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Early detection of diabetic neuropathy: a neurophysiological study on 100 patients.
Electromyogr Clin Neurophysiol. 1997 Oct; 37(7):399-407.EC

Abstract

As a long-term complication of diabetes mellitus, autonomic neuropathy has received considerable attention in the last few years since a tripled 5-year-mortality of patients with diabetic neuropathy including autonomic disturbances has been observed. In a total of 100 diabetics with clinical manifest neuropathy of different stages (N0 = 8, N1 = 15, N2a = 24, N2b = 28, N3 = 25), 26 of whom were insulin-dependent and 74 non-insulin-dependent, the validity of different neurophysiologic and autonomic function test procedures proposed in literature was assessed. Apart from clinical examination, nerve conduction velocity measurement of five nerves as well as amplitude measurement of evoked sensory and motor actin potentials, electromyography of at least four muscles of the lower limbs, and measurement of sympathetic skin response on hands and feet were performed. Furthermore, heart rate variation at deep periodical breathing (E/I-ratio), during Valsalva's manoeuver and after standing up (30/15-ratio) was determined. In addition, the drop in systolic blood pressure to standing up was measured. The further developed the clinical picture of neuropathy, the more pathological were the results obtained in different tests. The results suggest that most changes leading to pathological values of nerve conduction velocity and heart rate variation measurement take place in a clinical stage, in which no or only very slight clinical signs give evidence of diabetic neuropathy (N0-N1). Therefore, especially these examinations should be performed on diabetics with no or only slight clinical signs of neuropathy in order to reveal those with beginning neuropathic disturbances. EMG examination is preferable in later stages of the disease.

Authors+Show Affiliations

Braune HJ
Department of Neurology, University of Marburg, Germany.

MeSH

Action PotentialsAdolescentAdultAgedAged, 80 and overAutonomic Nervous SystemAutonomic Nervous System DiseasesBlood PressureDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic NeuropathiesElectromyographyEvoked PotentialsEvoked Potentials, MotorFemaleFootHandHeart RateHumansLegMaleMiddle AgedMotor NeuronsMuscle, SkeletalNeural ConductionNeurons, AfferentNeurophysiologyPhysical ExaminationReproducibility of ResultsRespirationSurvival RateSympathetic Nervous SystemValsalva Maneuver

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9402428

Citation

Braune, H J.. "Early Detection of Diabetic Neuropathy: a Neurophysiological Study On 100 Patients." Electromyography and Clinical Neurophysiology, vol. 37, no. 7, 1997, pp. 399-407.
Braune HJ. Early detection of diabetic neuropathy: a neurophysiological study on 100 patients. Electromyogr Clin Neurophysiol. 1997;37(7):399-407.
Braune, H. J. (1997). Early detection of diabetic neuropathy: a neurophysiological study on 100 patients. Electromyography and Clinical Neurophysiology, 37(7), 399-407.
Braune HJ. Early Detection of Diabetic Neuropathy: a Neurophysiological Study On 100 Patients. Electromyogr Clin Neurophysiol. 1997;37(7):399-407. PubMed PMID: 9402428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early detection of diabetic neuropathy: a neurophysiological study on 100 patients. A1 - Braune,H J, PY - 1997/12/24/pubmed PY - 1997/12/24/medline PY - 1997/12/24/entrez SP - 399 EP - 407 JF - Electromyography and clinical neurophysiology JO - Electromyogr Clin Neurophysiol VL - 37 IS - 7 N2 - As a long-term complication of diabetes mellitus, autonomic neuropathy has received considerable attention in the last few years since a tripled 5-year-mortality of patients with diabetic neuropathy including autonomic disturbances has been observed. In a total of 100 diabetics with clinical manifest neuropathy of different stages (N0 = 8, N1 = 15, N2a = 24, N2b = 28, N3 = 25), 26 of whom were insulin-dependent and 74 non-insulin-dependent, the validity of different neurophysiologic and autonomic function test procedures proposed in literature was assessed. Apart from clinical examination, nerve conduction velocity measurement of five nerves as well as amplitude measurement of evoked sensory and motor actin potentials, electromyography of at least four muscles of the lower limbs, and measurement of sympathetic skin response on hands and feet were performed. Furthermore, heart rate variation at deep periodical breathing (E/I-ratio), during Valsalva's manoeuver and after standing up (30/15-ratio) was determined. In addition, the drop in systolic blood pressure to standing up was measured. The further developed the clinical picture of neuropathy, the more pathological were the results obtained in different tests. The results suggest that most changes leading to pathological values of nerve conduction velocity and heart rate variation measurement take place in a clinical stage, in which no or only very slight clinical signs give evidence of diabetic neuropathy (N0-N1). Therefore, especially these examinations should be performed on diabetics with no or only slight clinical signs of neuropathy in order to reveal those with beginning neuropathic disturbances. EMG examination is preferable in later stages of the disease. SN - 0301-150X UR - https://www.unboundmedicine.com/medline/citation/9402428/Early_detection_of_diabetic_neuropathy:_a_neurophysiological_study_on_100_patients_ L2 - https://medlineplus.gov/diabeticnerveproblems.html DB - PRIME DP - Unbound Medicine ER -