scholarly journals MR Micro-Neurography and a Segmentation Protocol Applied to Diabetic Neuropathy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
P. F. Felisaz ◽  
G. Maugeri ◽  
V. Busi ◽  
R. Vitale ◽  
F. Balducci ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Healthy Volunteers ◽  
Diabetic Peripheral Neuropathy ◽  
Structural Changes ◽  
Ultrastructural Changes ◽  
Diabetic Patients ◽  
Tissue Segmentation ◽  
Cross Sectional ◽  
Imaging Protocol

The aim of this study was to assess with MRI morphometric ultrastructural changes in nerves affected by diabetic peripheral neuropathy (DPN). We used an MR micro-neurography imaging protocol and a semiautomated technique of tissue segmentation to visualize and measure the volume of internal nerve components, such as the epineurium and nerve fascicles. The tibial nerves of 16 patients affected by DPN and of 15 healthy volunteers were imaged. Nerves volume (NV), fascicles volume (FV), fascicles to nerve ratio (FNR), and nerves cross-sectional areas (CSA) were obtained. In patients with DPN the NV was increased and the FNR was decreased, as a result of an increase of the epineurium (FNR in diabetic neuropathy 0,665; in controls 0,699, p=0,040). CSA was increased in subjects with DPN (12,84 mm2 versus 10,22 mm2, p=0,003). The FV was increased in patients with moderate to severe DPN. We have demonstrated structural changes occurring in nerves affected by DPN, which otherwise are assessable only with an invasive biopsy. MR micro-neurography appears to be suitable for the study of microscopic changes in tibial nerves of diabetic patients.

Peripheral Vascular and Sweat-Gland Reflexes in Diabetic Neuropathy

1973 ◽  
Vol 45 (3) ◽  
pp. 281-289 ◽  
Author(s):  
H. K. Goadby ◽  
C. B. B. Downman
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Diabetic Patients ◽  
Peripheral Vascular ◽  
Vasomotor System ◽  
Sympathetic Function ◽  
Vasomotor Reflexes ◽  
Significant Impairment ◽  
Electrodermal Responses

1. In two groups of diabetic patients, one with and one without signs of peripheral neuropathy, reflex short vasoconstrictor responses to such stimuli as a cough, a sharp inspiration or sudden noise were recorded from a finger and both big toes by volume plethysmography. Simultaneous electrodermal responses to the same stimuli were recorded from a hand and a foot. Vasodilator responses to body warming were also recorded. 2. Significant impairment of these vasomotor reflexes in diabetic patients with neuropathy indicates that the sympathetic vasomotor system can be involved in diabetic peripheral neuropathy. 3. Loss of the reflex electrodermal responses is also evidence of impairment of another sympathetic function in such patients. 4. Because stimuli vary in their effectiveness in causing responses in both groups of subjects, it is suggested that changes of central nervous conductivity also occur in diabetes.

Flow Motion in Peripheral Diabetic Neuropathy

1995 ◽  
Vol 88 (2) ◽  
pp. 191-196 ◽  
Author(s):  
S. J. Benbow ◽  
D. W. Pryce ◽  
K. Noblett ◽  
I. A. MacFarlane ◽  
P. S. Friedmann ◽  
...  
Keyword(s):  
Blood Flow ◽  
Peripheral Neuropathy ◽  
Confidence Interval ◽  
Diabetic Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Relative Amplitude ◽  
Diabetic Patients ◽  
Flow Motion ◽  
Hands And Feet ◽  
Motion Amplitude

1. Flow motion is the cyclical variation in blood flow owing to the rhythmical opening and closing of arterioles. Previous studies have suggested that cutaneous flow motion may be altered in diabetic neuropathy but have not been consistent in their findings. 2. In order to assess the effect of diabetic peripheral neuropathy on flow motion, we have examined the frequency and amplitude of flow motion in 12 patients with diabetic peripheral neuropathy, 10 age-matched diabetic patients without peripheral neuropathy and 10 age-matched non-diabetic controls. 3. Peripheral neuropathy was diagnosed by a history of foot ulceration or chronic painful neuropathy, clinical examination and abnormal peroneal nerve conduction velocities. Blood flow, using laser Doppler flowmetry, was measured at four sites on the dorsum of both hands and feet. Flow motion was analysed using fast Fourier transform analysis, between 0.05 and 0.2 Hz, and displayed on a power spectral density graph. Predominant frequency and relative amplitude of flow motion were calculated. 4. Relative amplitude and frequency of flow motion were similar in the hands of all three groups, as was the frequency in the feet of the three groups. Relative amplitude was significantly smaller in the feet of diabetic patients with neuropathy (median 7.2%, 95% confidence interval 4.9–9.4%) than in diabetic patients without neuropathy (median 13.5%, 95% confidence interval 6.3–21.5%, P < 0.02) or in non-diabetic control subjects (median 10.3%, 95% confidence interval 6.9–27.4%, P < 0.02). 5. Flow motion amplitude is reduced in diabetic peripheral neuropathy. The control of flow motion amplitude appears to be at least partly under neurological control.

