Clinical Approach to Peripheral Neuropathy

Alport, Adina R.; Sander, Howard W.

doi:10.1212/01.con.0000411546.13207.b1

Cited by 14 publications

(9 citation statements)

References 35 publications

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“…Steroid injections alleviate early asymptomatic neuropathy, but cannot treat advanced cases, 2 while surgical interventions for nerve release have proven to be very helpful in preclinical and clinical scenarios of severe peripheral neuropathy. 3 In a radiation-induced peripheral neuropathy model using rats, a chitosan nerve scaffold successfully improved functional nerve recovery and restored nerve structures as evaluated by magnetic resonance imaging. 4 Grooved silica conduits have been used for repairing short sciatic nerve gaps in rats.…”

Section: Introductionmentioning

confidence: 99%

(‐)‐Epigallocatechin gallate‐loaded polycaprolactone scaffolds fabricated using a 3D integrated moulding method alleviate immune stress and induce neurogenesis

et al. 2019

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Objectives In peripheral neuropathy, the underlying mechanisms of nerve and muscle degeneration include chronic inflammation and oxidative stress in fibrotic tissues. (‐)‐Epigallocatechin gallate (EGCG) is a major, active component in green tea and may scavenge free radical oxygen and attenuate inflammation. Conservative treatments such as steroid injection only deal with early, asymptomatic, peripheral neuropathy. In contrast, neurolysis and nerve conduit implantation work effectively for treating advanced stages. Materials and methods An EGCG‐loaded polycaprolactone (PCL) porous scaffold was fabricated using an integrated moulding method. We evaluated proliferative, oxidative and inflammatory activity of rat Schwann cells (RSCs) and rat skeletal muscle cells (RSMCs) cultured on different scaffolds in vitro. In a rat radiation injury model, we assessed the morphological, electrophysiological and functional performance of regenerated sciatic nerves and gastrocnemius muscles, as well as oxidative stress and inflammation state. Results RSCs and RSMCs exhibited higher proliferative, anti‐oxidant and anti‐inflammatory states in an EGCG/PCL scaffold. In vivo studies showed improved nerve and muscle recovery in the EGCG/PCL group, with increased nerve myelination and muscle fibre proliferation and reduced macrophage infiltration, lipid peroxidation, inflammation and oxidative stress indicators. Conclusions The EGCG‐modified PCL porous nerve scaffold alleviates cellular oxidative stress and repairs peripheral nerve and muscle structure in rats. It attenuates oxidative stress and inflammation in vivo and may provide further insights into peripheral nerve repair in the future.

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Section: Introductionmentioning

confidence: 99%

(‐)‐Epigallocatechin gallate‐loaded polycaprolactone scaffolds fabricated using a 3D integrated moulding method alleviate immune stress and induce neurogenesis

et al. 2019

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“… 4 Sudomotor function is affected by the reduced C-fibers density of active sweat glands and/or microcirculatory disorders, which may be associated with chronic pain and/or tingling in the toes. 5 The main cause of sudomotor dysfunction is diabetes. However, it has been found in different diseases (ie, vitamin deficiency, Parkinson’s disease, HIV/AIDS, amyotrophic lateral sclerosis, hypothyroidism, kidney and liver diseases, alcoholism, Alzheimer’s disease, and Guillain–Barré syndrome) and/or medication side effects, such as in cancer treatment, antihypertensive treatment (in particular, beta and alpha blockers, and calcium antagonists), and metformin treatment.…”

