P0267CLINICAL MANIFESTATIONS, PREVALENCE AND PREDICTORS OF PERIPHERAL NEUROPATHY IN NON DIABETIC CHRONIC KIDNEY DISEASE PATIENTS. A CROSS SECTIONAL STUDY FROM TERTIARY CARE CENTRE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
D PRABHAKAR ◽  
Satya kumar Kothakota ◽  
Umashankar Mishra
Keyword(s):  
Peripheral Neuropathy ◽  
Nerve Conduction ◽  
Motor Nerve ◽  
Serum Magnesium ◽  
Sensory Nerve ◽  
Cross Sectional Study ◽  
Serum Phosphorus ◽  
Motor Neuropathy ◽  
Cross Sectional ◽  
Duration Of Disease

Abstract Background and Aims There is a progressive increase in the prevalence of chronic kidney disease (CKD). The impairment of functions of kidney secondary to CKD leads to uraemia. Peripheral neuropathy is one of the common manifestations of uraemia. The present study focuses on the prevalence, clinical manifestations and predictors of peripheral neuropathy in patients with non-diabetic CKD. Method This was a cross sectional study conducted in the Department of General Medicine, Maharaja Krishna Chandra Gajapathi Medical College and Hospital, Berhampur, Odisha, India from October 2015 to October 2017. Patients with serum creatinine >2 mg/dl, estimated glomerular filtration rate <60 ml/min (calculated by using Modification of Diet in Renal Disease equation), kidney size < 8.5cm on ultrasound abdomen were included in the study and patients with age less than 18 years, patients with diabetes mellitus and other recognizable risk factors for peripheral neuropathy (Alcoholism, Drugs, Connective tissue disorders, Sarcoidosis, Vasculitis, Thyroid dysfunction, HIV, Hansen’s disease, Paraneoplastic disease etc.) and patients on dialysis were excluded. Peripheral neuropathy was assessed by both clinical methods and nerve conduction studies (NCS). Reduced motor nerve conduction velocity, delayed distal latency, fall in the amplitude of compound muscle action potential on Motor Nerve Conduction Study (MNCS) and delay in the peak latencies, reduced sensory nerve action potential on Sensory Nerve Conduction study (SNCS) were considered as evidence for peripheral neuropathy. From upper limb, median nerve and ulnar nerve were selected for MNCS and SNCS. From lower limb, common peroneal and posterior tibial nerves were selected for MNCS and sural nerve was selected for SNCS. Results Total 109 patients were included in the study and 75(68.8%) were proved to have peripheral neuropathy. Majority of the affected patients were in 40 to 50 years age group (n=24;32%). Forty four of 75 (58.6%) were males and 31(41.33%) were females. Patients with both sensory and motor neuropathy were 35(32.1%), 26(23.9%) were affected with only sensory neuropathy, while 14(12.8%) were affected with only motor neuropathy. Patients with clinical neuropathy (patients who have clinical symptoms and signs of neuropathy and also evidence on NCS) were 35(46.6%) and with subclinical neuropathy (only evident on NCS) were 40(53.3%).On univariate analysis, age (p-0.015), hypertension (p-0.031), duration of disease (p<0.0001), serum creatinine (p<0.0001), eGFR (p<0.0001), serum uric acid (p<0.0001), serum parathyroid (p<0.0001), serum phosphorus (p<0.0001), serum calcium (p-0.0003), serum magnesium (p-0.0002) and serum potassium (p-0.0028) were significantly correlated with peripheral neuropathy however on logistic regression analysis, sex [OR-0.058;95%CI(0.004-0.831)], serum parathyroid hormone [OR-1.032;95%CI(2.708-6043.5)], serum phosphorus[OR3.881;95%CI(1.114-13.524)], serum magnesium [OR-127.28;95%CI(0.901-1.113)] and duration of CKD[OR1.109;95%CI(1.005-1.224)] were shown to be independent predictors. Conclusion Peripheral neuropathy is one of the frequent complications of uremia. Subclinical presentation is most common. Serum parathyroid, serum phosphorus, serum magnesium and duration of disease are independent predictors of uremia induced peripheral neuropathy

scholarly journals Normative Data for Median Nerve Conduction in Healthy Young Adults from Punjab, India

