The H-Reflex as a Biomarker for Spinal Disinhibition in Painful Diabetic Neuropathy |
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| Authors: | Corinne Lee-Kubli Andrew G. Marshall Rayaz A. Malik Nigel A. Calcutt |
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| Affiliation: | 1.The Salk Institute for Biological Sciences,La Jolla,USA;2.Faculty of Medical and Human Sciences, Institute of Cardiovascular Sciences,University of Manchester and National Institute for Healthy Research/Wellcome Trust Clinical Research Facility,Manchester,UK;3.Department of Clinical Neurophysiology, Salford Royal Hospital, National Health Service Foundation Trust,Manchester Academic Health Science Centre,Manchester,UK;4.Department of Medicine,Weill Cornell Medicine-Qatar,Doha,Qatar;5.Department of Pathology,University of California San Diego,La Jolla,USA |
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| Abstract: | Purpose of ReviewNeuropathic pain may arise from multiple mechanisms and locations. Efficacy of current treatments for painful diabetic neuropathy is limited to an unpredictable subset of patients, possibly reflecting diversity of pain generator mechanisms, and there is a lack of targeted treatments for individual patients. This review summarizes preclinical evidence supporting a role for spinal disinhibition in painful diabetic neuropathy, the physiology and pharmacology of rate-dependent depression (RDD) of the spinal H-reflex and the translational potential of using RDD as a biomarker of spinally mediated pain.Recent FindingsImpaired RDD occurs in animal models of diabetes and was also detected in diabetic patients with painful vs painless neuropathy.SummaryRDD status can be determined using standard neurophysiological equipment. Loss of RDD may provide a clinical biomarker of spinal disinhibition, thereby enabling a personalized medicine approach to selection of current treatment options and enrichment of future clinical trial populations. |
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