Electrophysiologic measures of diabetic neuropathy: Mechanism and meaning

Arezzo, Joseph C.; Zotova, Elena

doi:10.1016/s0074-7742(02)50079-9

Cited by 59 publications

(51 citation statements)

References 84 publications

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“…We have shown that neuropathy progressed electrophysiologically at a rate comparable with other studies in patients with type 1 [28] and type 2 diabetes [29]. Alterations in nerve conduction velocity and amplitude have been considered to reflect underlying structural pathology of the myelinated fibres [30]. Such pathology includes demyelination and a significant loss of myelinated fibres due to axonal degeneration [9,10].…”

Section: Discussionsupporting

confidence: 78%

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

et al. 2005

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Aims/hypothesis: The early pathological features of human diabetic neuropathy are not clearly defined. Therefore we quantified nerve fibre and microvascular pathology in sural nerve biopsies from diabetic patients with minimal neuropathy. Methods: Twelve diabetic patients underwent detailed assessment of neuropathy and fascicular sural nerve biopsy at baseline, with repeat assessment of neuropathy 8.7±0.6 years later. Results: At baseline, neuropathic symptoms, neurological deficits, quantitative sensory testing, cardiac autonomic function and peripheral nerve electrophysiology showed minimal abnormality, which deteriorated at follow-up. Myelinated fibre density, fibre and axonal area, and g-ratio were normal but teased fibre studies showed paranodal abnormalities (p<0.001), segmental demyelination (p<0.01) and remyelination (p<0.01) without axonal degeneration. Unassociated Schwann cell profile density (p<0.04) and unmyelinated axon density (p<0.001) were increased and axon diameter was decreased (p<0.007). Endoneurial capillaries demonstrated basement membrane thickening (p<0.006), endothelial cell hyperplasia (p<0.004) and a reduction in luminal area (p<0.007). Conclusions/interpretation: The early pathological features of human diabetic neuropathy include an abnormality of the myelinated fibre Schwann cell and unmyelinated fibre degeneration with regeneration. These changes are accompanied by a significant endoneurial microangiopathy.

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Section: Discussionsupporting

confidence: 78%

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

et al. 2005

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“…The earliest reports of altered NCV in patients without clinical symptoms or signs of DPN date back for more than 40 years and have been confirmed in recent studies (204,205).…”

Section: Specific Electrophysiologic Measures In Dpnmentioning

confidence: 81%

“…• Changes in NCV can reflect underlying structural pathology in large-diameter axons, including atrophy, demyelination, and loss of fiber density (205).…”

Section: Specific Electrophysiologic Measures In Dpnmentioning

confidence: 99%

Diabetic Somatic Neuropathies

et al. 2004

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“…Lower NCV was not related to fast walking speed in the InCHIANTI Study, an Italian cohort aged Ն60 years, although it was related to longer 400-m walk time and lower summary performance score (16). Low CMAP is related to nerve axonal damage and low NCV is related to nerve demyelination (17). Interestingly, the InCHIANTI Study showed that lower peroneal CMAP, but not NCV, was independently associated with lower calf muscle density (18).…”

Section: Statistical Analysesmentioning

confidence: 86%

The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black Adults

Strotmeyer

Rekeneire²,

Schwartz³

et al. 2008

Diabetes Care

113

125

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FOR THE HEALTH ABC STUDYOBJECTIVE -Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance.RESEARCH DESIGN AND METHODS -Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n ϭ 2,364; 48% men; 38% black; aged 73-82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10-and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. The Health ABC lower-extremity performance battery was a supplemented version of the Established Populations for the Epidemiologic Studies of the Elderly battery (chair stands, standing balance, and 6-m walk), adding increased stand duration, single foot stand, and narrow walk.RESULTS -Diabetic participants had fewer chair stands (0.34 vs. 0.36 stands/s), shorter standing balance time (0.69 vs. 0.75 ratio), slower usual walking speed (1.11 vs. 1.14 m/s), slower narrow walking speed (0.80 vs. 0.90 m/s), and lower performance battery score (6.43 vs. 6.93) (all P Ͻ 0.05). Peripheral nerve function was associated with each physical performance measure independently. After addition of peripheral nerve function in fully adjusted models, diabetes remained significantly related to a lower performance battery score and slower narrow walking speed but not to chair stands, standing balance, or usual walking speed.CONCLUSIONS -Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults.

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Electrophysiologic measures of diabetic neuropathy: Mechanism and meaning

Cited by 59 publications

References 84 publications

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

Diabetic Somatic Neuropathies

The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black Adults

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