Diabetic Neuropathies

Russell, James W.; Zilliox, Lindsay

doi:10.1212/01.con.0000455884.29545.d2

Cited by 80 publications

(120 citation statements)

References 26 publications

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“…The major neurologic complication of DM is neuropathy, and the lifetime incidence of diabetic polyneuropathy in patients with type 2 DM is approximately 50% (Dyck et al 1993(Dyck et al , 1995Edwards et al 2008). The most common type of diabetic polyneuropathy is distal symmetrical polyneuropathy, and it is predominantly axonal, involving longest myelinated and unmyelinated sensory axons (Russell and Zilliox 2014). Diabetic peripheral neuropathic pain occurs in 7.5% to 24% of all patients with DM with or without diabetic polyneuropathy and can be one of the most painful complications leading to decrease in life quality of DM patients (Zilliox and Russell 2011).…”

Section: Introductionmentioning

confidence: 99%

High Plasma Pentraxin 3 Levels in Diabetic Polyneuropathy Patients with Nociceptive Pain

Salcini

Arslan

Sünter

et al. 2016

Tohoku J. Exp. Med.

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Diabetic polyneuropathy is the most common neurologic complication of diabetes mellitus. Underlying mechanisms of diabetic polyneuropathy are related to various metabolic and inflammatory pathways. Pentraxin 3 (PTX3) is an acute phase protein that is produced locally at the inflammatory sites by several cell types. Thioredoxin binding protein 2 (TBP2) is a thioredoxin regulator involved in intracellular energy pathways and cell growth. We measured the plasma levels of PTX3 and TBP2 in type 2 diabetic patients (n = 27) with pain complaints and compared their levels with those of healthy age-and sex-matched subjects (n = 24). Moreover, the diabetic patients were divided into two groups using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale: patients with nociceptive pain that is caused by tissue damage and patients with neuropathic pain that is caused by nerve damage. Patients with LANSS scores of < 12 were considered to have nocicceptive pain (n = 15), while patients with LANSS scores of ≥ 12 were considered to have neuropathic pain (n = 12). We found that PTX3 levels were significantly higher in diabetic patients compared to controls (p = 0.03), but there was no significant difference in the TBP2 levels. Importantly, patients with nociceptive pain had significantly higher PTX3 levels compared to patients with neuropathic pain (p < 0.05). Thus, plasma PTX3 levels can be helpful for discrimination of nociceptive pain from neuropathic pain in diabetic patients. We propose that PTX3 may contribute to the onset of nociceptive pain.

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Section: Introductionmentioning

confidence: 99%

High Plasma Pentraxin 3 Levels in Diabetic Polyneuropathy Patients with Nociceptive Pain

Salcini

Arslan

Sünter

et al. 2016

Tohoku J. Exp. Med.

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“…Of the various types of diabetic neuropathy that exist, distal symmetric sensorimotor polyneuropathy (DSPN) is the most common, accounting for up to 75% of all diabetic-related neuropathies diagnosed in the US [2,3]. DSPN initially affects the smaller unmyelinated C fibers in the hands and feet, which controls light touch, pain and temperature sensation before progressing to the larger myelinated A delta fibers which convey vibratory sensation, proprioception and joint position [4,5]. Advanced DSPN leads to the loss of protective sensation, a precursor in the development of Charcot deformities of the foot and one of the components in the triad of diabetic foot ulceration (DFU) development, both of which are associated with increased morbidity, mortality and healthcare costs [3,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A Randomized, Sham-Controlled, Double-Blind Pilot Study of Pulsed Electromagnetic Field Therapy to Evaluate Small Fiber Nerve Growth and Function and Skin Perfusion in Subjects with Painful Peripheral Diabetic Neuropathy

Aj¹,

Rp²,

Muhlenfeld³

et al. 2017

J Diabetic Complications Med

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Abstract:Purpose: The objective of this study was to determine the potential efficacy and safety of dual energy pulsed electromagnetic field therapy (PEMF) on painful distal symmetric diabetic sensorimotor polyneuropathy (DSPN).Methodology: Subjects with Type 2 diabetes and painful DSPN were randomized to receive either an active or sham PEMF device. Objective measures of efficacy (skin biopsy, nerve conduction velocity (NCV) studies, dorsal and plantar foot skin perfusion pressure (SPP) were performed prior to and following 60-days of twice daily 30 minute treatments. Patient reported outcomes included perception of pain, concomitant medication use and adverse events.Major findings: Dorsal foot SPP improved with PEMF (n=11), change from baseline=19.6 mmHg) vs. sham (n=7, change=-17.4 mmHg), p=0.03. Trends in favor of PEMF vs sham were observed for medial nerve (n=4), planter nerve (n=4) and sural nerve (n=15) onset time and amplitude (p>0.05) other than medial planter onset time (p=0.04). Although change in pain scores were similar, compliance with device use was higher in the active group compared to the sham control. The series of tests and long-term use of PEMF was well-tolerated and feasible. No device related adverse effects were recorded.Principal conclusions: Twice daily PEMF therapy was feasible, well-tolerated, and associated with trends suggesting improved nerve function and microcirculation in patients with painful DSPN. Future, large randomized controlled trials are necessary to confirm these findings and evaluate the potential longer term benefits on symptoms and pathology of DSPN.Keywords: Diabetes; Nerve conduction velocity; Peripheral neuropathy; Pulsed electromagnetic field; Skin biopsy; Skin perfusion pressure Key MessagesPainful diabetic neuropathy affects the majority of patients with diabetes during their lifetime. The presence of diabetic neuropathy increases the potential for diabetes-related lower extremity complications.The aim of this randomized, sham-controlled trial was to determine the feasibility and effects of 60 days of treatment with PEMF therapy on skin perfusion, nerve growth and function as well as pain perception, compliance and safety in subjects with painful diabetic neuropathy. Nineteen patients (12 active; 7 sham) participated in this study.This pilot study demonstrated feasibility of use and trends in favor of PEMF in nerve function and skin perfusion of the dorsal foot. Although a reduction in average pain intensity score was not observed, subjects in the active group were relatively more compliant with device use. No device adverse effects were reported.

