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Trofin D, Salmen BM, Salmen T, Trofin DM, Reurean-Pintilei D. Advancing the Diagnosis of Diabetic Neuropathies: Electrodiagnostic and Skin Autofluorescence Methods. J Pers Med 2024; 14:884. [PMID: 39202075 PMCID: PMC11355645 DOI: 10.3390/jpm14080884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening value. This article highlights the diagnostic challenges and raises awareness of the often underdiagnosed neuropathic conditions in diabetes patients. MATERIAL AND METHODS We present common entrapment neuropathy cases from our diabetes clinic's electrodiagnosis laboratory in Iași, Romania. We selected seven type 2 diabetes patients with sensory or sensory-motor distal polyneuropathy and atypical DN presentations investigated through electroneurography (ENG) and electromyography (EMG) with the Neurosoft® EMG instrument and SAF measured by standard procedures. Subsequently, a narrative literature review was conducted. RESULTS Entrapment neuropathies were diagnosed in all the patients: three carpal tunnel syndromes, two ulnar neuropathies (one proximal, one distal), one peroneal neuropathy, and one case of meralgia paresthetica. The lower-limb cases showed radiculoplexopathy, and there was one case of superficial radial nerve neuropathy. The SAF values ranged from 2.5 AU to 3.4 AU. CONCLUSIONS Electrodiagnosis is essential for detecting focal neuropathies in patients with sensory-motor distal polyneuropathy. Elevated SAF levels may correlate with symptom severity, although further research, including large cohorts, is needed.
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Affiliation(s)
- Dan Trofin
- Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania; (D.T.); (D.R.-P.)
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, 700454 Iasi, Romania
| | - Bianca-Margareta Salmen
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Teodor Salmen
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - Delia Reurean-Pintilei
- Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania; (D.T.); (D.R.-P.)
- Department of Medical-Surgical and Complementary Sciences, Faculty of Medicine and Biological Sciences, “Ștefan cel Mare” University, 720229 Suceava, Romania
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Billerot E, Nguyen TH, Sedira N, Espinoza S, Vende B, Heron E, Habas C. Ocular motor nerve palsy in patients with diabetes: High-resolution MR imaging of nerve enhancement. J Fr Ophtalmol 2023; 46:726-736. [PMID: 37210294 DOI: 10.1016/j.jfo.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate the extent of signal abnormality in impaired ocular motor nerves using high signal and spatial resolution MRI sequences and to discuss the involvement of inflammatory or microvascular impairment in patients with diabetic ophthalmoplegia. METHODS We conducted a retrospective study of 10 patients referred for acute ocular motor nerve palsy in the context of diabetes mellitus from September 15th, 2021 to April 24th, 2022. 3T MRI evaluation included diffusion, 3D TOF, FLAIR, coronal STIR and post-injection 3D T1 SPACE DANTE sequences. RESULTS Ten patients were included: 9 males and 1 female aged from 46 to 79 years. Five patients presented with cranial nerve (CN) III palsy, and 5 presented with CN VI palsy. Third nerve palsy was pupil-sparing in 4 patients and pupil-involved in 1 patient. Pain was associated in all patients with CN III deficiencies and in 2 patients CN VI deficiencies. In all patients, MRI sequences ruled out mass effect and vascular pathology, such as acute stroke or aneurysm. Eight patients presented with STIR hypersignals, some with enlargement of the involved nerve. The diagnosis was confirmed through a post-injection 3D T1 SPACE DANTE sequence, which showed extended enhancement along the abnormal portion of the nerve. CONCLUSION High-resolution MRI evaluation of diplopia in diabetic patients is used to rule out a diagnosis of acute stroke and contributes to the positive diagnosis of ocular motor nerve impairment, possibly combining the influences of inflammatory and microvascular phenomena. Dedicated MR imaging should be included in the initial diagnosis and longitudinal follow-up of patients with diabetic ophthalmoplegia.