2017 ◽  
Vol 08 (S 01) ◽  
pp. S083-S088
Author(s):  
Manjinder Singh ◽  
Sharat Gupta ◽  
Kamal Dev Singh ◽  
Avnish Kumar
Keyword(s):  
Median Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Normative Data ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Standardized Protocol ◽  
Conduction Velocities

ABSTRACT Background: Nerve conduction studies (NCSs) are essential for diagnosing various kinds of focal and diffuse neuropathies. Due to the paucity of local NCS data, electrodiagnostic laboratories in Punjab rely on values from Western and other Indian studies. Aim: This study was conducted to provide normative data for median nerve conduction parameters (motor and sensory) in Punjabi populace. Materials and Methods: A cross-sectional study was done on 290 participants (150 males and 140 females), aged 17–21 years, as per standardized protocol. The data were analyzed separately for both genders using SPSS version 20. It consisted of distal latencies and conduction velocities of motor and sensory divisions of median nerve. Student's unpaired t-test was used for statistical analysis. Results: There was no effect of gender on any of the median nerve conduction parameters. Height and weight had nonsignificant negative and positive correlation, respectively (P > 0.05), with conduction velocity in both motor and sensory median nerves. For median motor nerve, the values of distal latency and conduction velocity in males were 2.9 ± 0.16 ms and 60.25 ± 2.99 m/s, respectively, whereas, in females, they were 2.6 ± 0.43 ms and 59.83 ± 2.82 m/s. Similarly, for median sensory nerve, the latency and velocity values in males were 2.8 ± 0.56 ms and 54.81 ± 3.70 m/s, whereas, in females, they were 2.4 ± 0.33 ms and 54.56 ± 3.65 m/s, respectively. Conclusion: The data in this study compared favorably with already existing data. It would help the local electrodiagnostic laboratories in assessing the median nerve abnormalities with greater accuracy in this population subset.

Non-invasive assessment of chemotherapy-induced peripheral neuropathy using neuromuscular ultrasound in breast cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23152-e23152
Author(s):  
Thomas Lycan ◽  
Alexandra Thomas ◽  
Fang-Chi Hsu ◽  
Michael Stephen Cartwright ◽  
Francis O Walker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Peripheral Neuropathy ◽  
Cancer Patients ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Breast Cancer Patients ◽  
Cross Sectional ◽  
Non Invasive ◽  
Intraepidermal Nerve Fiber Density ◽  
Care Assessment

e23152 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity for breast cancer patients that leads to early treatment discontinuation and worse outcomes. Neuromuscular ultrasound (NMUS) is a non-invasive assessment of peripheral nerves that has not been studied in taxane CIPN. Methods: This cross-sectional study enrolled breast cancer patients with subjective complaints of CIPN symptoms during or after taxane chemotherapy and compared nerve cross-sectional area (CSA) by NMUS with historical values in 120 healthy adults. Findings were correlated with self-reported symptom scale (EORTC-QLQ CIPN20, range 0-72, higher more severe); nerve conduction studies; and skin biopsies for intraepidermal nerve fiber density (IENF). Results: We evaluated 20 participants (mean 55.4 ± 10.5 yrs) with NMUS at 74 nerve sites after median 3.7 months (IQR 1.0-6.1) since last taxane (paclitaxel 10, docetaxel 8, nab-paclitaxel 2). Participants reported moderate-to-severe CIPN symptoms which were predominantly sensory (19.1 ±4.9, max 32) as opposed to motor (15.6 ±5.8, max 32) or autonomic (3.3 ±1.6, max 8). Sural sensory nerve CSA was 1.2 mm2 smaller than in historical controls (4.1 vs. 5.3 mm2, 2-sample t-test p = 0.005) and decreased with more days from last taxane (Spearman’s r -0.46, p = 0.04). Tibial motor nerve was not significantly different from controls (p = 0.35). Median nerve CSA was enlarged at the distal wrist crease entrapment site (12.5 vs 10.1, p = 0.03). Older age was associated with smaller sural CSA (r = -0.72, p < 0.001). When controlling for age and days from last taxane, for each 1mm2 decrease in sural CSA, distal IENF reduced by 2.1 nerve/mm2 (p = 0.04, R2 = 0.30). Conclusions: NMUS showed expected sensory predominant distal axonopathy in taxane CIPN. Evaluation of nerve CSA by non-invasive NMUS may serve as an objective point-of-care assessment to risk-stratify women with taxane CIPN prior to the development of debilitating symptoms. Clinical trial information: NCT03139435. [Table: see text]