scholarly journals Corneal Confocal Microscopy – A Novel, Noninvasive Method to Assess Diabetic Peripheral Neuropathy

2014 ◽  
Vol 21 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Georgeta Inceu ◽  
Horea Demea ◽  
Ioan Andrei Veresiu
Keyword(s):  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Diabetic Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Diabetic Patients ◽  
Noninvasive Method ◽  
Anthropometric Parameters ◽  
Perception Threshold ◽  
Peripheral Diabetic Neuropathy ◽  
Corneal Confocal Microscopy

AbstractBackground and aims. This article aims to compare corneal confocal microscopy (CCM) with acknowledged tests of diabetic peripheral neuropathy (DPN), to assess corneal nerve morphology using CCM in diabetic patients, and to underline possible correlations between clinical and biological parameters, diabetes duration and DPN severity. Material and methods. A total of 90 patients with type 2 diabetes were included in the study for whom we measured anthropometric parameters and we performed laboratory measurements (tests). The patients were assessed for diabetic peripheral neuropathy using Semmes-Weinstein Monofilament Testing (SWMT), Rapid-Current Perception Threshold (R-CPT) measurements using the Neurometer®, and CCM. We stratified the patients according to DPN severity, based on four parameters extracted after image analysis. Results. A higher percentage of patients were diagnosed with DPN using CCM (88.8%), compared with SWMT and R-CPT measurement (17.8% and 40% respectively). The incidence of DPN detected with CCM was considerable in patients with normal protective sensation and with normal R-CPT values. Conclusions. Our study showed that corneal confocal microscopy is a useful noninvasive method for diabetic neuropathy assessement in early stages. It was proven to directly quantify small fiber pathology, and to stratify neuropathic severity, and therefore can be used as a new, reliable tool in the diagnosis, clinical evaluation, and follow-up of peripheral diabetic neuropathy.

scholarly journals USEFULNESS OF ADDING BIOTHESIOMETRY TO CLINICAL ASSESSMENT PROTOCOLS IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY AFFECTING LOWER LIMBS

2020 ◽  
pp. 49-52
Author(s):  
Padma Kumar G ◽  
Selvan P ◽  
George Zachariah ◽  
S Abdul Gafoor
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Lower Limbs ◽  
Perception Threshold ◽  
Cross Sectional ◽  
Major Health Problem ◽  
Patients With Diabetes

BACKGROUND Diabetes Mellitus is a major health problem of which Diabetic Peripheral Neuropathy (DPN) is an important complication resulting in ulceration and amputation. There are a number of bedside tests and evaluation which has been suggested for early diagnosis of DPN. This study aims to evaluate the usefulness of Biothesiometry when combined along with Diabetic Neuropathy Symptom Score (DNS) and Diabetic Neuropathy Examination Score (DNE) as compared against Nerve Conduction Study (NCS). NCS is considered as the gold standard in diagnosis of DPN. METHODS This is a cross-sectional study which was done in the Department of Physical Medicine & Rehabilitation, Government Medical College, Thiruvananthapuram, Kerala which is a tertiary level referral center. The study was done in a one-year period between January 2018 and January 2019 in patients with diabetes who satisfied the inclusion criteria. Patients were first evaluated with a Performa which included DNS and DNE scoring and compared with NCS parameters. Vibration Perception Threshold (VPT) was assessed with a Biothesiometer and the combined results were compared with Nerve Conduction Study (NCS). The values obtained were entered in excel sheet and statistically evaluated. RESULTS 127 patients with Diabetes were recruited into the study out of which 49 were males and 78 were females with a mean age of 57.2 +/- 9.9 years. When patients who were clinically positive for DPN on evaluation with DNS and DNE were compared with NCS parameters, it was shown that there was a sensitivity of 96.2 % and specificity of 38.1% and when VPT measurement using Biothesiometer was added to the clinical evaluation the sensitivity was 100% with a negative predictive value of 100% and specificity of 23.8%. This study has shown that all of the patients who tested negative were true negatives. CONCLUSION This study concluded that addition of Biothesiometry to the combination of DNS, DNE for the evaluation of DPN is as good as NCS evaluation. Hence this combination will be useful in rural settings, where accessibility to expensive Electrodiagnostic machine is limited.

