S110
P2-10
Pain threshold of diabetic patients: An investigation using
intraepidermal electrical stimulation
M. Matsumura1 , K. Inui2 , S. Uchiyama3
Institute of Geriatrics, Tokyo Women’s Medical University, 2 Department
of Sensory-Motor Integration, National Institute for Physiological
Science, 3 Department of Neurology, Tokyo Women’s Medical University
1
Purpose: It is believed that small peripheral nerve disorders are present
from an earlier stage in diabetic patients. In this study, in order to assess
the functions of the Ad nerve fibers of diabetic patients, we examined
the pain threshold using intraepidermal electrical stimulation.
Subjects: The subjects comprised 26 diabetic patients. A 23 healthy
subjects without diabetes served as controls.
Method: Using a surface stimulation device and stimulating electrode
NM990 manufactured by the Nihon Kohden and measured the pain
threshold in the inner side of the legs and the knees on both sides based
on the method of Inui, et al. (Pain 96; 247, 2002).
Results: The mean pain threshold values in the patient group were
0.03±0.02 mA in the both legs, 0.05±0.04 mA in the right knee, and
0.05±0.03 mA in the left knee, while the mean pain threshold values
of the control group were 0.03±0.01 mA in the both legs, 0.03±0.01 mA
in the right knee, and 0.04±0.02 mA in the left knee, and a statistically
significant difference was observed only in the right knee (p < 0.05).
Discussion and Conclusion: No abnormalities were observed in the
pain thresholds of the diabetic patients except in the right knee. In
patients with diabetic peripheral neuropathy, small fibers such as C
and Ad fibers become impaired first, but there are also reports that, in
immunopathological studies, impaired Ad fibers recover faster than the
C fibers. We showed that no abnormalities in both legs were observed
in the pain thresholds in th present study reflected the result that the
function of legs was maintained through the continuous regeneration of
Ad fibers in patients with diabetes. The reason for satistically difference
of right knee threshold in patient group remains unclarified.
P2-11
Quantitative sensory test: normal range in Korean adults and
application to diabetic polyneuropathy
S.H. Kim1 , J.E. Kim1 , S.W. Ahn1 , S.M. Kim1 , Y.-H. Hong2 , J.J. Sung1 ,
K.S. Park1 , K.W. Lee1
1
Department of Neurology, Seoul National University College of
Medicine, Seoul, Korea, 2 Department of Neurology, Seoul Boramae
Hospital, Seoul, Korea
Objective: Although quantitative sensory test (QST) is used with
increasing frequency to measure sensory thresholds in clinical practice
and epidemiologic studies, there is no normative data of QST considering
age in Korean adults. The objective of this study is to investigate the
normative data of QST and to evaluate the value of QST compared to
NCS in patients with diabetic polyneuropathy.
Methods: The Computer Aided Sensory Examination IV 4, 2, and 1 stepping
algorithm was used to determine vibration and cold perception in total
70 normal controls and 19 diabetic patients aged from 21 to 79 years. The
data were used to define normal upper and lower limits by age and normal
range of side to side difference. We evaluated the duration of diabetes,
serum HbA1C, nerve conduction study (NCS) and QST in patients with
diabetic polyneuropathy.
Results: In general, normal sensory thresholds increased slightly with
age and a little side to side difference even in normal adults was
observed. Sensory threshold test in elderly people revealed much wider
normal range. Although 11 patients with normal NCS finding showed
increased sensory threshold, the diagnostic sensitivity of QST was not
higher than NCS in diabetic polyneuropathy (36.8% vs. 42.1%, p = 0.716)
and especially, elderly patients showed lower diagnostic sensitivity of
QST.
Conclusions: QST might be complement to NCS for detection of diabetic
polyneuropathy. Although the QST is a simple measuring method for
peripheral nerve function, there are some limits that QST measuring
is dependent on subjective response of patients and concentration and
cooperation of patient can affect the result of QST. Therefore, we should
pay attention to interpretation of QST considering the limitations in
patients with peripheral neuropathy.