scholarly journals Comparing the Diagnostic Accuracy of Simple Tests to Screen for Diabetic Peripheral Neuropathy: Protocol for a Cross-Sectional Study (Preprint)

2017 ◽  
Author(s):  
Kate Goddard ◽  
Prashanth Vas ◽  
Alistair Purves ◽  
Viktoria McMillan ◽  
Thomas Langford ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diagnostic Accuracy ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Velocity Measurement ◽  
Sural Nerve ◽  
Nerve Conduction Velocity ◽  
Cross Sectional Study ◽  
Cross Sectional

BACKGROUND Various tests are used to detect diabetic peripheral neuropathy by assessing sense perception in the feet. Tests vary in terms of time and resources required. Simple tests are those that can be conducted quickly and easily in primary care without laboratory equipment. There are some limitations to these simple tests, an example being the variable amplitude of the 128 Hz tuning fork. A new test, VibraTip (McCallan Medical, UK), might be a valuable alternative as it emits a consistent amplitude and may offer improved diagnostic accuracy. OBJECTIVE The aims of this study are to estimate the diagnostic accuracy of the VibraTip device for diabetic peripheral neuropathy against the reference standard of sural nerve conduction velocity measurement, and to assess whether the VibraTip offers superior diagnostic accuracy to other routine tests based on vibration or touch. METHODS The study will prospectively recruit adults with type 2 diabetes who are due to attend a routine follow-up clinic. A cross-sectional study design will be employed to assess the diagnostic accuracy of 5 standard index tests for peripheral neuropathy, including VibraTip. The reference test will be sural nerve conduction velocity measurement. RESULTS Funding is being sought to conduct this research. The outcomes assessed will be the diagnostic accuracy of the 5 index tests against sural nerve conduction velocity measurement, including sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic curves will be constructed and compared for each test. CONCLUSIONS This study will be the first within-study comparison of 5 simple tests for screening diabetic peripheral neuropathy and will address uncertainties in the potential benefits of using VibraTip in comparison with the other tests.

Peripheral Neuropathy (PN) in Multiple Myeloma (MM) Responder Patients during Maintenance Therapy with Low-Intermittent Doses of Thalidomide (TAL).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4829-4829
Author(s):  
Michele Bibas ◽  
Teresa Mignogna ◽  
Carla Gualandi ◽  
Claudio Geraldini ◽  
Nicoletta Villivà ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Motor Nerve ◽  
Cranial Nerves ◽  
Lower Limbs ◽  
High Rate ◽  
Motor Neuropathy ◽  
Sensory Motor

