Sensory Nerve Conduction Velocity and Vibratory Sensibility in Juvenile Diabetics

Ludvigsson, Johnny; Johannesson, Gunvor; Heding, L. G.; Häger, A; Larsson, Yngve

doi:10.1111/j.1651-2227.1979.tb18449.x

Cited by 34 publications

(15 citation statements)

References 22 publications

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“…We did not find any beneficial effects and could not confirm previous reports [13,43]. It should be noted that only two patients had circulating C-peptide levels within the physiological range and the levels in most of the patients may have been too low to be effective.…”

Section: Discussioncontrasting

confidence: 54%

Subclinical nerve dysfunction in children and adolescents with IDDM

1995

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SummaryThe 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, peroheal, 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, longterm 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. [Diabetologia (1995) 38: 685-692] Key words Insulin-dependent diabetes mellitus, children, neuropathy, nerve conduction velocity, glycaemic control, height.Peripheral neuropathy is a common complication of insulin-dependent diabetes mellitus (IDDM) [1], which increases in frequency with the duration of disease [2][3][4] and is uncommon in children [5]. Although Received: 3 October 1994 and in revised form: 2 December 1994Corresponding author: Dr. L. Hyllienmark, Department of Clinical Neurophysiology, University Hospital, S-58185 Link6ping, Sweden Abbreviations: IDDM, Insulin-dependent diabetes mellitus; MIT, multiple insulin injection therapy; MCV, motor nerve conduction velocity; CMAR compound muscle action potential; DML, distal motor latency; SCV, sensory nerve conduction velocity; SNAP, sensory nerve action potential. unproven, we assume that overt neuropathy with symptoms is preceded by a subclinical form which is important to detect and describe. Electrophysiological studies of nerve conduction velocity are probably our most sensitive tools to quantify early abnormalities [6][7][8]. Such studies exist in paediatric patients on conventional treatment [9-22] but not in patients on modern multiple insulin injection therapy (MIT). The benefits of using MITwith tight metabolic control on diabetic late complications have been clearly shown [23][24][25][26]. The aim of the present study was to ascertain whether young IDDM patients using MIT still d...

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Section: Discussioncontrasting

confidence: 54%

Subclinical nerve dysfunction in children and adolescents with IDDM

1995

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“…Early neuropathy is most likely caused by sorbitol accumulation and/or myoinositol de pletion in nerve tissue [27], This conception seems to be supported by the present study, since diabetic microan giopathy as a cause can probably be excluded, as auto nomic disturbances were found very early after onset when no vascular complications seem to exist. In this respect, Ludvigsson et al [28] provided further impor tant data. They found a positive correlation between sen sory-nerve conduction velocity and C peptide levels in insulin-dependent diabetic children.…”

Section: Discussionmentioning

confidence: 99%

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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“…Early impairment of pupillary adaptation in darkness, as an index of sympathetic function, has been reported in 19% of diabetic children with a relatively short diabetes duration 9 . Limited information exists on vibration sense 10 and limited joint mobility (LJM) 11 in children and adolescents with IDDM.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Microvascular and Neurologic Abnormalities in a Population of Diabetic Children

Karavanaki¹,

Baum²

1999

Journal of Pediatric Endocrinology and Metabolism

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One hundred and twenty-nine (87%) of a total county population of 150 eligible diabetic children together with 144 age- and sex-matched control children participated in a longitudinal, epidemiological study of the evolution of diabetic microvascular disease. At enrollment the median (range) age of the diabetic children was 12.5 (3.7-16.8) years with a median diabetes duration of 2.9 (0.1-13.4) years and a median HbAl of 11.1 (6.8-17.9)%. Two sets of measurements were made over a period of 18 months for all indices of microvascular disease, while autonomic function was studied on one occasion. Urinary albumin excretion in diabetic children was assessed from all voidings during two timed 48-h urine collections and was expressed as urinary albumin/creatinine ratios (ACR). Blood pressure (BP) was measured using a random zero sphygmomanometer. Autonomic function was assessed by pupillary adaptation in darkness, using a portable Polaroid pupillometer, and by heart rate (HR) variation recorded by dedicated computer. Vibration sensation thresholds (VST) (as indices of peripheral neuropathy) were recorded using a Biothesiometer. Limited joint mobility (LJM) was assessed by the "prayer sign". Five (3.9%) diabetic children presented raised mean ACR in more than two of four 24-h urine collections. Fourteen (10.8%) diabetic children were identified as having persistently raised BP during both study periods. Impaired HR response in one HR test was observed in 20 (15.5%) diabetic children, while ten (7.7%) diabetic children demonstrated abnormalities in two or more HR tests. Reduced pupillary adaptation in darkness was found in eight (7.9%) diabetic children. Persistent vibration sensation impairment (VST) in lower limbs was detected in eight (6.2%) diabetic children, while LJM was present in 12 (9.3%) diabetic children. Eight of the 129 diabetic children (6.2%) were found to have abnormality in two and one in three indices of microvascular and autonomic function. Six of nine children had coexistence of impaired autonomic neuropathy and nephropathy. These nine children were diagnosed at a younger age than the rest of the diabetic population (5.1 vs 8.0 yr, p=0.002). Four of nine were aged >11 yr and five of nine had had diabetes for >5 yr. Thus, a constellation of microvascular and neurological abnormalities were demonstrable in a small proportion of diabetic children, who were younger than the rest of the population at the time of onset of their disease. Longitudinal study of this population will demonstrate the clinical significance of these findings.

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Sensory Nerve Conduction Velocity and Vibratory Sensibility in Juvenile Diabetics

Cited by 34 publications

References 22 publications

Subclinical nerve dysfunction in children and adolescents with IDDM

Subclinical nerve dysfunction in children and adolescents with IDDM

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

Prevalence of Microvascular and Neurologic Abnormalities in a Population of Diabetic Children

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