Sensory and Motor Peripheral Nerve Findings in Patients with Diabetes Mellitus Referred for Electrodiagnosis

  • Saeid Khosrawi Associate Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran https://orcid.org/0000-0002-7618-3689
  • Shila Haghighat Resident, Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Eiman Shayegannia Resident, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Keywords: Diabetes mellitus; Peripheral neuropathies; Electrodiagnosis

Abstract

Background: Diabetes mellitus (DM) is the most prevalent endocrine disease and the most common cause of peripheral neuropathy, which is one of the important long-term complications of diabetes. Careful neurologic examination and electrodiagnosis are essential and valuable to the early diagnosis of neuropathy and prevention of its consequences. The aim of this study was to assess electroneurographic findings in patients with diabetes.

Methods: This study was conducted on 103 randomly selected patients with diabetes who referred for electroneurographic studies. Neurologic and electroneurographic examination were performed in all patients. Moreover, 3 motor nerves (M-median, deep peroneal, and tibial) and 3 sensory nerves (S-median, sural and superficial peroneal) were evaluated and in each nerve its conduction velocity, distal latency, and amplitude were assessed. Furthermore, bilateral H-reflex was measured in the soleus muscle.

Results: Among the 103 studied subjects, 30 patients (29.1%) had type I DM and 73 (70.9%) had type II DM. The overall incidence of diabetic neuropathy was 79.6%. There was a direct correlation between disease duration and prevalence of diabetic neuropathy. The most common complaint was numbness and tingling of distal parts (72.0%) (P < 0.0001). The most common physical finding was abnormal ankle jerk (94.0%) (P < 0.0010). The most sensitive finding in electroneurographic examination was absent or prolonged H-reflex (92.5%) (P < 0.0001). Overall, the amplitude was a more sensitive parameter than distal latency.

Conclusion: Nerve conduction parameters especially H-reflex study and amplitude of sensory responses are valuable in the early diagnosis of diabetic neuropathy. There is a good correlation between clinical and electroneurographic findings; thus, clinical examination is highly recommended in order to prevent unnecessary work-ups, and help prevent untoward complications.

References

1. Zdravkovic V, Daneman D, Hamilton J. Presentation and course of Type 2 diabetes in youth in a large multi-ethnic city. Diabet Med 2004; 21(10): 1144-8.
2. Otieno CF, Kayima JK, Omonge EO, Oyoo GO. Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr Med J 2005; 82(12 Suppl): S197-S203.
3. Congdon P. Estimating diabetes prevalence by small area in England. J Public Health (Oxf) 2006; 28(1): 71-81.
4. Lin SF, Lin JD, Huang YY. Diabetic ketoacidosis: comparisons of patient characteristics, clinical presentations and outcomes today and 20 years ago. Chang Gung Med J 2005; 28(1): 24-30.
5. Rowland LP, Pedley TA. Merritt's neurology. 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
6. Dumitru D. Nerve Conduction Studies. In: Dumitru D, Amato AA, Zwarts MJ, Editors. Electrodiagnostic Medicine. Philadelphia: Hanley & Belfus; 2002. p. 194-217.
7. Behse F, Buchthal F, Carlsen F. Nerve biopsy and conduction studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry 1977; 40(11): 1072-82.
8. Fleisher LA, Breslow MJ. Prevalence of Diabetic neuropathy in adolescents. Arch Pediatr Adolesc 2003; 277: 1127-234.
9. Jazayeri M, Ranjbaran Z. Nerve conduction studies in 40 patients with diabetic neuropathy. [Thesis]. Shiraz: Shiraz University of Medical Sciences; 2004.
10. DeLisa JA, Gans BM, Bockenek WL, Frontera WR, Gerber LH, Gerber LH, et al. Physical Medicine and Rehabilitation Principles and Practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
11. Ropper AH, Brown RH. Adams and Victor's Principles of Neurology. 8th ed. New York: McGraw-Hill Professional; 2005.
12. Marker E, Goll V. Proceeding of a consensus development conference on standardized measures in diabetic neuropathy. Neurology 2002; 42: 1823-39.
13. Pease WS, Lew HL, Johnson EW, Editors. Johnson's Practical Electromyography. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
Published
2019-06-01
Section
Original Article(s)