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Cambieri C, Libonati L, Moret F, Tartaglia G, Garibaldi M, Chimenti C, Inghilleri M, Ceccanti M. The Silent Period for Small Fiber Sensory Neuropathy Assessment in a Mixed Cohort of Transthyretin-Mediated Amyloidosis. Biomedicines 2022; 10:biomedicines10092073. [PMID: 36140174 PMCID: PMC9495326 DOI: 10.3390/biomedicines10092073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Transthyretin-mediated amyloidosis (ATTR) is a rare multisystemic disease involving the peripheral nervous system and heart. Autonomic and small fiber involvement is one of the hallmarks of ATTR, and many tools have been proposed to assess this aspect. Aim: The aim of this study was to investigate cutaneous and mixed nerve silent periods (CSP and MnSP) as instruments for small fiber assessment. Methods: A total of 21 ATTR patients, 20 healthy controls, and 18 asymptomatic carriers underwent a sensory conduction study from the right sural and non-dominant ulnar nerves. A motor conduction study from the right deep peroneal and non-dominant ulnar nerves, with their F waves, CSPs, and MnSPs, was performed. Results: The amplitudes of the sural and ulnar sensory nerves and of the peroneal and ulnar motor nerves were reduced in ATTR patients compared to the other groups. F waves from the ulnar and peroneal nerves showed no differences between the three groups. The CSP and MnSP latency, but not amplitude, were increased in both the ulnar and peroneal nerves of ATTR patients. Conclusions: ATTR patients showed axonal involvement of large sensory and motor nerve fibers and demyelinating features of small sensory fibers.
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Affiliation(s)
- Chiara Cambieri
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Laura Libonati
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Moret
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Giorgio Tartaglia
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Center, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University, 00185 Rome, Italy
- Cellular and Molecular Cardiology Lab, IRCCS Lazzaro Spallanzani, 00149 Rome, Italy
| | - Maurizio Inghilleri
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Ceccanti
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
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Kenis-Coskun O, Giray E, Gunduz OH, Akyuz G. The effect of vitamin D replacement on spinal inhibitory pathways in women with chronic widespread pain. J Steroid Biochem Mol Biol 2020; 196:105488. [PMID: 31589918 DOI: 10.1016/j.jsbmb.2019.105488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/05/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D replacement helps in pain reduction in patients with chronic widespread pain (CWP). But the current literature lack studies that investigate its mechanism. Cutaneous silent period (CSP) is the electrophysiologic analog of the spinal inhibitory pathways and an objective method to document their involvement. This study aims to show if vitamin D replacement has an effect on the spinal inhibitory pathways through CSP parameters. Female patients who have CWP with vitamin D deficiency were included. Patients received an 8-week replacement therapy of vitamin D. Patients' pain were evaluated using the visual analog scale (VAS) and Leeds assessment of neuropathic symptoms and signs pain scale (LANSS). Quality of life with Nottingham Health Profile (NHP) and CSP parameters were also recorded before and after treatment. A total of 51 patients were included in the final analyses. The mean age of the patients was 44.3 ± 12.7 (minimum 18-maximum 65). Mean symptom duration was 13.1 ± 6.7 (minimum3-maximum 24) months. Patients' mean BMI was 21.6 ± 3.9 (minimum 18.0 maximum 29.1). Patients' median VAS and LANSS scores decreased significantly (p < 0.01) and NHP scores improved significantly in all subsets (p < 0.01). Vitamin D replacement did not significantly change CSP latency and duration (p = 0.06 and p = 0.12).Vitamin D replacement does not seem to work via modifying the spinal inhibitory pathways that are involved in the formation of the cutaneous silent period. This is the first study to objectively investigate the effect of vitamin D replacement on central sensitization mechanisms.
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Affiliation(s)
- Ozge Kenis-Coskun
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey.
| | - Esra Giray
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| | - Osman Hakan Gunduz
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| | - Gulseren Akyuz
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
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Drnda S, Suljic E. Diabetes Mellitus Type Has Impact on Cutaneous Silent Period. Med Arch 2019; 73:326-330. [PMID: 31819306 PMCID: PMC6885233 DOI: 10.5455/medarh.2019.73.326-330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Neurophysiological tests allow accurate assessment of the function of the peripheral nervous system. Detection of neurophysiological changes allows us to understand the neurological clinical symptoms and signs of patients with type 1 and type 2 diabetes and the possibility for their symptomatic treatment. Aim: Evaluate the effect of diabetes mellitus on the “cutaneous silent period” in detecting diabetic polyneuropathy. Material and Methods: The study included 150 subjects, 90 suffering from diabetes, divided into three groups of 30, depending on the disease duration, and a control group of 60 respondents not suffering from diabetes or other polyneuropathies. The control group are referred for EMG analysis on another basis (cervical radiculopathy, brachialgia, etc.). Group 1 consisted of 30 subjects with diabetes mellitus type 2 and duration of illness up to 5 years. Group 2 consisted of 30 subjects with type 2 diabetes mellitus 2 and illness duration from 5 to 10 years. Group 3 consisted of 30 patients with type 1 diabetes mellitus. The study groups consisted of patients referred for EMNG analysis to the EMG office of the Clinical Center of Sarajevo University, Neurology Clinic and the Neurophysiology Laboratory in Ljubljana, from July 1, 2011 to May 1, 2016. All patients were examined neurologically and electroneurographic analysis was performed. Results: A statistically significant difference was found in the incidence of pathologic CSP with respect to the study groups, χ2 = 26.153; p=0.001. Pathologic CSP was more common in group 1 and group 2 of subjects (56.17%) compared to group 3 and control subjects, where it occurred in 13.3% of the cases. Conclusion: The pathological cutaneous period of silence was more frequent in subjects of group 1 and group 2, that is, in subjects with DM type 2, compared to subjects with DM type 1.
