Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases

Abstract

Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.

Electrodiagnostic testing in diabetic neuropathy: Which limb?

“…Similarly, in a recent study [8] on a larger sample of 500 patients affected by diabetic neuropathies at an early stage, the SNAP amplitude turned out to be the most sensitive neuropathy marker, in agreement with previous findings by Bi et al [9]. The highest rate of abnormality was observed in the median nerve SNAP (42.3%), followed by alterations in that of the ulnar (36.6%) [8].…”

“…Although we are aware that such an opinion about the particular usefulness of upper limb nerve conduction studies in DM is currently supported by limited evidence [3,4,7,8], we do feel that this is something that should be taken into account carefully when the nerve conduction criteria for diagnosis of diabetic neuropathies is being assessed''. As the aforementioned criterion of 1 abnormal attributes in 2 nerves has been reported to be the most useful to obtain a good sensitivity and specificity [2], we propose that the median and ulnar nerve, in their motor and sensitive component, be the two target nerves for an early diagnosis of diabetic neuropathies.…”

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

“…Confirming Zhang et al [46] and Zhong et al [38], Rota et al [47] report NCV changes typical of entrapment neuropathy to be present in 70% of a consecutive series of patients referred to an Italian diabetology unit.…”

Diabetic Neuropathy Evaluated by a Novel Device: Sural Nerve Conduction Is Associated with Glycemic Control and Ankle–Brachial Pressure Index in Japanese Patients with Diabetes

“…However, the heterogeneity of the method for evaluating DN may be the primary barrier to clarify the effect of glycemic control on DN progression ( 14 ). In patients with DN, nerve conduction studies revealed abnormalities, such as reduced amplitude, slowed conductive velocity, or prolonged latent phase ( 23 ). Distal, symmetrical, length-dependent sensorimotor polyneuropathy, which is the most common pattern of DN, is associated with progressive distal axonopathy ( 24 ).…”