scholarly journals The Correlation between Malondialdehyde and Nerve Growth Factor Serum Level with Diabetic Peripheral Neuropathy Score

2019 ◽  
Vol 7 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Eva Decroli ◽  
Asman Manaf ◽  
Syafril Syahbuddin ◽  
Yuliarni Syafrita ◽  
Dwisari Dillasamola
Keyword(s):  
Nerve Growth Factor ◽  
Peripheral Neuropathy ◽  
Growth Factor ◽  
Serum Level ◽  
Diabetic Peripheral Neuropathy ◽  
Thiobarbituric Acid ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Nerve Growth

AIM: This study was conducted to identify malondialdehyde (MDA) serum level, nerve growth factor (NGF) serum level, diabetic peripheral neuropathy score and the correlation between MDA and NGF serum level with diabetic peripheral neuropathy score. METHODS: A cross-sectional study was conducted to observe diabetic patients in the internal medicine department in Dr M. Djamil Hospital, Padang, Indonesia. The MDA serum level was measured using Beuge method with thiobarbituric acid. The NGF serum level was analysed using ELISA method. Diabetic peripheral neuropathy score was defined when history score in Michigan Neuropathy Screening Instrument (MNSI) ≥ 7 and physical assessment score in MNSI > 2. RESULTS: Thirty subjects with diabetes has diabetic peripheral neuropathy score 3.53 (± 0.91), MDA serum level 2.16 (± 2.89) nmol/ml, and NGF serum level 10.56 (± 2.89) pg/dl. There were significant correlations between the MDA serum level and the diabetic peripheral neuropathy score (r = 0.364, p = 0.048), and between the NGF serum level with the diabetic peripheral neuropathy score (r = -0.59, p = 0.001). CONCLUSION: There are high MDA serum level and low NGF serum level in patients with diabetic peripheral neuropathy. Low NGF serum level plays a bigger role than high MDA serum level in diabetic peripheral neuropathy.

scholarly journals Prevalence and Determinants of Diabetic Peripheral Neuropathy/Foot Syndrome in a rural population of North India

2020 ◽  
Author(s):  
MD Abu Bashar
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
North India ◽  
Limb Amputation ◽  
Bivariate Analysis ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Type 2 Diabetic Patients ◽  
Cross Sectional

Abstract Background Diabetic peripheral neuropathy (DPN), a common and troublesome complication in patients with type 2 diabetes mellitus (T2DM), contributes to a higher risk of diabetic foot ulcer and lower limb amputation. These situations can negatively impact the quality of life of affected individuals.Objectives The study aimed to assess prevalence of DPN in patients of type 2 DM from rural North India and associated risk factors. Methods A facility based cross sectional study was carried out among type 2 diabetic patients attending NCD clinic of a secondary care hospital in rural North India. A questionnaire which included socio-demographic details, clinical and laboratory parameters, and the Michigan Neuropathy Screening Instrument (MNSI) for detecting peripheral neuropathy, was administered to 100 consecutive patients. Statistical Package for Social Sciences (SPSS) version 25.0 was used for entering and analyzing data. Bivariate analysis was performed for determining the factors significantly associated with presence of DPN. Results The prevalence of DPN was 42.0%. Male gender, advancing age(≥60 years), longer duration of diabetes (>10 years ), smoking, physical inactivity, obesity, uncontrolled blood pressure, poor A glycaemic control and altered lipid profile were found to be significantly associated with the presence of DPN. Conclusion Prevalence of DPN among type 2 diabetics from rural north India is alarmingly high. There is need of essential screening of all diabetic patients by their primary care provider for early detection of DPN particularly in rural India.

