Electrodiagnostic testing in diabetic neuropathy: Which limb?

Rota, Eugenia; Cocito, Dario

doi:10.1016/j.diabres.2015.07.009

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Approximately 50% of patients with LL-N had concomitant UL-N. We used QST to assess neuropathic deficits in our study cohort. Although EPT is commonly used to detect DSPN [9,11,34], this remains limited by cost and time consumption. Moreover, nerve conduction studies cannot detect small fiber neuropathy [35].…”

Section: Discussionmentioning

confidence: 99%

Diabetic neuropathy is a generalized phenomenon with impact on hand functional performance and quality of life

Κender

Groener

Jende

et al. 2022

Euro J of Neurology

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Section: Discussionmentioning

confidence: 99%

Diabetic neuropathy is a generalized phenomenon with impact on hand functional performance and quality of life

Κender

Groener

Jende

et al. 2022

Euro J of Neurology

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“…Conventional standpoint suggested that the symptoms of DPN mostly manifest on the lower limbs 2 , 3 , while a growing number of studies highlighted the effects of DPN on the upper-limbs 1 , 4 . Approximately 58% to 82% and 37% to 69% of patients with DM suffer from subclinical neuropathy on their median nerves and ulnar nerves, respectively, exhibiting confined digit range of motion, reduced grip and pinch strength, decreased tactile sensitivity or slower nerve conduction velocity 5 – 9 .…”

Section: Introductionmentioning

confidence: 99%

Dynamical Coordination of Hand Intrinsic Muscles for Precision Grip in Diabetes Mellitus

Wei

Cheng

et al. 2018

Sci Rep

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This study investigated the effects of diabetes mellitus (DM) on dynamical coordination of hand intrinsic muscles during precision grip. Precision grip was tested using a custom designed apparatus with stable and unstable loads, during which the surface electromyographic (sEMG) signals of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) were recorded simultaneously. Recurrence quantification analysis (RQA) was applied to quantify the dynamical structure of sEMG signals of the APB and FDI; and cross recurrence quantification analysis (CRQA) was used to assess the intermuscular coupling between the two intrinsic muscles. This study revealed that the DM altered the dynamical structure of muscle activation for the FDI and the dynamical intermuscular coordination between the APB and FDI during precision grip. A reinforced feedforward mechanism that compensates the loss of sensory feedbacks in DM may be responsible for the stronger intermuscular coupling between the APB and FDI muscles. Sensory deficits in DM remarkably decreased the capacity of online motor adjustment based on sensory feedback, rendering a lower adaptability to the uncertainty of environment. This study shed light on inherent dynamical properties underlying the intrinsic muscle activation and intermuscular coordination for precision grip and the effects of DM on hand sensorimotor function.Diabetes mellitus (DM) is a metabolic disorder characterized by chronic high blood glucose levels. A primary complication of DM is diabetic peripheral neuropathy (DPN), which has a prevalence from 30% to 50% of the patients with DM 1 . Conventional standpoint suggested that the symptoms of DPN mostly manifest on the lower limbs 2,3 , while a growing number of studies highlighted the effects of DPN on the upper-limbs 1,4 . Approximately 58% to 82% and 37% to 69% of patients with DM suffer from subclinical neuropathy on their median nerves and ulnar nerves, respectively, exhibiting confined digit range of motion, reduced grip and pinch strength, decreased tactile sensitivity or slower nerve conduction velocity [5][6][7][8][9] .Quantitative evaluation of the hand sensorimotor function provides a useful tool for clinical diagnosis of DPN 10 . Accumulating evidence suggests that the effects of DM on hand sensorimotor function could be observed from precision grip -a fundamental grasping manner with opposable thumb and index finger. For example, the patients with DM showed reduced force structural complexity (lower approximate entropy values) than healthy subjects when producing grip force upon a spatially fixed apparatus within 15-50% maximum voluntary contraction (MVC) 11 . Compared to the healthy subjects, the DM patients showed higher force ratio in execution of grip-to-lift task; and the force ratio could serve as indicator to DPN whose sensitivity was 85% and specificity was 51% 10 . The debilitated grip force in DM is associated with reduced tactile sensitivity, blurred afferent inputs and reduced efferent conductivity [10][11][12][13] , and i...

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“…The majority of studies on diabetes consider peripheral sensorimotor neuropathy of the lower extremities, and only a few, mostly sensory and motor nerve conduction velocity studies have examined sensory function in the hands (57)(58)(59)(60)(61).…”

Section: Discussionmentioning

confidence: 99%

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

et al. 2021

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IntroductionThe prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care.Patients and MethodsTwenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests.ResultsT1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01).ConclusionIn this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.

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Electrodiagnostic testing in diabetic neuropathy: Which limb?

Cited by 6 publications

References 10 publications

Diabetic neuropathy is a generalized phenomenon with impact on hand functional performance and quality of life

Diabetic neuropathy is a generalized phenomenon with impact on hand functional performance and quality of life

Dynamical Coordination of Hand Intrinsic Muscles for Precision Grip in Diabetes Mellitus

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

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