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Affiliation(s)
- E Billerot
- Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France
| | - T H Nguyen
- Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France.
| | - N Sedira
- Department of Internal Medicine, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France
| | - S Espinoza
- Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France
| | - B Vende
- Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France
| | - E Heron
- Department of Internal Medicine, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France
| | - C Habas
- Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France
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Bell DSH. Diabetic Mononeuropathies and Diabetic Amyotrophy. Diabetes Ther 2022; 13:1715-1722. [PMID: 35969368 PMCID: PMC9500121 DOI: 10.1007/s13300-022-01308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023] Open
Abstract
This brief review describes the etiology, pathophysiology, clinical features, therapy and prognosis of the diabetic mononeuropathies and diabetic amyotrophy and neuropathic cachexia. Mononeuropathies include cranial neuropathies, of which the oculomotor nerve is most commonly affected, and are thought to be due to microvascular occlusion. Peripherally, entrapment neuropathies occur in both the upper and lower limbs and are due to compression of an already damaged nerve in anatomically restricted channels. Diabetic radiculopathies occur in the dermatones of the thorax and abdomen, mimicking intraabdominal or intrathoracic pathology. I also describe the features of the rare but very distinctive diabetic amyotrophy and neuropathic cachexia. Overall, the prognosis from these conditions is excellent with residual pain or muscle weakness being rare with the exception of diabetic amyotrophy where the prognosis is dependent upon cooperation with intensive rehabilitation. Therapies include "watchful waiting," physical therapy and rarely surgical intervention, which may be urgently needed for nerve decompression and reversal of motor defects.
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Affiliation(s)
- David S H Bell
- Southside Endocrinology, 1900 Crestwood Blvd, Suite 201, Irondale, AL, 35210, USA.
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Yakovleva O, Albova P, Sitdikova G. The Role of Nitric Oxide in Regulation of Exocytosis and Endocytosis of Synaptic Vesicles in Motor Nerve Endings of Mice in Alloxan Model of Diabetes Mellitus. BIONANOSCIENCE 2022. [DOI: 10.1007/s12668-022-00976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nissen TD, Meldgaard T, Nedergaard RW, Juhl AH, Jakobsen PE, Karmisholt J, Drewes AM, Brock B, Brock C. Peripheral, synaptic and central neuronal transmission is affected in type 1 diabetes. J Diabetes Complications 2020; 34:107614. [PMID: 32571684 DOI: 10.1016/j.jdiacomp.2020.107614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/06/2019] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
AIMS We hypothesized that adults with type 1 diabetes and severe polyneuropathy have alterations in neuronal transmission at different anatomical levels. The aims were to investigate upstream sensory neuronal activation in terms of peripheral, spinal, precortical, and cortical transmission. METHODS 48 participants with type-1 diabetes and polyneuropathy, and 21 age-matched healthy participants were included. Electrophysiological median nerve recordings were used to analyze peripheral transmission at Erb's point (P9-N11); spinal evoked potentials at Cv7 (P11-N14); subcortical evoked potentials at Oz (N14-P18); early cortical evoked potentials at CP5 (N20-P22); late cortical evoked potentials at C1 (N60-P80) and estimated cortical inter-peak latencies as measures of central conduction time. RESULTS In comparison to healthy, the presence of diabetes prolonged peripheral transmission at P9 and N11 (+0.49 ms, p = .000; +0.47 ms, p = .04, respectively), early cortical evoked potentials at CP5: N20 (+2.41 ms, p = .003) and P22 (+5.88 ms, p = .001) and cortical potentials at C1: N60 (+39.08 ms, p = .001) and P80 (+54.55 ms, p = .000) and central conduction time. Decreased amplitudes were shown peripherally (-2.13 μV, p = .000), spinally (-0.57 μV, p = .005) and pre-cortically (-0.22 μV, p = .004). In both healthy and people with diabetes increased central conduction time were associated with decreased parasympathetic tone (ρ = -0.52, p = .027; ρ = -0.35, p = .047, respectively). CONCLUSION Neuronal afferent transmission and brain responses were significantly impaired in diabetes and the presence of prolonged central conduction time is indicative of severe extensive neuronal damage. Trial registry number: EUDRA CT: 2013-004375-12; clinicaltrials.gov: NCT02138045.
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Affiliation(s)
- Thomas Dahl Nissen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Theresa Meldgaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Wiberg Nedergaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne H Juhl
- Department of Neurophysiology, Aalborg University Hospital, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North, Denmark; Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Jesper Karmisholt
- Steno Diabetes Center North, Denmark; Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North, Denmark
| | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Region Hovedstaden, Gentofte, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review. J Clin Med 2020; 9:jcm9020602. [PMID: 32102313 PMCID: PMC7074122 DOI: 10.3390/jcm9020602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot is the most frequent disorder among the chronic complications of diabetes, happening in 25% of patients. Objective clinical outcome measures are tests or clinical instruments that provide objective values for result measurement. The aim of this study was to carry out a systematic review of specific objective clinical outcome measures focused on the assessment and monitoring of diabetic foot disorders. The databases used were PubMed, CINAHL, Scopus, PEDro, Cochrane, SciELO and EMBASE. Search terms used were foot, ankle, diabet*, diabetic foot, assessment, tools, instruments, objective outcome measures, valid*, reliab*. Because of the current published evidence, diabetic neuropathy assessment via sudomotor analysis, cardiovascular autonomic neuropathy and peripheral vascular disease detection by non-invasive electronic devices, wound 3D dimensional measurement, hyperspectral imaging for ulcer prediction and the probe-to-bone test for osteomyelitis diagnosis were highlighted in this study.
