Peripheral Neuropathy in Diabetic Children and Adolescents

Käär, M.‐L.; Saukkonen, Anna‐Liisa; Pitkänen, Matti; Åkerblom, H. K.

doi:10.1111/j.1651-2227.1983.tb09731.x

Cited by 34 publications

(15 citation statements)

References 18 publications

(1 reference statement)

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“…Our observation that the motor nerves of the lower extremities are most often affected in adolescents with diabetes is supported by previous data (2,17), although diabetes also affects less myelinated sensory nerve fibers early in the course of the disease (1). The finding that the adolescent patients with distal DP also had parasympathetic nerve dysfunction is in line with previous results in adult patients (3,19) and supports the observation of distal neural damage in diabetic polyneuropathy.…”

Section: Table 3-h-reflex Latency Difference (Milliseconds) In the Tisupporting

confidence: 80%

“…The finding that the adolescent patients with distal DP also had parasympathetic nerve dysfunction is in line with previous results in adult patients (3,19) and supports the observation of distal neural damage in diabetic polyneuropathy. The fact that only a few of the adolescent patients had signs or symptoms of distal nerve dysfunction is in accordance with some previous reports (2,17) showing that only ϳ4% of the children or adolescent patients with type 1 diabetes had symptoms or signs consistent with clinical neuropathy. However, abnormal deep tendon reflexes and signs of DP are already detectable in one-fifth of all young and otherwise healthy adult diabetic patients (3).…”

Section: Table 3-h-reflex Latency Difference (Milliseconds) In the Tisupporting

confidence: 78%

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Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Riihimaa

Suominen²,

Tolonen³

et al. 2001

Diabetes Care

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OBJECTIVE -To evaluate the impact of puberty on peripheral nerve function in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Of 138 eligible patients with type 1 diabetes, 100 patients (age Ͼ9 years and diabetes duration Ͼ2 years) attending an outpatient diabetes clinic and 100 age-and sex-matched healthy control subjects took part in this cross-sectional study. Peripheral motor and sensory nerve conduction tests, cardiovascular reflex tests on the autonomic nervous system, and measurements of vibration-perception threshold (VPT) were performed.RESULTS -Nerve conduction velocity (NCV) in the distal motor and sensory nerves, the motor nerve distal latency, and the sensory nerve action potential (SNAP) amplitude were impaired in the adolescent patients with type 1 diabetes. The deterioration in motor NCV, H-reflex latency, and SNAP amplitude became more conspicuous in late puberty and postpuberty and was related to poor metabolic control. A total of 10 patients had distal diabetic polyneuropathy (DP) neurophysiologically, and these patients had significantly lower heart-rate variation in the deep breathing test than the other patients. Three of the patients with DP had peripheral neurological signs or symptoms. A slight difference in the VPT between the patients and control subjects was observed after puberty.CONCLUSIONS -Increasing subclinical motor nerve impairment can be detected during late puberty and after puberty, and sensory NCV and SNAP amplitude are reduced in adolescents with type 1 diabetes. Poor metabolic control during puberty appears to induce deteriorating peripheral neural function in young patients with type 1 diabetes.

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Section: Table 3-h-reflex Latency Difference (Milliseconds) In the Tisupporting

confidence: 80%

Section: Table 3-h-reflex Latency Difference (Milliseconds) In the Tisupporting

confidence: 78%

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Riihimaa

Suominen²,

Tolonen³

et al. 2001

Diabetes Care

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“…The greatest impairment was found in peroneal motor conduction velocity: 49 patients (30%) had an abnormal value. There was a strong correlation between the duration of diabetes and peroneal conduction veloc ity impairment [ 17], According to our present and pre vious studies [21], it is noteworthy that we found auto nomic nervous system dysfunction in a significant pro portion of the examined diabetic children compared to the control group. This suggests the more frequent occur rence of subclinical signs referring to the early distur bance of the autonomic nervous system in childhood diabetes, in contrast with peripheral neuropathy.…”