scholarly journals Prevalence, Patterns, and Factors Associated with Peripheral Neuropathies among Diabetic Patients at Tertiary Hospital in the Kilimanjaro Region: Descriptive Cross-Sectional Study from North-Eastern Tanzania

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Ahlam A. Amour ◽  
Nyasatu Chamba ◽  
Johnstone Kayandabila ◽  
Isaack A. Lyaruu ◽  
Dekker Marieke ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Associated Factors ◽  
Medical Center ◽  
Tertiary Hospital ◽  
Severe Form ◽  
Diabetic Patients ◽  
Diabetes Clinic ◽  
Cross Sectional ◽  
Duration Of Diabetes

Objective. Diabetic peripheral neuropathy (DPN) is a common microvascular complication of diabetes mellitus (DM) and may progress to diabetic foot, which frequently leads to amputation and/or disability and death. Data is scanty on the burden of diabetic peripheral neuropathy in Tanzania. The aim of this study was to assess the burden of peripheral neuropathy, its severity, and the associated factors. Methods. The study was a cross-sectional hospital-based study and was carried out from October 2017 to March 2018 among adolescent and adult patients attending Kilimanjaro Christian Medical Center (KCMC) diabetes clinic. Results. A total of 327 diabetic patients, females n=215 (65.7%) and males n=121 (34.3%), were included in the study. The mean age was 57.2 yrs. A total of 238 (72%) had type 2 and 89 (27.2%) had type1 DM. The prevalence of peripheral neuropathy was 72.2% of whom 55% were severe, 19% were moderate, and 26% were mild. The severity of neuropathy increased with the increase in age >40 years (p < 0.001) and increase in body mass index (p<0.001) and duration of diabetes; duration >7 years (p <0.006). The main associated factors were age >40 years, OR 2.8 (1.0-7.7), >60 years, OR 6.4 (2.3-18.2), obesity, OR 6.7 (0.9-27.7), and hypertension, OR 4.3 (2.2-8.2). Conclusion. More than half of the patients included in this study were found to have neuropathy, nearly half of whom presented with the severe form. The main risk factors were increasing age, increasing duration of diabetes, obesity, and hypertension. Diabetic peripheral neuropathy is underdiagnosed in northern Tanzania where screening for neuropathy is not routinely done.

High Resolution Ultrasound of the Tibial Nerve in Diabetic Peripheral Neuropathy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eman Soliman Metwally ◽  
Khaled Ahmed Mohamed Ali ◽  
Reham Shaaban Ahmed Abdel-Baqy
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Tibial Nerve ◽  
Morphological Changes ◽  
Cross Sectional Area ◽  
Lower Limbs ◽  
Diabetic Patients ◽  
Main Role ◽  
Sectional Area ◽  
Cross Sectional

Abstract Background The main role of this study was to highlight the value of musculoskeletal ultrasound in the diagnosis of nerve affection in patients with diabetic peripheral neuropathy. This was evident by the significant correlation between cross sectional area and all study parameters with sensitivity and specificity of 90% and 100% respectively. Objectives Our study aims to highlight the value of newer ultrasound imaging techniques in identifying morphological changes of the tibial nerve in the patients with diabetic peripheral neuropathy. Patients and Methods During a period of ten months duration started in November 2019, 40 subjects were enrolled in this study. 20 diabetic patients with clinical manifestations of DPN had undergone nerve conduction study of both lower limbs then compared to 20 healthy control subjects as regard the ultrasound examination of TN bilaterally. The study was conducted according to the stipulations of the ASU ethical and scientific committee. The privacy of participants and confidentiality of data were guaranteed during the various phases of the study. Results We found that the cross sectional area (CSA) in patients with diabetic peripheral neuropathy (DPN) is significantly larger than the healthy controls. A positive significant correlation was found between CSA and duration of diabetes, HbA1c% and tibial nerve (TN) latency while a negative significant correlation was found with TN amplitude and conduction velocity. Conclusion Despite giving significantly larger values in cases than controls, MTNF was found to non-significantly correlated with all studied parameters. In view of the above data, CSA can be adopted as a reliable screening and diagnostic tool for DPN but further work-up is needed to assess its role in the follow up of the disease process. On the other hand, MTNF can be used for description of the morphological changes in a diabetic nerve.

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