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Gilloteaux J, Subramanian K, Solomon N, Nicaise C. The leptin receptor mutation of the obese Zucker rat causes sciatic nerve demyelination with a centripetal pattern defect. Ultrastruct Pathol 2018; 42:377-408. [PMID: 30339059 DOI: 10.1080/01913123.2018.1522405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Young male Zucker rats with a leptin receptor mutation are obese, have a non-insulin-dependent diabetes mellitus (NIDDM), and other endocrinopathies. Tibial branches of the sciatic nerve reveal a progressive demyelination that progresses out of the Schwann cells (SCs) where electron-contrast deposits are accumulated while the minor lines or intermembranous SC contacts display exaggerated spacings. Cajal bands contain diversely contrasted vesicles adjacent to the abaxonal myelin layer with blemishes; they appear dispatched centripetally out of many narrow electron densities, regularly spaced around the myelin annulus. These anomalies widen and yield into sectors across the stacked myelin layers. Throughout the worse degradations, the adaxonal membrane remains along the axonal neuroplasm. This peripheral neuropathy with irresponsive leptin cannot modulate hypothalamic-pituitary-adrenal axis and SC neurosteroids, thus exacerbates NIDDM condition. Additionally, the ultrastructure of the progressive myelin alterations may have unraveled a peculiar, centripetal mode of trafficking maintenance of the peripheral nervous system myelin, while some adhesive glycoproteins remain between myelin layers, somewhat hindering the axon mutilation. Heading title: Peripheral neuropathy and myelin.
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Affiliation(s)
- Jacques Gilloteaux
- a Department of Anatomical Sciences , St George's University School of Medicine, K.B. Taylor Global Scholar's Program at Northumbria University , Newcastle upon Tyne , UK.,b Unité de Recherche en Physiologie Moléculaire (URPhyM), Laboratoire de Neurodégénérescence et Régénération, Département de Médecine , Université de Namur , Namur , Belgium
| | - Kritika Subramanian
- a Department of Anatomical Sciences , St George's University School of Medicine, K.B. Taylor Global Scholar's Program at Northumbria University , Newcastle upon Tyne , UK.,c Department of Clinical and Epidemiological Virology , Rega Institute of Medical Research, Katholiele Universiteit Leuven , Leuven , Belgium
| | - Nadia Solomon
- a Department of Anatomical Sciences , St George's University School of Medicine, K.B. Taylor Global Scholar's Program at Northumbria University , Newcastle upon Tyne , UK
| | - Charles Nicaise
- b Unité de Recherche en Physiologie Moléculaire (URPhyM), Laboratoire de Neurodégénérescence et Régénération, Département de Médecine , Université de Namur , Namur , Belgium
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Yakovleva OV, Zakharov AV, Zefirov AL, Sitdikova GF. Analysis of exo- and endocytosis in the mouse nerve ending in experimental diabetes mellitus. BIOCHEMISTRY (MOSCOW), SUPPLEMENT SERIES A: MEMBRANE AND CELL BIOLOGY 2017. [DOI: 10.1134/s199074781702009x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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9
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Rota E, Morelli N. Entrapment neuropathies in diabetes mellitus. World J Diabetes 2016; 7:342-353. [PMID: 27660694 PMCID: PMC5027001 DOI: 10.4239/wjd.v7.i17.342] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/18/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.