Section: Discussionmentioning

confidence: 61%

“…Nevertheless, some authors recorded the fre quency of abnormal motor nerve conduction as a subclinical sign of peripheral (somatic) neuropathy in about 10% [1], and others in 36% [4], In a study by Kaar et al [17], the median motor and sensory conduction veloci ties and peroneal motor conduction velocity were regis tered in 161 unselected diabetic children and adoles cents. The greatest impairment was found in peroneal motor conduction velocity: 49 patients (30%) had an abnormal value.…”

Section: Discussionmentioning

confidence: 99%

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Investigation of Subclinical Signs of Autonomic Neuropathy in the Early Stage of Childhood Diabetes

1990

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It has been suggested that subclinical signs of neuropathy appear earlier than microvascular complications of diabetes. To evaluate the occurrence of autonomic nervous system dysfunction in the early stage of childhood diabetes, subclinical signs of autonomic neuropathy (resting heart rate, hyperventilatory arrhythmia, standing/lying heart rate ratio, orthostatic decrease in blood pressure, and increase in blood pressure during sustained handgrip) were investigated in 54 children with type 1 diabetes divided into three groups: 14 recent-onset diabetics (3 weeks after the diagnosis), 20 diabetics in the remission phase, and 20 patients after the remission phase. 30 healthy age-matched children were used as control group. The mean resting heart rates of the diabetic groups in the remission phase and after the remission phase were significantly higher than those in the healthy control group (81.7 ± 5/min and 88.5 ± 6/min vs. 72.2 ± 8/min; p < 0.01). The hyperventilatory arrhythmia in the group of diabetic children after the remission phase in comparison with the control group was significantly decreased (29.1 ± 4/min vs. 22.7 ± 3/min; p < 0.01). In a few cases of the recent-onset diabetic group, the increase in resting heart rate, the decrease in hyperventilatory arrhythmia, and the standing/lying heart rate ratio proved to be significant. In the remission phase, the same parameters showed abnormal values in one third to one fifth of the children. In the diabetic group after the remission phase, these parameters were established as pathologic in one half to one fifth of the children, and in some cases, the orthostatic decrease in blood pressure and the increase in blood pressure during sustained handgrip were pathognomic as well. These results indicate that the initial, functional disturbances of the autonomic nervous system may appear early during the course of childhood diabetes and they emphasize the necessity to search for subclinical neuropathy in diabetic children.

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Subclinical nerve dysfunction in children and adolescents with IDDM

1995

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The purpose of this study was to investigate whether young insulin-dependent diabetic patients still develop peripheral nerve dysfunction when using modern multiple insulin injection therapy and to elucidate if this correlated with various disease parameters. Seventy-five patients, 7 to 20 years old with a duration of diabetes of more than 3 years, and 128 age-matched healthy control subjects underwent bilateral studies of median, peroneal, and sural nerves. Presence of diabetes lowered motor conduction velocity (p < 0.0001), sensory conduction velocity (p < 0.0001) and sensory nerve action potential (p < 0.05) in all examined nerves. The mean change in conduction velocity induced by diabetes was -4.8 m/s in the peroneal nerve, -3.3 m/s in the median motor nerve, -2.6 m/s in the sural nerve and -2.4 m/s in the median sensory nerve. Fifty-seven percent of the patients had abnormal conduction (values outside 95% predictive interval) which was seen most often in the motor nerves, especially in the peroneal nerve (41%) followed by the median nerve (24%). In multiple regression analysis, long-term poor metabolic control and increased body length correlated with nerve dysfunction identified in most examined parameters. Three patients had signs or symptoms suggestive of neuropathy. It is concluded that despite modern multiple insulin injection therapy, with reasonably good metabolic control, nerve dysfunction is still common in children and adolescents with insulin-dependent diabetes mellitus. Risk factors are increased height and long-term poor metabolic control.

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Peripheral Neuropathy in Diabetic Children and Adolescents

Cited by 34 publications

References 18 publications

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Investigation of Subclinical Signs of Autonomic Neuropathy in the Early Stage of Childhood Diabetes

Subclinical nerve dysfunction in children and adolescents with IDDM

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