Unit:
Κατεύθυνση Κλινική ΝευροφυσιολογίαLibrary of the School of Health Sciences
Supervisors info:
Kαρανδρέας Νικόλαος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Κοκότης Παναγιώτης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αναγνώστου Ευάγγελος, ΕΔΙΠ, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ο λόγος του ύψους του σύνθετου αισθητικού δυναμικού ενεργείας του επιπολής κερκιδικού νεύρου κατά την καταγραφή του σε δύο σημεία, ως δείκτης αρχόμενης πολυνευροπάθειας σε ασθενείς με σακχαρώδη διαβήτη
Translated title:
The ratio of the amplitude of the sensory action potential of the superficial radial nerve recorded over two sites, in the early diagnosis of polyneuropathy in patients with diabetes melitus
Summary:
Objective: Diabetic neuropathy is a common long-term complication of diabetes mellitus. Nerve conduction studies can be used to confirm diagnosis of diabetic neuropathy when there are signs or symptoms as well as to enable detection of subclinical abnormalities. Diabetic neuropathy is a length dependent neuropathy and distal parts of the nerves are affected first. The purpose of this study was to examine the ratio of the amplitude of the superficial radial nerve (SRN) sensory action potential (SNAP) recorded at the palm to the amplitude when it is recorded more distally, at the medial branch, and investigate its usefulness in the early diagnosis of diabetic neuropathy.
Methods: In this case control study SNAP was recorded in the superficial branch and medial branch of the radial nerve in 28 healthy subjects (18 female, 10 male) and 25 diabetic patients (15 female, 10 male). Diabetic patients with neurophysiological findings consistent with neuropathy were excluded. The ratio of radial medial branch/radial SNAP was examined in both groups.
Results: In healthy controls, the mean amplitude of the superficial radial nerve SNAP was 54.29±14.63μV and in diabetics 44.76±13.02 μV. SNAP amplitude in the diabetic group was lower even when multiple linear regression was used to test the correlation between amplitude as a dependent factor and diabetes, BMI, height and age as independent factors (β=-5.63, SE=2.77, p=0.045). The mean amplitude of the medial branch SNAP was 13.59±4.46 μV in healthy controls and 11.14±4,87 μV in diabetic patients. Diabetes displayed a negative correlation with amplitude. After the linear regression model was applied the correlation was not confirmed (β=-0.84, SE=1.01, p=0.407). The mean ratio of medial branch to superficial radial nerve SNAP amplitude was 0.26 ±0.08 in healthy controls and 0.25±0.1 in the diabetic group. There was no statistically significant difference between the two groups. Αge displayed a negative correlation with ratio in diabetic patients. The mean sensory conduction velocity (SCN) for SRN was 60.61±4.28 m/s in healthy controls groups and 60.15±5.44 in the diabetic group. The mean SCV for medial branch was 53.8±8.12 in healthy controls and 54.9±8.2 m/sec in diabetic patients. There was no statistically significant difference between the two groups.
Conclusions: The superficial radial nerve SNAP amplitude was significantly lower in diabetic patients, showing that axonal dysfunction of the sensory nerves of upper arm is prominent in asymptomatic diabetic patients. Due to simultaneous decrease in the SNAP amplitude of the medial branch, their ratio did not prove to be early affected in diabetic patients. The ratio was significantly lower in diabetic patients with older age, result which could be attributed to the more intense phenomenon of dying back degeneration in this group of patients. In conclusion, further studies which would evaluate nerve conduction studies of both radial sensory nerve and its medial branch as well as their ratio progression rate in a larger population, including patients with mild neuropathy, are suggested in order to provide further understanding regarding the natural history of the disease.
Main subject category:
Health Sciences
Keywords:
Radial nerve, Medial branch of SRN, Ratio of sensory action potential, Diabetic polyneuropathy