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Chakravarthy H, Navitskaya S, O'Reilly S, Gallimore J, Mize H, Beli E, Wang Q, Kady N, Huang C, Blanchard GJ, Grant MB, Busik JV. Role of Acid Sphingomyelinase in Shifting the Balance Between Proinflammatory and Reparative Bone Marrow Cells in Diabetic Retinopathy. Stem Cells 2016; 34:972-83. [PMID: 26676316 DOI: 10.1002/stem.2259] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/31/2015] [Accepted: 11/12/2015] [Indexed: 12/20/2022]
Abstract
The metabolic insults associated with diabetes lead to low-grade chronic inflammation, retinal endothelial cell damage, and inadequate vascular repair. This is partly due to the increased activation of bone marrow (BM)-derived proinflammatory monocytes infiltrating the retina, and the compromised function of BM-derived reparative circulating angiogenic cells (CACs), which home to sites of endothelial injury and foster vascular repair. We now propose that a metabolic link leading to activated monocytes and dysfunctional CACs in diabetes involves upregulation of a central enzyme of sphingolipid signaling, acid sphingomyelinase (ASM). Selective inhibition of ASM in the BM prevented diabetes-induced activation of BM-derived microglia-like cells and normalized proinflammatory cytokine levels in the retina. ASM upregulation in diabetic CACs caused accumulation of ceramide on their cell membrane, thereby reducing membrane fluidity and impairing CAC migration. Replacing sphingomyelin with ceramide in synthetic membrane vesicles caused a similar decrease in membrane fluidity. Inhibition of ASM in diabetic CACs improved membrane fluidity and homing of these cells to damaged retinal vessels. Collectively, these findings indicate that selective modulation of sphingolipid metabolism in BM-derived cell populations in diabetes normalizes the reparative/proinflammatory cell balance and can be explored as a novel therapeutic strategy for treating diabetic retinopathy.
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Affiliation(s)
| | - Svetlana Navitskaya
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Sandra O'Reilly
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Jacob Gallimore
- Department of Chemistry, Michigan State University, East Lansing, Michigan, USA
| | - Hannah Mize
- Department of Chemistry, Michigan State University, East Lansing, Michigan, USA
| | - Eleni Beli
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Qi Wang
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Nermin Kady
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Chao Huang
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Gary J Blanchard
- Department of Chemistry, Michigan State University, East Lansing, Michigan, USA
| | - Maria B Grant
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Julia V Busik
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
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Abstract
PURPOSE OF REVIEW This article provides an overview for understanding the diagnosis, pathogenesis, and management of diabetic neuropathy. RECENT FINDINGS New information about the pathogenesis of diabetic neuropathy continues to emerge, which will lead to identifying new drug targets. It is clear that the natural history of diabetic neuropathy is changing and the rate of progression is slowing. This is likely because of a combination of earlier diagnosis, improved glycemic management, and improved control of related complications such as hyperlipidemia and hypertension. Early diagnosis is critical, and small fiber neuropathy or subclinical diabetic neuropathy may be reversed or significantly improved with appropriate intervention. The American Academy of Neurology recently published guidelines for the treatment of painful diabetic neuropathy. SUMMARY Diabetic neuropathy is common and can present with varied clinical presentations discussed in this article. Although treatment currently focuses on pain management, attention should be paid to potential risk factors for neuropathy. For example, glycemic control, hyperlipidemia, and hypertension should be managed with diet, exercise, and medications. Class I or II clinical studies indicate that pregabalin, duloxetine, amitriptyline, gabapentin, and opioids are effective in the management of diabetic neuropathic pain.
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Alsunousi S, Marrif HI. Diabetic neuropathy and the sensory apparatus "meissner corpuscle and merkel cells". Front Neuroanat 2014; 8:79. [PMID: 25177276 PMCID: PMC4132297 DOI: 10.3389/fnana.2014.00079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/22/2014] [Indexed: 01/30/2023] Open
Affiliation(s)
- Salma Alsunousi
- Department of Histology, Faculty of Medicine, Benghazi University Benghazi, Libya
| | - Husnia I Marrif
- Department of Pharmaceutical Sciences, Princess Noura University Riyadh, Saudi Arabia
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Abstract
SIGNIFICANCE Mitochondrial dynamics describes the continuous change in the position, size, and shape of mitochondria within cells. The morphological and functional complexity of neurons, the remarkable length of their processes, and the rapid changes in metabolic requirements arising from their intrinsic excitability render these cells particularly dependent on effective mitochondrial function and positioning. The rules that govern these changes and their functional significance are not fully understood, yet the dysfunction of mitochondrial dynamics has been implicated as a pathogenetic factor in a number of diseases, including disorders of the central and peripheral nervous systems. RECENT ADVANCES In recent years, a number of mutations of genes encoding proteins that play important roles in mitochondrial dynamics and function have been discovered in patients with Charcot-Marie-Tooth (CMT) disease, a hereditary peripheral neuropathy. These findings have directly linked mitochondrial pathology to the pathology of peripheral nerve and have identified certain aspects of mitochondrial dynamics as potential early events in the pathogenesis of CMT. In addition, mitochondrial dysfunction has now been implicated in the pathogenesis of noninherited neuropathies, including diabetic and inflammatory neuropathies. CRITICAL ISSUES The role of mitochondria in peripheral nerve diseases has been mostly examined in vitro, and less so in animal models. FUTURE DIRECTIONS This review examines available evidence for the role of mitochondrial dynamics in the pathogenesis of peripheral neuropathies, their relevance in human diseases, and future challenges for research in this field.