Section: Introductionmentioning

confidence: 99%

Detection of neuropathy using a sudomotor test in type 2 diabetes

Gandhi¹,

Rao

2015

DNND

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correspondence: Pratiksha g gandhi a 103/104, Prathamesh Building, raghuvanshi Mill compound, senapati Bapat Marg, lower Parel (W), Mumbai -400 013, india Tel +91 902 253 0033 Fax +1 909 450 9625 email chairpersonipc@yahoo.co.in Background:The sudomotor test is used to evaluate the postganglionic cholinergic sympathetic nervous system. The aim of this study was to evaluate the efficacy of a sudomotor testing device to detect peripheral distal neuropathy (PDN) and cardiac autonomic neuropathy (CAN) in patients with type 2 diabetes. Materials and methods: A total of 133 type 2 diabetic patients were included in the study. The patients underwent examination at the IPC Heart Care Centre (Mumbai, India) in order to assess the diabetic neuropathy symptoms (DNS) score, using a questionnaire, and the CAN score, using heart rate variability analysis and Ewing tests. In addition, patients were given a sudomotor test using the SudoPath™ system. The diagnosis of PDN is based on the DNS score. A DNS score of 1 or higher is defined as a positive result for PDN. According to the DNS score, the patients were separated into two groups: Group 1 comprised 35 patients (21 males), with the mean age of 66 years (standard deviation [SD] =12.1), who had a DNS score $1. Group 2 comprised 98 patients (65 males), with the mean age of 56 years (SD =9.6), who had a DNS score =0. The SudoPath system is a galvanic skin response device that uses the quantitative sudomotor axon reflex approach to assess for small and unmyelinated fiber neuropathy. The system provides a sudomotor response (SMR) score based on these three measured sudomotor parameters. A statistical analysis was performed using the analysis of variance to compare mean differences between the groups as well as receiver operating characteristic (ROC) curves, to determine the specificity and sensitivity of SMR score to detect PDN, comparing the diabetic groups 1 and 2, and the coefficient of correlation between the CAN score and the SMR score in all the subjects included in the study. Results: When comparing the diabetes groups 1 and 2, the SMR Score had a sensitivity of 91.4% and specificity of 79.1% (cutoff number .3) to detect PDN (P=0.0001). Area under the ROC curve (AUC) =0.893. A correlation analysis of the CAN score and SMR score returned a coefficient of correlation r=0.68 (P,0.0001). Conclusion: The SudoPath system is easy to use, operator-independent, and fast (3-minute testing time). This study shows that the device will be useful to assess the susceptibility of type 2 diabetes patients in developing PDN complications.

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“…For subclinical polyneuropathy, the abovementioned signs had to be present in the absence of symptoms. All examinations including criteria for pathology are presented in the Supplement (see Supplement Table S2) [40][41][42][43][44][45][46]. Finally, the hands were examined for the presence of a positive tabletop sign or prayer sign as a manifestation of stiff hand syndrome (see Supplement Table S3) [47][48][49].…”

Section: Physical Examinationmentioning

confidence: 99%

What Is the Diagnosis in Patients with Type 2 Diabetes Who Have a Painful Shoulder? Results from a Prospective Cross-Sectional Study

Alabdali

Jaeken

Alfen

et al. 2020

JCM

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Background: Patients with diabetes mellitus have higher risk of developing shoulder pathology. However, only adhesive capsulitis is addressed in shoulder pain guidelines as a disorder associated with diabetes. Yet, patients with diabetes are at risk of having several other shoulder disorders, including focal neuropathy. Our aim was to quantify the presence of shoulder disorders using physical examination and ultrasound imaging in patients with type 2 diabetes (T2DM) suffering from shoulder pain in general practice. Methods: In this prospective cross-sectional study, patients with T2DM who had had a painful shoulder for at least four weeks were included. Patients filled out a questionnaire and underwent a physical examination of the shoulders and feet and ultrasound imaging of the shoulder. Results: A total of 66 patients were included, of whom 40.9% (n = 27) had bilateral complaints resulting in 93 symptomatic shoulders. Subacromial pain syndrome was most frequently diagnosed by physical examination (66.6%, 95% CI 51.6–72.0%; p < 0.0001), while ultrasound imaging showed that subacromial disorders were statistically significantly the most prevalent (90.3%, 95% CI 81.9–95.2%). Only two patients (3%) were diagnosed with neuropathic shoulder pain. Conclusion: When choosing treatment, general practitioners should be aware that in patients with T2DM the subacromial region is most frequently affected.

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Clinical Approach to Peripheral Neuropathy

Cited by 14 publications

References 35 publications

(‐)‐Epigallocatechin gallate‐loaded polycaprolactone scaffolds fabricated using a 3D integrated moulding method alleviate immune stress and induce neurogenesis

(‐)‐Epigallocatechin gallate‐loaded polycaprolactone scaffolds fabricated using a 3D integrated moulding method alleviate immune stress and induce neurogenesis

Detection of neuropathy using a sudomotor test in type 2 diabetes

What Is the Diagnosis in Patients with Type 2 Diabetes Who Have a Painful Shoulder? Results from a Prospective Cross-Sectional Study

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