Sural nerve pathology in diabetic patients with minimal but progressive neuropathy (original) (raw)
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Acta Neuropathologica, 2001
Nerve fibre pathology is poorly described in diabetic patients with mild neuropathy and has not been adequately related to clinical evaluation, quantitative sensory examination and neurophysiology. Sural nerve myelinated and unmyelinated fibre pathology was morphometrically quantified and related to the presence of pain and conventional measures of neuropathic severity in 15 diabetic patients with mild neuropathy and 14 control subjects. Diabetic patients demonstrated a significant (P<0.01) reduction in myelinated fibre density, but no change in fibre/axonal area, or g-ratio, compared to control subjects. Unmyelinated fibre degeneration was evidenced by an increase in the percentage of unassociated Schwann cell profiles (P<0.0001) and a reduction in axon density (P<0.0008) in diabetic patients. This was associated with a significant reduction in unmyelinated axon diameter (P<0.001) with a shift of the size frequency distribution to the left (P<0.02). Neurophysiology, quantitative sensory testing and nerve fibre pathology failed to differentiate diabetic patients with painful and painless neuropathy and failed to correlate with any measure of unmyelinated fibre pathology.
Journal of Iranian medical council, 2022
Background: Some clinical scoring systems as the quantitative tools have been developed to assess the presence and severity of Diabetic Peripheral Neuropathy (DPN) based on both the patient's complaints and the physicians' findings. This study was aimed at assessing the presence and severity of sural and peroneal nerve neuropathies using Michigan Neuropathy Screening Instrument (MNSI) and United Kingdom Screening Test (UKST) questionnaire compared with electrodiagnosis assessments. Methods: 148 patients with Diabetes Mellitus (DM) including 80 females and 68 males with a mean age of 57.6, 19 type 1DM and 129 type 2 DM were recruited in this study. The findings of the electrophysiological study such as peroneal and sural nerves' conduction delay, velocity and amplitude were gathered. The patients were also assessed regarding the clinical neuropathy status using the two instruments of MNSI and UK. Results: The mean neuropathy score of MNSI and UKST were 2.2 (1.7) and 4.1 (3.0), respectively. Each instrument detected the DPN in 47.3% and 64.9% of the patients, respectively. Also, based on the nerve conduction studies (NCS), the neuropathy of sural and peroneal nerves was found in 54.1% and 79.7%, respectively. Unlike the peroneal nerve, there was a significant agreement between the electrodiagnosis assessment and the screening tools in the diagnosis of sural nerve neuropathy. Conclusion: Given that NCS is a practical, simple, and non-invasive approach and also can determine the level of damage and regeneration in peripheral nerves, sural nerve conduction study is suggested as a convenient option for screening and diagnosing the diabetic neuropathy.
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.8\_Aug2022/IJHSR-Abstract23.html, 2022
Background: Diabetes mellitus has become a rapidly rising global health-care problem in the recent decades. Amongst the wide spectrum of concurrent complications, Diabetic peripheral neuropathy (DPN) is quite common and distressing. The sensory symptoms may vary from numbness, hypoaesthesia, allodynia to severe paresthesia. Long term consequences of these sensory disturbances are foot ulceration, imbalance, increased risk of fall and even amputations too. Since these symptoms interfere with the quality of life of diabetic individuals and also lead to increased socioeconomic burden, immediate action to combat these is prerequisite for health care development of any nation. Further, if timely diagnosed, these complications can largely be prevented. Nerve conduction study holds the gold standard tool to detect Diabetic neuropathy at its subclinical stage itself. Sural nerve is the commonest and most prevalent nerve involved, so it was considered for analysis. Duration of diabetes is an important factor which affects neurophysiology. Thus, the aim of the present study is to study the effect of duration of diabetes on Sural nerve conduction parameters in subjects with type-II Diabetes Mellitus having varying duration of diabetes. Method: Seventy-three Subjects with type-II Diabetes mellitus were divided into three groups according to the duration of disease. Group A:<5 years, B: 5-10 years, C: >10 years of diabetes. Bilateral Sural nerves were analysed using RMS EMG SALUS machine. Result: Significant reduction of Sensory nerve action potential (p<0.05) was found as the duration of diabetes increased from Group A to C. Conclusion: Long term Diabetes leads to Axonal degeneration in Sural nerves.
