Magnetic Resonance Imaging of the Central Nervous System in Diabetic Neuropathy

Wilkinson, Iain D.; Selvarajah, Dinesh; Greig, Marni; Shillo, Pallai Rappai; Boland, Elaine; Gandhi, Rajiv; Tesfaye, Solomon

doi:10.1007/s11892-013-0394-8

Cited by 16 publications

(17 citation statements)

References 46 publications

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“…Additionally, the observed WM microstructural changes around the PAG, a vital region involved in the inhibition of nociceptive inputs through its interactions with ascending and descending projections from numerous sites (Lewis & Gebhart, ; Ossipov et al, ), suggest that DPN might be associated with impaired PAG‐mediated analgesia, which would lead to exaggerated pain sensation. In fact, the insula, cingulate cortex, PFC, and PAG are linked and activated when processing painful stimuli, and are thus regarded as key regions of a network termed the pain matrix (Davis & Moayedi, ; Ohara, Crone, Weiss, Kim, & Lenz, ; Wilkinson et al, ). It is conceivable that the observed GM or WM alterations in these regions underlie the impairments in multidimensional aspects of pain processing that are found in DPN, including abnormal encoding of pain intensity and anticipation, abnormal pain modulation, and the experience of negative emotions, such as anxiety.…”

Section: Discussionmentioning

confidence: 99%

Sensorimotor and pain‐related alterations of the gray matter and white matter in Type 2 diabetic patients with peripheral neuropathy

Zhang

et al. 2019

Human Brain Mapping

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Although diabetic peripheral neuropathy (DPN) has long been considered a disease of the peripheral nervous system, recent neuroimaging studies have shown that alterations in the central nervous system may play a crucial role in its pathogenesis. Here, we used surface-based morphometry (SBM) and tract-based spatial statistics (TBSS) to investigate gray matter (GM) and white matter (WM) differences between patients with DPN (n = 67, 44 painless and 23 painful) and healthy controls (HCs; n = 88). Compared with HCs, patients with DPN exhibited GM abnormalities in the pre-and postcentral gyrus and in several deep GM nuclei (caudate, putamen, medial pallidum, thalamus, and ventral nuclear). They also exhibited altered WM tracts (corticospinal tract, spinothalamic tract, and thalamocortical projecting fibers). These findings suggest impaired motor and somatosensory pathways in DPN. Further, patients with DPN (particularly painful DPN) exhibited morphological differences in the cingulate, insula, prefrontal cortex, and thalamus, as well as impaired WM integrity in periaqueductal WM and internal and external capsules. This suggests pain-perception/modulation pathways are altered in painful DPN. Intermodal correlation analyses found that the morphological indices of the brain regions identified by the SBM analysis were significantly correlated with the fractional anisotropy of brain regions identified by the TBSS analysis, suggesting that the GM and WM alterations were tightly coupled. Overall, our study showed sensorimotor and pain-related GM and WM Youming Zhang and Minli Qu contributed equally to this work.

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Section: Discussionmentioning

confidence: 99%

Sensorimotor and pain‐related alterations of the gray matter and white matter in Type 2 diabetic patients with peripheral neuropathy

Zhang

et al. 2019

Human Brain Mapping

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“…Altered structure and/or activity at central nervous system levels are undoubtedly present in patients with both somatic and autonomic neuropathies, as has been demonstrated by several MRI studies [7, 31–33]. Furthermore, electrophysiological studies using evoked potentials with advanced brain activity modeling have also detected abnormal brain activity patterns in patients with diabetes, autonomic neuropathy, and gastrointestinal symptoms [4, 34].…”

Section: Discussionmentioning

confidence: 99%

Rectal Sensitivity in Diabetes Patients with Symptoms of Gastroparesis

Søfteland

Brock

Frøkjær

et al. 2014

Journal of Diabetes Research

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In a clinical setting, diabetic autonomic complications (cardiac, gastrointestinal, urogenital, etc.) are often handled as separate entities. We investigated rectal sensitivity to heat, mechanical distension, and electrical stimulations in 20 patients with diabetes and symptoms of gastroparesis, to evaluate the extent of visceral neuronal damage. Furthermore, to evaluate the relation between the nervous structures we examined gastric emptying and cardiac autonomic function with the hypothesis being an association between these. We found that 60% of patients had delayed gastric empting. Rectal hyposensitivity was a general finding as they tolerated 67% higher thermal, 42% more mechanical, and 33% higher electrical current intensity compared to healthy controls. In patients, most heart rate variability parameters were reduced; they reported significantly more gastrointestinal symptoms and a reduced quality of life in all SF-36 domains. Shortened RR interval correlated with reduced rectal temperature sensitivity, and gastric retention rate was negatively associated with symptoms of nausea and vomiting. To conclude, in these patients with signs and symptoms of diabetic gastroparesis, rectal sensitivity was reduced, and heart rate variability was impaired. Thus, we suggest regarding diabetic autonomic neuropathy as a diffuse disorder. Symptoms of widespread autonomic dysfunction and sensory disorders should be expected and treated in these patients.

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“…137–140 More recent work has shown that DTI can be used for diagnosis of neuropathy, 141 as well as bring new insights into the involvement of central nervous system in DPN. 142,143 …”

Section: Non-invasive Mri Techniques To Assess Dpn Featuresmentioning

confidence: 99%

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

Parasoglou

Rao

Slade

2017

Clinical Therapeutics

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Purpose In this review, we highlight the current concepts in the effects of diabetic peripheral neuropathy (DPN) in skeletal muscle. We discuss the lack of effective pharmacological treatments and the role of physical exercise intervention in limb protection and symptom reversal. We also highlight the importance of Magnetic Resonance Imaging (MRI) techniques in providing a mechanistic understanding of the disease and helping develop targeted treatments. Methods This review provides a comprehensive reporting on the effects of DPN in the skeletal muscle of diabetic patients. It also provides an update on the most recent trials of exercise intervention targeting DPN pathology. Lastly, we report on emerging MRI techniques that have shown promise in providing a mechanistic understanding of DPN and can help improve the design and implementation of clinical trials in the future. Findings Impairments in lower limb muscles reduce functional capacity and contribute to altered gait, increased fall risk, and impaired balance in patients with DPN. This is an important concern for DPN patients as their falls are very likely to be injurious, and lead to bone fractures, poorly healing wounds, and chronic infections that may require amputation. Preliminary studies have shown that moderate intensity exercise programs are well tolerated by patients with DPN. They can improve their cardiorespiratory function and can partially reverse some of the DPN symptoms. MRI has the potential to bring new mechanistic insights into the effects of DPN as well as to objectively measure small changes in DPN pathology as a result of intervention. Implications Non-invasive exercise intervention is particularly valuable in DPN due to its safety, low cost, and potential to augment pharmacological interventions. As we gain a better mechanistic understanding of the disease, more targeted and effective interventions can be designed.

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Magnetic Resonance Imaging of the Central Nervous System in Diabetic Neuropathy

Cited by 16 publications

References 46 publications

Sensorimotor and pain‐related alterations of the gray matter and white matter in Type 2 diabetic patients with peripheral neuropathy

Sensorimotor and pain‐related alterations of the gray matter and white matter in Type 2 diabetic patients with peripheral neuropathy

Rectal Sensitivity in Diabetes Patients with Symptoms of Gastroparesis

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

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