Abstract Novel agents for MM treatment such as TAL, bortezomib and lenalidomide while offering higher rates of response and CR have lead to new side-effects, in particular peripheral neuropathy that is dose limiting in more than 40% of patients. We have investigated the toxicity and the effectivness of low doses of TAL as maintenance treatment in MM in order to minimize this harmful side-effect. METHODS: From October 1999, 54 pts (20 males/34 females) with advanced/relapsed MM (IgG-K 28; IgG-λ 11; IgA-K 8; IgA-λ 4; λ 2; K 1) were treated with TAL at 100 mg/day; if well tolerated, the dose could be increased to a maximum of 400 mg/day. 2 pts stopped treatment and weren’t valuables for response. 11 pts (20%) progressed and 5 (9%) reached only a stable disease/minimal response. 27 pts (50%) responded to treatment with 22 (81%) PR (> 50% of reduction of MC) and 5 (9%) CR. Somnolence and stypsis were seen in all pts but were reversible and treated with symptomatic drugs. In 17 pts (11 F, 6 M, median age 70 yrs) we observed a symptomatic neuropathy and we decided to reduce dosage at 100 mg dayly only for 10 days at month as MT. All other causes of neuropathies were excluded. We prospectively performed longitudinal neurological and nerve conduction study before and during TAL treatment every 3 months. Nerve conduction studies included recording of sensory and motor nerve action potential from surale, radial, ulnar, common peroneal and tibial nerves. We considered -p SNAP and Cmap amplitude for each nerve. Electromyography examination was performed in distal muscles of the limbs including denervation potentials and pattern of activation. RESULTS: In 2 out of 17 we found a mild distal sensory-motor neuropathy before TAL treatment. One referred paresthesia in the 8 months before the diagnosis of MM; the other one was asymptomatic and the diagnosis of neuropathy was made on the basis of clinical and electrophysiological data. The 2 pts with PN before TAL treatment showed a mild clinical and electrophysiological progression of the disease after 6 months of therapy. The first clinical symptoms were painful paresthesias and numbness in all pts. At neurological examination we found a symmetric distal polyneuropathy of sensory type with major evidence at lower limbs. Hypopallestesia and hyporeflexia at lower limbs were detected in all pts; in 3 there was areflexia of achillei reflexes. In 2 pts we found hyperesthesia a stock and gloves distribution. No pts showed motor deficits or cranial nerves impairments. In 12 out of 17 pts an axonal sensory-motor neuropathy was found; in 3 pts a pure sensitive neuropathy, more evident at lower limbs, was detected. In the subsequent 58 months follow-up evaluation, no progression of clinical and electrophysiological findings was demonstrated in the 17 pts. Two of them, however, had to discontinue TAL therapy for severe painful paresthesias. After a median of 8 months’ follow-up, 10/17 pts are alive (2–58 months) and in remission (2 CR and 8 PR); 5 pts showed a disease progression after a median therapy of 5 months (2–23 months) and two pts, who had achieved a PR, had to stop therapy because of severe neurotoxicity after 8 months of treatment (5–12 months). CONCLUSIONS: The incidence of TAL neuropathy is high and problematic, but the lower cumulative doses of this schedule appear to be less toxic and manageble also mainteining a high rate of response (58%).

scholarly journals A Cross-sectional Study on Electrophysiological Evaluation of Neuropathy in Rheumatoid Arthritis

2021 ◽  
Author(s):  
Ravinder Singh ◽  
PV Sripadma ◽  
Vaibhav Mathur ◽  
Sujata Ganguly
Keyword(s):  
Rheumatoid Arthritis ◽  
Peripheral Neuropathy ◽  
Nerve Conduction ◽  
Disease Duration ◽  
Cross Sectional Study ◽  
Nerve Conduction Studies ◽  
Laboratory Evaluation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Subclinical Neuropathy

Introduction: Rheumatoid Arthritis (RA) is a chronic multisystem immune mediated disease. Rheumatoid associated neuropathy causes significant disability and adds to the economic burden. Aim: To assess clinical determinants of peripheral neuropathy (diagnosed electrophysiologically using nerve conduction studies) among patients with RA. Additionally, it was also aimed to study the various patterns of peripheral neuropathy in patients with RA. Materials and Methods: A cross-sectional study was conducted on 100 consecutive adult patients with RA between 01stFebruary, 2020 to 02nd January, 2021 at medicine and neurology departments of SMS Medical College and Hospital, Jaipur, Rajasthan, India. Inclusion and exclusion criteria were followed and eligible patients after appropriate laboratory evaluation underwent nerve conduction studies. Statistical analysis was performed using student’s unpaired t-test and Chi-square test for continuous and categorical variables respectively. Results: Mean age of the study population was 42.4±14.2 years with 88 females and 12 males. Mean duration of RA was 7.0±7.4 years. Nerve conduction studies detected neuropathy in 18 patients, of these only four patients were symptomatic with tingling, pins and needles sensation and numbness. Fourteen patients had subclinical neuropathy. Patients with neuropathy had significantly longer disease duration (p=0.0001), were older (p=0.014) with more joint deformities (p=0.0008). Conclusion: Subclinical neuropathy is not infrequent in RA patients. Those with advanced age, longer disease duration, higher Erythrocyte Sedimentation Rate (ESR), erosions and deformities should be assessed electrophysiologically for neuropathy.

