Using a biothesiometer in clinical routine might be a sensitive method to detect large nerve fibre dysfunction in the lower extremity, whereas skin biopsies in combination with methods measuring vibrotactile sense could increase the diagnostic sensitivity of detecting peripheral neuropathy at an early stage.
Aims/hypothesis High levels of serum heat shock protein 27 (sHSP27) have been associated with distal symmetric polyneuropathy in patients with type 1 diabetes. Our objective was to investigate the association between sHSP27, neuropathic signs and nerve function in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and type 2 diabetes. Methods Participants were recruited consecutively from the population-based Västerbotten Intervention Program (NGT, n=39, IGT, n=29, and type 2 diabetes, n=51) and were matched for age and sex. sHSP27 levels were measured and nerve conduction studies were performed (peroneal and sural nerves). z Scores for each nerve conduction measure were calculated and compiled into a composite z score for the leg. Neuropathy disability score (NDS) was used to assess neuropathic signs. Results Patients with diabetes had significantly lower sHSP27 levels (geometric mean sHSP27 206 pg/ml, 95% CI 142, 299) than those with IGT (geometric mean sHSP27 455 pg/ml, 95% CI 319, 650, p<0.05) and controls (geometric mean sHSP27 361 pg/ml, 95% CI 282, 461, p<0.05). Participants with few signs of neuropathy (first tertile, NDS ≤2) had significantly higher sHSP27 levels (geometric mean sHSP27 401 pg/ml, 95% CI 310, 520) than participants with many signs (third tertile, NDS ≥7) (geometric mean sHSP27 192 pg/ml, 95% CI 128, 288, p=0.007). The highest sHSP27 tertile was associated with better nerve function, adjusted for age, sex, statin medication and HbA 1c (OR 2.51, 95% CI 1.25, 5.05, p<0.05). Conclusions/interpretation High sHSP27 levels were associated with better nerve function and fewer neuropathic signs in NGT, IGT and type 2 diabetes.
OBJECTIVETo assess small and large nerve fiber function in people with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSParticipants were recruited consecutively from a population-based cohort: NGT (n = 39), IGT (n = 29), and T2D (n = 51). Electrophysiological measures included nerve conduction studies and thermal thresholds. Intraepidermal nerve fiber density (IENFD) in skin biopsies was calculated.RESULTSThere was no difference between IGT and NGT in sural nerve conduction, IENFD, and thermal thresholds. IENFD was significantly lower in T2D (median = 2.8 fibers/mm [interquartile range 1.1–4.7 fibers/mm]) than NGT individuals (4.5 fibers/mm [3.4–6.1 fibers/mm]; P < 0.05). T2D participants had poorer nerve conduction and higher heat thresholds than NGT and IGT.CONCLUSIONSLarge and small nerve function in people with IGT did not differ from those with NGT. Our finding does not support the existence of neuropathy in a prediabetic stage.
BackgroundAutonomic neuropathy in diabetes, in addition to causing a range of symptoms originating from the autonomic nervous system, may increase cardiovascular morbidity. Our aim was to study the progression of autonomic neuropathy, based on symptom score and evaluation of an autonomic test, in persons with normal and impaired glucose tolerance and in patients with type 2 diabetes (T2D).MethodsParticipants were recruited in 2003/2004 with a follow-up in 2014. The participants’ glucose tolerance was categorized using oral glucose tolerance tests. Symptoms were evaluated using an autonomic symptom score (ASS), ECG was used to test cardiac autonomic function based on the expiration/inspiration ratio (E/I ratio), and blood samples were taken on both occasions.ResultsASSs were higher at follow-up in the T2D patients than in the normal glucose tolerance group (mean 1.21 ± 1.30 vs. 0.79 ± 0.7; p < 0.05). E/I ratio did not deteriorate more than could be expected as an aging effect in well-controlled T2D. No relationship was found between E/I ratio and HbA1c or ASS.ConclusionThe presence of autonomic symptoms increased over time in T2D patients, but the symptoms did not correlate with the E/I ratio in this metabolically well-controlled cohort. ASSs can be a useful clinical tool when assessing the progression of autonomic dysfunction in patients with abnormal glucose metabolism.
