Prevalence of subclinical neuropathy in diabetic patients: assessment by study of conduction velocity distribution within motor and sensory nerve fibres

Abstract

Nerve conduction velocity distribution (CVD) study is a newly-developed electrodiagnostic method for detecting alterations in the composition of nerve fibres according to their conduction velocity. The presence of subclinical neuropathy was evaluated in 138 diabetic patients by CVD study of four motor nerves (external popliteal and ulnar nerves bilaterally) and two sensory nerves (median nerve bilaterally), and the data obtained were compared with standard electrophysiological parameters in the same nerve segments. CVD studies revealed an altered distribution pattern in 106 of 129 evaluable patients for motor nerves (82%) and in 67 of 115 evaluable patients for sensory nerves (58%), while standard examination gave abnormal findings in 92 of 137 patients (67%) and in 33 of 118 patients (11%), respectively. Of the patients adequately evaluated by both techniques, 21 of 129 patients (16%) revealed altered CVD data unaccompanied by slowing of maximum nerve conduction velocity, and 37 patients of 101 (37%) showed similar findings for sensory nerves. Subclinical alterations of motor and sensory nerve CVD were not significantly related to age or to metabolic control expressed as glycated haemoglobin levels; a significantly longer duration of disease was found in patients with motor and mixed subclinical neuropathy with respect to non-neuropathic patients. The CVD study allowed us to detect subclinical abnormalities of motor and sensory nerve fibres; often this is a more sensitive method than the standard electrodiagnostic study. This method can be very useful as a diagnostic tool and in research in the study of the progression of diabetic neuropathy.

Do we underestimate influences of diabetic mononeuropathy or polyneuropathy on hand functional performance and life quality?

“…Among those patients with neuropathies, 42.2% showed median neuropathy12. Bertora et al 11. also reported that approximately 82% of patients with diabetes were estimated to have subclinical hand neuropathy, based on the results of neurophysiological tests.…”

Recent developments in the assessment of efficacy in clinical trials of diabetic neuropathy

“…Using a computer-assisted collision procedure with an assessment of velocities in slower conducting fibers, subclinical neuropathy was detected in 58% of subjects compared with only 11% of subjects using standard electrophysiology [35].…”

How the Impact of Median Neuropathy on Sensorimotor Control Capability of Hands for Diabetes: An Achievable Assessment from Functional Perspectives

“…In addition, a recent study reported that 16.8% of asymptomatic diabetic hands met the inclusion criteria for subclinical median neuropathy, including abnormal nerve conduction velocity and an enlarged cross-sectional area of the carpal tunnel [16]. In addition, a previous nerve conduction study reported that the prevalence of subclinical neuropathy was 58% to 82% in the median nerves of diabetic patients [17]. Since asymptomatic neuropathy progresses as the number of nerve fibers gradually reduces, a sensitive and precise evaluation tool to detect neuropathy in the early stage is critical in a clinical setting.…”