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Affiliation(s)
- Senad Drnda
- Department for Urgent Neurology, Clinic for Neurology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Enra Suljic
- Department for Science, Teaching and Clinical Trials, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Kofler M, Leis A, Valls-Solé J. Cutaneous silent periods – Part 1: Update on physiological mechanisms. Clin Neurophysiol 2019; 130:588-603. [DOI: 10.1016/j.clinph.2019.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
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Cutaneous silent periods – Part 2: Update on pathophysiology and clinical utility. Clin Neurophysiol 2019; 130:604-615. [DOI: 10.1016/j.clinph.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
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Kilinc O, Sencan S, Ercalik T, Koytak PK, Alibas H, Gunduz OH, Tanridag T, Uluc K. Cutaneous silent period in myofascial pain syndrome. Muscle Nerve 2017; 57:E24-E28. [PMID: 28877555 DOI: 10.1002/mus.25964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION An increased response to painful stimuli without spontaneous pain suggests a role of central hyperexcitability of pain pathways in the pathogenesis of myofascial pain syndrome (MPS). In this study we aimed to test the hypothesis that spinal pain pathways are affected in MPS. We used cutaneous silent period (CSP) parameters to demonstrate the hyperexcitability of spinal pain pathways in MPS. METHODS Twenty-nine patients diagnosed with MPS and 30 healthy volunteers were included in the study. The CSP recordings were performed in the right upper and left lower extremities. RESULTS In both upper and lower extremities, patients had prolonged CSP latencies (P = 0.034 and P = 0.049 respectively) and shortened CSP durations (P = 0.009 and P = 0.008, respectively). DISCUSSION Delayed and shortened CSP in MPS patients implies dysfunction in the inhibitory mechanism of the spinal/supraspinal pain pathways, suggesting central sensitization in the pathogenesis of MPS and supporting our research hypothesis. Muscle Nerve 57: E24-E28, 2018.
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Affiliation(s)
- Ozden Kilinc
- Department of Neurology, Marmara University School of Medicine, Fevzi Cakmak Mah. Muhsin Yazicioglu, Cadde No. 10 Pendik Istanbul, 34899, Turkey
| | - Savas Sencan
- Department of Physical Medicine and Rehabilitation, Section of Pain Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulay Ercalik
- Department of Physical Medicine and Rehabilitation, Section of Pain Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Pinar Kahraman Koytak
- Department of Neurology, Marmara University School of Medicine, Fevzi Cakmak Mah. Muhsin Yazicioglu, Cadde No. 10 Pendik Istanbul, 34899, Turkey
| | - Hande Alibas
- Department of Neurology, Marmara University School of Medicine, Fevzi Cakmak Mah. Muhsin Yazicioglu, Cadde No. 10 Pendik Istanbul, 34899, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Section of Pain Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulin Tanridag
- Department of Neurology, Marmara University School of Medicine, Fevzi Cakmak Mah. Muhsin Yazicioglu, Cadde No. 10 Pendik Istanbul, 34899, Turkey
| | - Kayihan Uluc
- Department of Neurology, Marmara University School of Medicine, Fevzi Cakmak Mah. Muhsin Yazicioglu, Cadde No. 10 Pendik Istanbul, 34899, Turkey
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Tiftikcioglu BI, Bilgin S, Duksal T, Kose S, Zorlu Y. Autonomic Neuropathy and Endothelial Dysfunction in Patients With Impaired Glucose Tolerance or Type 2 Diabetes Mellitus. Medicine (Baltimore) 2016; 95:e3340. [PMID: 27057914 PMCID: PMC4998830 DOI: 10.1097/md.0000000000003340] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Autonomic neuropathy is one of the most common complications of diabetes mellitus (DM). The etiology of autonomic impairment is not well-understood, yet. There is need for studies to investigate the cause-effect relationships of inflammation and/or endothelial dysfunction and diabetic autonomic neuropathy. Only a few reports have mentioned autonomic neuropathy in individuals with impaired glucose tolerance (IGT), previously. Furthermore, the association between the plasma markers of endothelial dysfunction (von Willebrand factor (vWF), soluble E-selectin) and autonomic neuropathy in patients with IGT or DM has not been studied before. In this study, we aimed to investigate the correlation between plasma markers of endothelial dysfunction and autonomic neuropathy in patients with IGT or type 2 DM (T2DM).In this case-control study, 25 IGT patients, 25 T2DM patients with autonomic symptoms, and 30 controls were included. Demographical data, HbA1c, vWF, and soluble E-selectin (sE-selectin) levels were analyzed. Sympathetic skin response (SSR) and heart rate variability (HRV) were used as the indicator of autonomic activity.Plasma levels of HbA1c, vWF, and sE-selectin were higher in patients with IGT