HighlightsCardiovascular autonomic nerve function (i.e. E/I ratio) deteriorates over time in type 1 diabetes.HSP27, MIF and PAI-1 concentrations do not correlate with cardiovascular autonomic nerve function.The change in HbA1c correlates negatively with the change in E/I over time.Higher HbA1c is associated with worse cardiovascular autonomic nerve function.
Aims:We investigated the long-term temporal trend of intraepidermal nerve fibre density (IENFD) and the association between changes in IENFD and metabolic factors in individuals with and without type 2 diabetes.Methods: A total of 66 participants were enrolled in this longitudinal populationbased study, at baseline consisting of 35 individuals (median 61 years) without diabetes and 31 individuals with type 2 diabetes mellitus. Participants underwent clinical and electrophysiological examinations, as well as a skin biopsy both at baseline and at the follow-up visit (mean 8.1 ± 0.5 years). IENFD was assessed in thin sections of 5 μm, stained with the protein gene product 9.5-antibody and compared between the groups.Results: IENFD decreased during the period in both groups, with a greater decline in the group without diabetes than in type 2 diabetes (−2.3 and −0.6 fibres/ mm respectively; p < 0.001). While IENFD at baseline was significantly reduced in type 2 diabetes relative to people without (p < 0.001), no difference in IENFD was found between groups at the follow-up (p = 0.183). Linear mixed model analysis indicated that age, weight and HbA 1c were associated with decrease in IENFD in the total population (p < 0.007). IENFD also decreased with increasing age and weight, but not with HbA 1c , in the separate groups (p < 0.049). Conclusions: Despite lower IENFD levels at baseline in type 2 diabetes, IENFD was equal between the groups at follow-up. A decrease in IENFD is to a limited extent affected by body weight, and HbA 1c , but age seems to be the long-term determinant of IENFD in an elderly population.
Variants in tumor suppressor genes and in genes encoding DNA repairing proteins are associated with syndromes conferring neurologic features and increased risk for malignancy. The best example for these conditions is ataxia-telangiectasia (AT). A more rare and recent disease is an ataxia-pancytopenia syndrome (ATXPC) associated with heterozygous gain-of-function variants in the tumor suppressor gene SAMD9L (MIM 159550). Here, we describe a patient with a complex cerebellar syndrome associated with a novel SAMD9L pathogenic variant. Case PresentationA 54-year-old Swedish man presented with progressive gait difficulties, impaired coordination, dizziness, falls, slurred speech, and urinary urgency. Age at onset was 42 years. Later, recurrent episodes with profuse sweating and crawling in both calves started to occur. There was no family history of movement disorders or other neurologic diseases. His mother died of glioblastoma at age 65 years and his father of cardiac disease. His medical history was unremarkable. Examination revealed dysmetria, inability to perform tandem gait, reduced arm swing, dysarthria, positive Romberg test, conjunctival telangiectasias, nystagmus, and pes cavus (Video 1). Reflexes were brisk, with mild spasticity in the legs. Muscle tone in the arms, sensation to pinprick, strength, and proprioception were normal, and the Babinski sign was absent, but vibration was reduced in both malleoli. At age 50 years, his Scale for the Assessment and Rating of Ataxia score was 10 p, and 3 years later, it was 11.5 p (range 0-40 points). 1 There were no signs of orthostatism, and the patient denied gastrointestinal symptoms. ENeG and quantitative sensory testing demonstrated a demyelinating sensorimotor neuropathy and elevated thresholds for heat and cold. EMG revealed chronic mild neurogenic abnormalities in the distal leg and arm muscles with no signs of active denervation, whereas motor evoked potential yielded normal findings. A mild symmetric sensorineural hearing loss was found, but the patient does not require hearing aids. Ophthalmologic evaluation, which included optical coherence tomography and eye-bottom examination, demonstrated presbyopia but no evidence of retinal pathology.Brain MRI with contrast demonstrated marked cerebellar atrophy and confluent periventricular hyperintensities. Additional hyperintensities were found in deep white matter regions that included the corpus callosum's left trunk. There were multiple cysts ranging in size between 1.5 and 3 mm within the hyperintensities and increased T2-weighted signal in the putamen, caudate, and dentate nuclei (Figure). A CT scan ruled out calcifications in the brain. A large
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