Distal Sensorimotor Neuropathy: Improvements in Diagnosis

Abstract

■ AbstractNeurological complications of diabetes are common, affecting up to 50% of people with diabetes. In these patients, diabetic sensorimotor neuropathy (DSPN) is by far the most frequent complication. Detecting DSPN has traditionally been a clinical exercise that is based on signs and symptoms. However, the appearance of morphometric and neurophysiological techniques along with composite scoring systems and new screening tools has induced a paradigm change in the detection and stratification of DSPN and our understanding of its natural history and etiopathogenesis. These newer techniques have provided further evidence that changes in small nerve fiber structure and function precede large fiber changes in diabetes. Although useful, the challenge for the use of these new techniques will be their sensitivity and specificity when widely adopted and ultimately, their ability to demonstrate improvement when pathogenic mechanisms are corrected. Concurrently, we have also witnessed an emergence of simpler screening tools or methods that are mainly aimed at quicker detection of large fiber neuropathy in the outpatient setting. In this review, we have focused on techniques and tools that receive particular attention in the current literature, their use in research and potential use in the clinical environment.Keywords: diabetic neuropathy · small fiber neuropathy · axon reflex test · nerve conduction · nerve fiber density · laser Doppler imager flare · corneal confocal microscopy · electromyography · sudomotor function

The Association Between Phosphorylated Neurofilament Heavy Chain (pNF-H) and Small Fiber Neuropathy (SFN) in Patients with Impaired Glucose Tolerance

“…Research indicates that DPN, including small fiber neuropathy (SFN) [4], may occur in patients with impaired glucose tolerance (IGT) [5,6]. Abnormalities in the structure and function of small fiber nerves precede those in large fiber nerves in diabetes [7]. SFN may be considered the 'microalbuminuric' equivalent of diabetic sensorimotor neuropathy (DSPN) [7].…”

“…Abnormalities in the structure and function of small fiber nerves precede those in large fiber nerves in diabetes [7]. SFN may be considered the 'microalbuminuric' equivalent of diabetic sensorimotor neuropathy (DSPN) [7]. Early recognition of SFN facilitates early treatment and delays the progression of DPN.…”

Painful and non‐painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues

“…A number of other diagnostic tests are available for DPN, PDPN and neuropathic pain in general. These tests include skin biopsies with quantitation of intra‐epidermal and dermal nerve fibers, measurements of small nerve fibers in the cornea using corneal confocal microscopy, and assessment of neurogenic flare with laser Doppler as a measure of small nerve fiber (C fiber) function.…”

“…These tests include skin biopsies with quantitation of intra‐epidermal and dermal nerve fibers, measurements of small nerve fibers in the cornea using corneal confocal microscopy, and assessment of neurogenic flare with laser Doppler as a measure of small nerve fiber (C fiber) function. In addition, assessment of sudomotor function and quantitative sensory tests exist. Still, abnormal nerve conduction studies are considered the first objective and quantifiable measure of DPN.…”

Depression and Diabetic Peripheral Neuropathy: Birds of a Feather, But When do They Flock Together?

“…Diabetic peripheral neuropathy (DPN) is a very frequent microvascular complication of diabetes [15]. Typically, it has an insidious onset with slow clinical progression towards often debilitating complications [15].…”