Electrophysiological studies in diabetic neuropathy

Abstract

SUMMARY In 30 patients with diabetic neuropathy sensory potentials in the median nerve, motor conduction in the lateral popliteal and median nerves, and electromyographic findings in distal and proximal muscles were compared with the severity of symptoms and signs. All patients had abnormalities in at least one of the electrophysiological parameters. The sensory potentials were the most sensitive indicator of subclinical involvement; abnormalities were found in 24 patients, 12 of whom had no sensory symptoms or signs and five of whom had no other clinical or electrophysiological evidence of neuropathy in the upper extremities. This indicates that sensory nerve fibres may be affected before motor. The next most sensitive parameter was the presence offibrillation potentials, found in more than half the distal muscles examined. Slowing in motor conduction in the lateral popliteal nerve was the only electrophysiological change correlated to the severity of the neuropathy, and no other electrophysiological parameter was correlated to the duration or the severity of the neuropathy or the diabetes. An onset of neuropathy before or simultaneously with the manifestations of the diabetes, as well as the frequent occurrence of asymptomatic changes in sensory conduction, support the evidence at hand that the neuropathy develops concomitantly with and as an integral part of the metabolic disturbance rather than as a consequence of the vascular complications of diabetes. Of three patients with clinical signs or symptoms of a diabetic amyotrophy, two had asymptomatic electrophysiological abnormalities in distal nerves and muscles, consistent with widespread involvement of the peripheral nerves. The third patient had electromyographic changes in the medial vastus muscles suggestive of a myopathy. Motor and sensory conduction in distal and proximal nerves were normal.Previous studies of electrophysiological changes in diabetic neuropathy have dealt with fibrillation potentials, polyphasic potentials, or conduction velocity in motor and, in a few instances, mixed and distal sensory nerves

Electrophysiological Patterns of Diabetic Polyneuropathy: Experience from a Tertiary Care Hospital of Bangladesh

“…The decrease in amplitude does not necessarily indicate a loss of sensory fibres, in that slowing can account for a decrease in amplitude. Up to a 50% decrease in the sensory potentials and increased temporal dispersion can be accounted for solely by the slowing in conduction without requiring the assumption of loss of fibres, consistent with findings of more or less advanced segmental demyelination and remyelination as the predominant histological abnormality 12 . Thus DPN is a continuous process, progressing over time.…”

Reversal Effects of Sugammadex in Diabetic Patients Having Neuromuscular Block with Rocuronium

“…4,5,8 This fact can explain the delayed return of the neuromuscular function in aforementioned studies of Saitoh and colleagues. However, sugammadex effects by incapsulation of rocuronium molecules without any impact on the neuromuscular junction, thus we think that is the reason of why no difference occurred in terms of reversal times from neuromuscular blockade between diabetic and nondiabetic patients.…”

Diabetes Mellitus and Neuromuscular Blockade: Review

“…Moreover, in this same study we found that even in patients without neuropathy, nerve conduction of the ulnar, peroneal and radial nerve was altered. Another study found that the development of diabetic neuropathy is not parallel to renal failure and we can find changes in nerve conduction in the absence of renal failure [8]. Therefore, the absence of clinical neuropathy does not rule alterations in nerve conduction in diabetic patients.…”