than the controls; patients with T2DM had higher levels than both the controls and the patients with IGT. SSR measures were similar among the groups. However, higher number of T2DM patients had absent plantar SSR than controls. HRV analysis at rest revealed lower standard deviation of R-R interval, coefficient of variation of R-R interval, low-frequency (LF) power and total power in patients with IGT and T2DM than the controls. In addition, HRV analysis at deep breathing showed lower high-frequency (HF) power in IGT group. LF:HF ratio was lower in both patient groups at rest. No strong correlation was found between the levels of HbA1c, vWF, sE-selectin, HRV, and SSR measures.Our results support that endothelial dysfunction is evident in individuals with IGT or T2DM and HRV is impaired in early stages in the course of T2DM. However, increased levels of biomarkers of endothelial damage do not correlate with HRV or SSR. More studies are needed to clarify the disease pathogenesis and its clinical correlates. Impaired HRV in T2DM could be due to mechanisms other than endothelial dysfunction.
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Affiliation(s)
- Bedile Irem Tiftikcioglu
- From the Department of Neurology (BIT, SB, TD, YZ); and Department of Infectious Diseases and Clinical Microbiology (SK), Tepecik Education and Research Hospital, Izmir, Turkey
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Ongun N, Erdoğan Ç, Tekin S, Oğuzhanoğlu A. An alternative nerve conduction study method to evaluate early diabetic neuropathy: Ratio of different diameter nerve fibers in peroneal nerve. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kamel JT, Vogrin SJ, Knight-Sadler RJ, Willems NK, Seiderer L, Cook MJ, MacIsaac RJ, Roberts LJ. Combining cutaneous silent periods with quantitative sudomotor axon reflex testing in the assessment of diabetic small fiber neuropathy. Clin Neurophysiol 2014; 126:1047-53. [PMID: 25449560 DOI: 10.1016/j.clinph.2014.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/01/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Routine electrophysiological testing is often normal in the evaluation of painful diabetic neuropathy, as it is unable to detect dysfunction of thinly myelinated (Aδ) and unmyelinated (C) small fibers. Although cutaneous silent periods (CSP) and quantitative sudomotor axon reflex testing (QSART) respectively evaluate these fiber types in the extremities, these two tests have yet to be assessed together. METHODS 26 patients with a clinical diagnosis of small fiber neuropathy (SFN) and 26 age-matched controls were assessed. Nine patients had Type I diabetes, nine had Type II diabetes, and eight had impaired glucose tolerance. The CSP onset latency and duration were recorded in each extremity. QSART was performed on the right side. RESULTS 58% (15/26) of patients had abnormal sweat volumes obtained from QSART, while 50% (13/26) of patients had abnormal CSP responses. Combining these two tests increased the sensitivity of testing to 77% (20/26). Abnormalities were seen equally across all patient groups. CONCLUSIONS Combining CSP with QSART significantly increases the sensitivity of testing when assessing patients with SFN related to diabetes, or prediabetes. SIGNIFICANCE For clinically suspected SFN, it is preferable to test more than one small fiber type, as each possess different structural and functional properties and may be heterogeneously affected between patients.
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Affiliation(s)
- J T Kamel
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia.
| | - S J Vogrin
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - R J Knight-Sadler
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - N K Willems
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - L Seiderer
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - M J Cook
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - R J MacIsaac
- Endocrinology & Diabetes, St. Vincent's Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | - L J Roberts
- St. Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research, Melbourne, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
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Zhang Y, Li J, Wang T, Wang J. Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases. Neural Regen Res 2014; 9:1389-94. [PMID: 25221597 PMCID: PMC4160871 DOI: 10.4103/1673-5374.137593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.
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Affiliation(s)
- Yunqian Zhang
- Department of Neurology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jintao Li
- Neuroscience Institute, Kunming Medical University, Kunming, Yunnan Province, China
| | - Tingjuan Wang
- Department of Neurology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jianlin Wang
- Department of Neurology, the Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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