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Affiliation(s)
- Marija Sajic
- Department of Neuroinflammation, UCL Institute of Neurology , Queen Square, London, United Kingdom
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Bendall LJ, Bradstock KF. G-CSF: From granulopoietic stimulant to bone marrow stem cell mobilizing agent. Cytokine Growth Factor Rev 2014; 25:355-67. [DOI: 10.1016/j.cytogfr.2014.07.011] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Tamás Várkonyi
- 1st Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Anna Körei
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Putz
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Kempler
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Abstract
Peripheral neuropathy is an important factor of disability in the elderly, which is significant now that up to 20% of the population is older than 60 years in industrialized countries. Potentially treatable neuropathies including primary inflammatory polyneuropathies and systemic disorders, especially vasculitic neuropathies, are as common in this age group as in younger patients. Neuropathies associated with diabetes, malignancy, and monoclonal gammopathies are even more common in these patients. It is thus essential to identify the causes of these neuropathies in this group of patients and treat them whenever feasible.
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Evliyaoglu F, Karadag R, Burakgazi AZ. Ocular neuropathy in peripheral neuropathies. Muscle Nerve 2012; 46:681-6. [PMID: 23055310 DOI: 10.1002/mus.23414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ocular movements and coordination require complex and integrated functions of somatic and autonomic nervous systems. Neurological disorders affecting these nervous systems may cause ocular dysfunction involving extraocular muscles and pupils. In this article, the prevalence, clinical presentations, and management of ocular neuropathy related to certain peripheral neuropathies, including diabetic neuropathy, Guillain-Barré syndrome (GBS), chronic inflammatory neuropathies, human immunodeficiency virus (HIV)-associated neuropathy, and hereditary neuropathies, are examined in detail.
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Affiliation(s)
- Ferhat Evliyaoglu
- Department of Ophthalmology, Okmeydani Research and Training Hospital, Istanbul, Turkey
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Abstract
OBJECTIVE Diabetes is the most common cause of neuropathy. Focal diabetic neuropathy, although less common than entrapment neuropathy, clinically mimics entrapment neuropathy. This article depicts the spectrum of MR abnormalities in diabetic subjects- from abnormal T2 hyperintensity and fascicular enlargement in the acute and subacute stages to atrophic-appearing fascicles with intraepineurial fat deposition in the chronic stage-on high-resolution high-field (3-T) MRI. CONCLUSION A spectrum of imaging abnormalities is observed in diabetic neuropathy. It is important for radiologists to understand the pathophysiology and recognize high-resolution MR appearances of these lesions and of related entities in the differential diagnosis for appropriate diagnosis and patient treatment.
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Affiliation(s)
- R T Ibitoye
- Department of Medicine, Lancashire Teaching Hospitals NHS Trust, Chorley and South Ribble Hospital, Preston Road, Chorley, Lancashire, PR7 1PP, UK.
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Sales KLDS, Souza LAD, Cardoso VS. Equilíbrio estático de indivíduos com neuropatia periférica diabética. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000200006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O diabetes mellitus (DM) é uma das enfermidades crônicas mais diagnosticadas nos últimos anos. A neuropatia diabética periférica (NP) é a complicação mais prevalente dessa doença, atingindo até 80% dos diabéticos, podendo modificar o equilíbrio. Este estudo teve por objetivo comparar o equilíbrio estático de indivíduos diabéticos neuropatas, diabéticos não neuropatas e indivíduos sem DM e averiguar a influência da visão nessa situação. Foram avaliados 30 indivíduos, divididos em três grupos diferentes: GC, 10 não diabéticos (média de idade 55,5±9,72 anos); GD: 10 diabéticos sem NP (54,4±7,76 anos); e GNP, 10 diabéticos com NP (60,4±5,35 anos). Cada indivíduo foi filmado nos planos frontal e sagital, com e sem visão, avaliado quadro a quadro no software Free Video to JPG Converter®, para a seleção dos momentos de maiores oscilações. As imagens foram quantificadas através da Biofotogrametria Computadorizada, utilizando-se o software SAPO. Os dados foram tratados estatisticamente no software Graph Pad Prism (versão 5). Os resultados evidenciam que o grupo GNP apresentou diferenças estatisticamente significantes nas amplitudes de oscilações no plano frontal e sagital, nas condições com e sem visão, quando comparado com os outros grupos (p=0,0001). Mediante os resultados, concluiu-se que a NP influencia negativamente na manutenção do equilíbrio estático, principalmente sem visão.