Posters
P2-12
The utility of conduction studies of distal branches of the superficial
peroneal nerve studies in diabetic patients
D. Borucu1 , K. Uluc1 , P. Kahraman Koytak1 , B. Isak1 , O. Us1 , T. Tanridag1
Marmara University Hospital, Department of Neurology, Istanbul,
Turkey
1
Objective: Distal sensory polyneuropathy (DSP) is the most commonly
encountered form of diabetic neuropathy. Nerve conduciton studies (NCS)
are the gold standards in the evaluation of diabetic polyneuropathy,
nevertheless they are unable to detect large fiber involvement below
the ankle. Therefore, reliable and sensitive methods to evaluate distal
parts of the feet are required. The purpose of this study was to evaluate
distal superficial peroneal nerve branches in a group of diabetic patients
with DSP and in healty controls.
Methods: Thirtytwo healthy and 36 diabetic adult patients were included.
In all subjects, peripheral motor and sensory NCS were performed
bilaterally with surface electrodes on the lower limbs including distal
branches of the superficial peroneal, medial plantar and dorsal sural
nerves. In addition, motor and sensory nerves were studied unilaterally
on the upper limb.
Results: We have shown that sensory sensory conduction in the distal
superficial peroneal nerve could be elicitable in all normal individuals
in the 20 65 year age range. Among clinically defined 36 DSP patients,
1st and 2nd branches of medial dorsal cutaneous nerve action potential
amplitude was abnormal in 14 (38.9%) and 11 (%30.6) of the patients.
Furthermore, 1st and 2nd branches of intermediate dorsal cutaneous
nerve amplitude was abnormal in 16 (44.4%) and 18 (50%) of the patients,
respectively.
Conclusion: We confirmed that bilateral NCS assessment of distal
superficial peroneal nerve branches increases the rate of diagnosis of
diabetic distal sensory neuropathy compared to assessment of rouitine
nerve conduction.
P2-13
VEGF expression in an alloxan-induced diabetic rabbit model
E.P. Wilder-Smith1 , N.N. Thaw Dar2 , Y. Guo2 , A. Chow2 , M.C. Wong3 ,
K.T. Moe4
1
Department of Medicine, National University of Singapore, Singapore,
2
National University of Singapore (NUS), Singapore, 3 National Cancer
Centre (NCC), Singapore, 4 National Heart Centre (NHC), Singapore
Introduction: Diabetic peripheral neuropathy (DPN) is a common
debilitating complication of diabetes, afflicting 60% of all diabetic
patients. The basic pathogenesis of DPN is still unknown and treatment
of DPN is symptomatic with glucose control.
Objective: The objective of our study was to investigate the changes
of an angiogenic factor (VEGF expression) and the relationship between
VEGF expression and clinical features of DPN in an alloxan-induced
diabetic rabbit model.
Methods: Male rabbits weighing from 2.1 to 4.1 kg were given IV injection
of alloxan to induce diabetes. Their blood glucose, body weight, motor
and sensory nerve conduction velocity were monitored up to 8 to
12 months. VEGF level of the muscle around the sciatic nerve was
measured by immunohistochemistry and western blot. All data were
compared and analyzed between the diabetic rabbits and control (nondiabetic) rabbits.
Results: The fasting blood glucose of alloxan-injected rabbits was
significantly increased 2 weeks after injection and they lost body-weight.
The nerve conduction velocity of the diabetic group gradually decreased
as the disease progressed. The most salient finding in our study was that
VEGF expression of the diabetic group was significantly higher (2.6 times)
than that of control group.
Conclusions: This finding supports the notion that VEGF expression of
the muscle around the sciatic nerve was increased in the early phase of
diabetes to compensate altered physiological needs.
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Arif Celebi
Bezmialem Vakif University
Carlo Semenza
Università degli Studi di Padova
María Del Carmen Garcia
Instituto Universitario Hospital Italiano
Mamta Singh
All India Institute of Medical Sciences, New Delhi
