were compared in 37 diabetic patients. For the median, ulnar, and tibial nerves, the Z scores of the minimal F-wave latency were significantly larger than those of the MCV. In addition for all four motor nerves, the Z scores of the minimal F-wave latency were significantly larger than those for the CMAP amplitude. Furthermore, 19 subjects showing abnormal results in the standard sensory nerve conduction study had a significantly lower sural/radial amplitude ratio (SRAR), and 84% of them had an SRAR of less than 0.5. In conclusion, minimal F-wave latency and the ratio between the amplitudes of the sural and superficial radial sensory nerve action potential are sensitive measures for the detection of nerve pathology and should be considered in electrophysiologic studies of diabetic polyneuropathy.     

Median nerve F wave conduction in healthy subjects over age sixty-five

Parameters of the median nerve F wave and peripheral motor nerve conduction in 51 healthy male and female human subjects 67 to 89 years of age are described. F wave responses were elicited by stimulation of the nerve at the wrist. Motor nerve conduction velocity (MNCV) was determined for the forearm segment. Major results of this study of an older group of subjects demonstrate that: 1) the shortest F wave latency (SFWL) and the MNCV were slower in our older subjects than values in younger subjects; 2) there was no significant correlation between SFWL and age within the age group examined; 3) distal motor conduction latency was significantly slower in subjects age 75-89 years than in those age 67-74 years; 4) SFWL and MNCV of females were significantly faster than that of males; 5) a positive correlation was found between SFWL and arm length and a predictive formula is derived. An upper limit of normal F wave wrist latency of 31 msec for females and 34.4 msec for males over 65 years of age is proposed as a guideline.     

Anterior tarsal tunnel syndrome

Three hundred twenty patients complaining of pain and/or numbness of their feet were evaluated in our Clinical Neurophysiology Laboratory. Nerve conduction studies of deep peroneal, superficial peroneal, sural and posterior tibial nerves were studied bilaterally. Needle electromyography (EMG) of anterior tibial, long peroneal, abductor hallucis longus, extensor hallucis longus, gastrocnemius and extensor digitorum brevis muscles were examined bilaterally. Nerve conduction studies of 25 healthy volunteer subjects (16 female, 9 male, age range 36-70, mean age 52.82 +/- 8.8) with no complaint composed the control group. Fourteen of these patients (8 female, 6 male, age range 40-70, mean age 55.73 +/- 12.04) were found to have anterior tarsal tunnel syndrome (anterior TTS) bilaterally or unilaterally. In the patients with anterior TTS, the nerve conduction studies revealed deep peroneal nerve distal latency as 6.5 +/- 1.9 msec; the amplitude as 1.8 +/- 1.3 mV at the ankle level; and the conduction velocity as 41.5 +/- 5.9 m/sec in the distal segment. When these values were compared with the control group statistically, results were found highly significant (p < 0.005). Needle EMG findings in the anterior TTS group showed only in the extensor digitorum brevis muscle. Other nerves and muscles were normal. All patients with anterior TTS were performing Namaz for years, and none of them had the predisposing factor which may cause entrapment neuropathy. So, we suggest that chronic prolonged stretching of the deep peroneal nerve on the dorsum of the foot during Namaz may cause anterior TTS.     

Electrophysiologic signs of sensory fiber lesion in spinal amyotrophies and the role of physiologic variations of sensory finger innervation pattern

In 33 patients, 30 to 64 years old, with spinal amyotrophy and brachial paresis, the sensory symptoms and electrophysiologic signs were analyzed. The paresthesias were felt most often in the ulnar nerve innervation region. The motor conduction velocities, terminal latency quotient, sensory conduction on direct nerve stimulation were within the limits of normal in both median and ulnar nerve. On percutaneous stimulation normal values were obtained for median nerve, and significantly slower for ulnar nerve innervation region. In four cases no nerve potential was obtained over the ulnar nerve with stimulation of the fifth finger. The nerve potential over the ulnar nerve was elicited mostly by stimulation of median nerve innervated fingers. Congenital variations of sensory innervation pattern were considered, which may increase the liability to destruction.