scholarly journals Efficacy and Safety of the Injection of the Traditional Chinese Medicine Puerarin for the Treatment of Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of 53 Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Baocheng Xie ◽  
Qinghui Wang ◽  
Chenhui Zhou ◽  
Jiahuan Wu ◽  
Daohua Xu
Keyword(s):  
Peripheral Neuropathy ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Nerve Conduction Velocity ◽  
Motor Nerve ◽  
Meta Analysis ◽  
Sensory Nerve ◽  
Control Group ◽  
Efficacy And Safety

Objective. The injection of the traditional Chinese patent medicine puerarin has been widely used in the treatment of various diseases such as angina pectoris or ischemic stroke. We aim to evaluate the efficacy and safety of puerarin injection for the treatment of diabetic peripheral neuropathy (DPN). Methods. A systematic literature search was performed in seven medical databases from their inception until June 2017. 53 studies with RCTs, totaling 3284 patients, were included in this meta-analysis. The included studies were assessed by the Cochrane risk of bias and analyzed by Review Manager 5.3 software. Results. The meta-analysis showed that puerarin injection for the treatment of DPN was significantly better compared with the control group in terms of the total effective rate. The result showed that puerarin injection for the treatment of DPN can significantly increase the probability of sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of the median and peroneal nerves. Conclusions. This meta-analysis demonstrated that puerarin injection may be more effective and safe for the treatment of DPN. However, further and higher quality RCTs are required to prove its efficacy and provide meaningful evidence for clinical treatment due to the poor methodological quality.

scholarly journals Comparison of diagnostic value of nerve conduction studies and F-wave in patients with diabetic polyneuropathy: a retrospective cross-sectional study

2021 ◽  
Vol 43 (1) ◽  
pp. 69-75
Author(s):  
Zahra Gorji ◽  
Hamid Azadeh
Keyword(s):  
Motor Neurons ◽  
Nerve Conduction ◽  
Motor Nerve ◽  
Diabetic Polyneuropathy ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Nerve Conduction Studies ◽  
Entire Length ◽  
Cross Sectional ◽  
F Wave

Background: Diagnosis of polyneuropathy is typically made using sensory and motor nerve conduction studies (NCS). These tests include measurement of amplitude, velocity, and delay of sensory and motor waves. These waves cannot assess the entire length of the nerve, proximal parts in special. F-wave is the only test capable of measuring the entire length of the nerve. The purpose of this study was to evaluate the value of F-wave in patients with diabetic polyneuropathy. Methods: This is a retrospective study assessing the value of nerve conduction studies and F-wave in the diagnosis of 148 patients with diabetic polyneuropathy referred to hospitals under the supervision of the University of Iowa from October 1, 2016, to September 5, 2018. Motor neurons of median, ulnar, peroneal, and tibial nerves and sensory neurons of median, ulnar, and sural nerves were assessed using two techniques of NCS and F-wave. Then the data were compared. Results: The results of this study showed that F-wave in all of the evaluated nerves (median, ulnar, tibial and peroneal) detected abnormalities to more extents than routine NCS (P <0.001). When total neuronal abnormalities were accumulated, this value was 82٪ for NCS, while 99٪ for the F wave (P < 0.001). Conclusion: Findings of the current study showed that the assessment of delayed nerve conducting through F-waves can diagnose diabetic polyneuropathy to better extents as compared to NCS. Further evaluations are recommended.

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