Abstract
ELECTROPHYSIOLOGICAL EVALUATION OF SUBCLINICAL NEUROPATHY IN DIABETES PATIENTS

Dr. S. Ramu MD DM (Neuro)*

ABSTRACT

Introduction: Diabetic neuropathy is defined as the presence of symptoms and signs of peripheral nerve dysfunction in diabetes after exclusion of the other causes. Diabetes is the leading cause of peripheral Polyneuropathy in developed countries. In general, to define diabetic neuropathy, should be based on symptoms, objective signs and EDX confirmation. Nerve conduction study is widely used for the diagnosis of diabetic neuropathy. Nerve conduction abnormalities exist in subclinical stages of neuropathy that can be detected at an early asymptomatic stage by various electrodiagnostic test. Hence aim of this study is to study the effect of diabetes in motor and sensory nerve conduction velocity of peripheral nerves in diabetes patients and to observe the functional status of peripheral nerve in asymptomatic diabetes patient. Methodology: Thirty Patients diagnosed as diabetes, who were asymptomatic regarding neuropathy, attending the diabetology outpatient department, at government Rajaji Hospital, Madurai from April 2013 to April 2016 were included in this study. Patient diagnosed as diabetes who are asymptomatic regarding neuropathy, Age group of 20 to 60 years and both male and female were included in this study. Results: A total of 30 patients were included in this study. Electrophysiological study was conducted in all the patients. Four of the patients had normal NCS .Out of the remaining 26 cases, majority of the patients had sensorimotor Polyneuropathy. The next common type of neuropathy noted in our study was Predominant sensory neuropathy was noted in 3 patients and one of the patient had isolated sensory nerve involvement (both ulnar sensory, median and sural sensory). In our study, out of 26 cases with abnormal NCS, the nerves that are most commonly affected in the decreasing order are as follows- Median SNAP, Sural SNAP, Median CMAP, peroneal CMAP, tibial CMAP, ulnar CMAP and Ulnar SNAP. Most common nerve affected in upper limb is Median Nerve while in lower limb is sural nerve. Conclusion: The results of the present study done in diabetics without complications with duration of diabetes, indicate that there is a significant impairment of motor and sensory nerve parameters even though they are asymptomatic. We conclude the study with the observation that nerve conduction study can be used as a screening tool to diagnose neuropathy in subclinical stages and should be considered at risk category for aggressive glycemic control by diet, drugs and life style modification to prevent progression of neuropathy.

Keywords: Diabetes, neuropathy, nerve study.


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