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“…In sensory neuropathy the lack of protective sensation makes the foot vulnerable to unattended minor injuries caused by an excess of pressure and mechanical or thermal injury. At present, an underdiagnosis of DPN is a fundamental issue and impedes the prevention of neuropathy-related sequels [4]. Studies of nerve conduction tests performed at the time of diabetes diagnosis demonstrate that in many cases neuropathy is already present in patients in subclinical forms.…”

mentioning

confidence: 99%

“…According to opinion of J.W. Russell just small fiber neuropathy is characterized by superficial burning pain in the feet caused by preferential involvement of the small unmyelinated nerve fibers that mediate pain, temperature sensation and autonomic functions [4]. Small fiber neuropathies may not have any abnormalities on nerve conduction studies and could be further evaluated only with skin biopsy.…”

mentioning

confidence: 99%

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The Place of Sensory Neuropathy in the Pathogenesis of Critical Limb Ischemia in Diabetic Patients

Nechytaylo¹,

Konovchuk²

2017

Buk. Med. Herald

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Abstract. In the article peculiarities of sensory neuropathy in 47 diabetic patients with and without surgical complications of the lower extremities have been studied. The simple clinical screening technique for diabetic neuropathy which included four tests: tactile and pain sensation, vibration perception, presence and level of Achilles reflex was used. Manifestations of neuropathy included the most common symptoms such as numbness, prickling, aching, decreased thermal sensation and burning. Approximately 75 % of all study subjects had sensory neuropathy (47,1 % patients without surgical complications and 88,9 % patients with complications in the lower extremities). The pathogenesis of critical limb ischemia in general is complex and includes impaired glycemic control, microcirculation deterioration and neuropathy. The study established that sensory neuropathy is one of the main causative factors in critical limb ischemia and development of diabetic foot syndrome.Key words: diabetes, sensory neuropathy, angiopathy, diabetic foot syndrome.The prevalence of diabetes mellitus is rising all over the world. Diabetes has a lot of different complications affecting the heart, kidneys, eyes, nerves and feet [1,2]. One of the main causes of diabetic complications is a decrease of blood supply as a result of vascular pathology on both levels -macroand microcirculation. Complications of feet are the most frequent problems of diabetes and key contributors to the medical and financial implicationsas nearly half of all hospitalizations due to diabetes are the feet complications [2,3]. The diabetic foot syndrome (DFS) is defined, according to the WHO, as "ulceration of the foot associated with neuropathy and different grades of ischemia and infection" [3]. DFS represents serious long-term consequences of diabetes leading to disability. The complications of foot ulcers are the major cause of hospitalization and amputation in diabetic patients and lead to significant health care costs as evidenced by the fact that 20-40% of health care resources for diabetes are spent on DFS [1,2].It has been recognized that the leading causes of feet ulcerations are microcirculation changes and diabetic neuropathy. Diabetic peripheral neuropathy (DPN) is an impairment of normal activities of the nerves throughout the body and which could alter autonomic, motor and sensory functions [7]. The lifetime incidence of neuropathy is approximately 45 % for patients with type 2 diabetes. According to the multicenter study, the most frequent component in the causal sequence to ulceration in diabetic patients was sensory neuropathy. In sensory neuropathy the lack of protective sensation makes the foot vulnerable to unattended minor injuries caused by an excess of pressure and mechanical or thermal injury. At present, an underdiagnosis of DPN is a fundamental issue and impedes the prevention of neuropathy-related sequels [4]. Studies of nerve conduction tests performed at the time of diabetes diagnosis demonstrate that in many cases neuropathy is already ...

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Diabetic Neuropathies

Cited by 80 publications

References 26 publications

High Plasma Pentraxin 3 Levels in Diabetic Polyneuropathy Patients with Nociceptive Pain

High Plasma Pentraxin 3 Levels in Diabetic Polyneuropathy Patients with Nociceptive Pain

A Randomized, Sham-Controlled, Double-Blind Pilot Study of Pulsed Electromagnetic Field Therapy to Evaluate Small Fiber Nerve Growth and Function and Skin Perfusion in Subjects with Painful Peripheral Diabetic Neuropathy

The Place of Sensory Neuropathy in the Pathogenesis of Critical Limb Ischemia in Diabetic Patients

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