Nerve biopsy findings in different patterns of proximal diabetic neuropathy
Annals of Neurology, 1994
Besides distal symmetrical sensory polyneuropathy (DSSP), middle-aged diabetic patients may present with focal or multifocal neuropathies, including proximal neuropathy of the lower limbs, the pathophysiological features of which are uncertain. We studied 10 non-insulin-dependent diabetic patients, 45 to 72 years of age, who developed a painful proximal neuropathy of the lower limbs for which other causes of neuropathy were carefully excluded. The proximal neuropathy was asymmetrical in all patients, sensory in 4, motor and sensory in the others. Signs of DSSP were present in all. A sample of the intermediate cutaneous nerve of the thigh, a sensory branch of the femoral nerve, was taken by biopsy and examined by light and electron microscopy. Examination of the nerve specimens revealed ischemic nerve lesions in 3 patients. Nerve ischemia was associated with vasculitis and inflammatory infiltration in 2 of them. In the other patients the lesions of the cutaneous nerve of the thigh included a varying incidence of axonal and demyelinative lesions similar to those observed in DSSP, with mild inflammatory infiltration in 4 of them. The density of myelinated and of unmyelinated was variably decreased. This study shows that axonal and demyelinative lesions similar to those found in diabetic DSSP are present in proximal nerves in mild forms of proximal diabetic neuropathy; while nerve ischemia, inflammatory infiltration, and vasculitis are encountered in the most severe forms of proximal diabetic neuropathy.
Small nerve fiber dysfunction in diabetic neuropathy
Muscle & Nerve, 1989
Sensory and autonomic small nerve fiber function was studied in 142 type I diabetics and 45 control subjects. Thermal sensitivity (TS), hot pain sensitivity, and the activity of sweat glands (SGs) were quantitated on the dorsum of the hand and the foot. TS was abnormal in 86% of patients in the foot and 66% in the hand. TS was more sensitive than the hot pain threshold, the number of pilocarpine activated SGs, or the amount of sweat secreted, all of which were abnormal in about 50% of patients for the foot and less than 25% in the hand. Thermal and sweating tests correlated significantly with the scores of abnormal temperature and pinprick sensation obtained by physical examination but not with the duration of the diabetes. TS was also correlated with motor and sensory nerve conduction parameters, but SG number was not. The results indicate that diabetic neuropathy has a variable presentation in different types of nerve fibers.
Vascular factors in diabetic neuropathy
Diabetologia, 1994
Despite considerable research we still do not have a comprehensive explanation for the pathogenesis of diabetic neuropathy. Although chronic hyperglycaemia is almost certainly involved, it is not known whether the primary pathology is metabolic, microvascular, or an interaction between the two. Hyperglycaemia-induced polyol pathway hyperactivity associated with nerve sorbitol accumulation and myo-inositol depletion may play a part in the genesis of diabetic neuropathy. The case for microvascular disease in diabetic neuropathy is now strong. Fibre loss in human sural nerve is multifocal, suggesting ischaemia. The degree of vessel disease has been related to the severity of neuropathy. People with chronic obstructive pulmonary disease develop the so called "hypoxic neuropathy" in which similar microvascular changes occur as in diabetic neuropathy. In rats with experimental diabetic neuropathy nerve blood flow is reduced and oxygen supplementation or vasodilator treatment improved the deterioration in conduction velocity and nerve blood flow. Similarly, in human diabetic neuropathy, there is impaired nerve blood flow, epineurial arterio-venous shunting and a reduction in sural nerve oxygen tension. At what stage during the development of nerve damage these changes occur is yet to be determined. [Diabetologia (1994) 37: 847-854]
Sural Nerve Electrophysiologic Profile in Normals and Type2 Diabetics of Dissimilar Duration
https://www.ijhsr.org/IJHSR\_Vol.9\_Issue.5\_May2019/IJHSR\_Abstract.030.html, 2019
Background and Purpose: Diabetes is the disease of major concern of all in the present Era. The morbidity, mortality and economical burden due to this illness is escalating at a faster pace. The incidence of foot complications like ulcers and amputations are getting increased because of late diagnosis of distal symmetrical peripheral neuropathy which is the common complication of Diabetes. In this the distal sensory nerves are affected commonly due to length dependent relation. Sural nerve which carries sensory information from lateral aspect of sole is involved most frequently. The morbidity is increased due to pain, numbness, pins and needles sensations. So early detection of this sensory neuropathy by evaluating Sural NCS will help the individuals to decrease the complications and improve quality of life. Methods: 20 participants with type2 diabetes were selected into the study, they were distributed into 2 groups, 10 individuals with less than 10yrs of diabetes duration and 10 with more than 10 yrs of diabetes duration. 10 age matched normal individuals were taken in the control group. For all the participants electro physiologic parameters of Sural Nerve were recorded bilaterally by making use of EMG OCTOPUS clarity machine. Results: Results of latency, amplitude and conduction velocity were analysed by micro soft excel and Graph pad prism software. Statistical significance was measured with p value less than 0.05 Conclusion-All 20 Diabetic individuals have shown decrease in amplitude and conduction velocity and increase in latency when compared to normal individuals. The values were more altered in diabetics of longer duration.