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Liu GS, Shi JY, Lai CL, Hong YR, Shin SJ, Huang HT, Lam HC, Wen ZH, Hsu KS, Chen CH, Howng SL, Tai MH. Peripheral gene transfer of glial cell-derived neurotrophic factor ameliorates neuropathic deficits in diabetic rats. Hum Gene Ther 2010; 20:715-27. [PMID: 19374591 DOI: 10.1089/hum.2009.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deprivation of neurotrophic factors contributes to the pathogenesis of diabetic neuropathy. However, the role of glial cell-derived neurotrophic factor (GDNF) in the pathogenesis of diabetic neuropathy remains unclear. The present study evaluated the pathogenic role of GDNF deficiency and the therapeutic potential of GDNF gene transfer for diabetic neuropathy. After injection of streptozotocin (STZ) for 2 weeks, diabetic rats displayed significant alteration in electrophysiological parameters, which was associated with structural changes and defective myelination in the sciatic nerves. The early diabetic neuropathy was accompanied by attenuation of the GDNF/GFRalpha1/Akt signaling cascade and depletion of sensory neuropeptides in the peripheral nerves. After detection of neuropathy, intramuscular GDNF gene transfer reversed the deficiency of GDNF/Akt signaling in the sciatic nerve and improved the neurological functions of diabetic rats. Moreover, GDNF gene delivery alleviated the axonal demyelination and restored the sensory neuropeptide levels in the sciatic nerve of diabetic rats. In summary, peripheral GDNF gene delivery ameliorates the diabetes-induced downregulation of the GDNF signaling complex in the peripheral nervous system and holds promises for treatment of diabetic neuropathy.
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Affiliation(s)
- Guei-Sheung Liu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
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Busik JV, Tikhonenko M, Bhatwadekar A, Opreanu M, Yakubova N, Caballero S, Player D, Nakagawa T, Afzal A, Kielczewski J, Sochacki A, Hasty S, Li Calzi S, Kim S, Duclas SK, Segal MS, Guberski DL, Esselman WJ, Boulton ME, Grant MB. Diabetic retinopathy is associated with bone marrow neuropathy and a depressed peripheral clock. ACTA ACUST UNITED AC 2009; 206:2897-906. [PMID: 19934019 PMCID: PMC2806461 DOI: 10.1084/jem.20090889] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present epidemic of diabetes is resulting in a worldwide increase in cardiovascular and microvascular complications including retinopathy. Current thinking has focused on local influences in the retina as being responsible for development of this diabetic complication. However, the contribution of circulating cells in maintenance, repair, and dysfunction of the vasculature is now becoming appreciated. Diabetic individuals have fewer endothelial progenitor cells (EPCs) in their circulation and these cells have diminished migratory potential, which contributes to their decreased reparative capacity. Using a rat model of type 2 diabetes, we show that the decrease in EPC release from diabetic bone marrow is caused by bone marrow neuropathy and that these changes precede the development of diabetic retinopathy. In rats that had diabetes for 4 mo, we observed a dramatic reduction in the number of nerve terminal endings in the bone marrow. Denervation was accompanied by increased numbers of EPCs within the bone marrow but decreased numbers in circulation. Furthermore, denervation was accompanied by a loss of circadian release of EPCs and a marked reduction in clock gene expression in the retina and in EPCs themselves. This reduction in the circadian peak of EPC release led to diminished reparative capacity, resulting in the development of the hallmark feature of diabetic retinopathy, acellular retinal capillaries. Thus, for the first time, diabetic retinopathy is related to neuropathy of the bone marrow. This novel finding shows that bone marrow denervation represents a new therapeutic target for treatment of diabetic vascular complications.
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Affiliation(s)
- Julia V Busik
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
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Alves C, Braid Z, Públio N. Chronic inflammatory demyelinating polyneuropathy in an adolescent with type 1 diabetes mellitus. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:311-3. [DOI: 10.1590/s0004-282x2009000200029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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