Cutaneous silent period in human immunodeficiency virus‐related peripheral neuropathy

Abstract

The aim of this work was first to determine whether the cutaneous silent period (CSP), a marker of small-nerve-fibre function, was altered in human immunodeficiency virus (HIV)-positive subjects with predominantly sensory symmetrical polyneuropathy and, second, to assess whether such alterations were predictive of an impairment in the largest calibre sensory and motor nerve fibres of the upper limb (UL) peripheral nerves. CSP was assessed in three groups of subjects: healthy control subjects, HIV-positive subjects with peripheral neuropathy (PN) of the lower limbs, and HIV-positive patients with clinical and neurophysiological involvement of the four limbs. CSP study showed a significant increase of the latency compared to the controls both in HIV-positive cases with no impairment in the UL (p=0.006) and in patients with four-limb neuropathy (p=0.002). CSP study in HIV-positive patients with mild lower limb distal sensory polyneuropathy can detect an early involvement of the UL peripheral nerves. CSP latency increase could therefore be addressed as the first sign of PN spreading to the UL.

Utility of the cutaneous silent period in patients with diabetes mellitus

“…Painful stimulation, 10-15 times the perception threshold, produces action potentials in afferent nerves with conduction velocities of 15-20 m/s, which is similar to the Aδ fiber conduction velocity, resulting in development of a CSP by inhibition of alpha motor neurons [17,18]. Many clinical studies involving patients with peripheral neuropathies have shown abnormal findings in CSP measurements [19,20]. A study which assessed the CSP in 26 HIV-positive patients with polyneuropathies showed a significant delay in the latency of the CSP in all patients [19].…”

“…Many clinical studies involving patients with peripheral neuropathies have shown abnormal findings in CSP measurements [19,20]. A study which assessed the CSP in 26 HIV-positive patients with polyneuropathies showed a significant delay in the latency of the CSP in all patients [19]. An absent CSP was observed in patients with hereditary sensory autonomic neuropathies [20].…”

Small fibre neuropathies

“…It has been suggested that CSP might be useful in investigating the progression of neuropathy [45]. This technique needs validation in larger studies, however.…”

Distal Sensory Polyneuropathy in the Context of HIV/AIDS

“…Osio et al (2004Osio et al ( , 2006 suggest that a disorder of mitochondrial oxidative metabolism related to a reduction of mitochondrial DNA content and interference with nerve growth factor activity may be associated with DSPN. Interference with DNA synthesis and mitochondrial abnormalities produced by nucleoside ART have been hypothesized as pathogenic factors in ATN Recently, Herrmann et al (2006) reported that measures of small sensory fibers (leg epidermal nerve fiber density, cooling and heat pain thresholds) may be associated with transition to symptomatic HIV-associated distal sensory neuropathy 6 to 12 months later.…”