The Impact of Serum Vitamin D Concentration on Median Nerve Conduction

Year 2018, Volume: 9 Issue: 2, 63 - 66, 13.06.2018

Gökhan Özer

https://doi.org/10.5799/jcei.433800

Abstract

Objectives: To perform nerve conduction studies (NCS)
and to evaluate distal latency, amplitude and conduction velocity values of the
median nerve in relation to serum vitamin D levels in patients with neuropathic
symptoms compared to controls.

Patients and Methods: Patients with
neuropathic symptoms of numbness, tingling and burning sensation were included
in the study. Serum 1,25(OH) D3 levels were measured and patients were
stratified by vitamin D status into three subgroups. Electrophysiological
assessments of the median nerve were performed as recommended by the American
Society of Electrodiagnostic Medicine. SPSS for Windows, version 24 was
used for statistical analyses. Median nerve conduction values were compared
between patient and control groups in relation to vitamin D concentration.

Results: The study enrolled 39 patients including
24 (61.5%) males and 15 (38.5%) females and 39 control subjects including 22
(56.4%) males 17 (43.6%) females. Patient and control groups had a mean age of 45
years. Average vitamin D concentration was 8.5 ng/ml in the patient group and
8.8 ng/ml in the control group. There was no statistically significant
difference between two groups with respect to age and average vitamin D
concentration (p=0.552). Greater distal latency values and a statistically
significant association between median nerve distal latency and vitamin D
deficiency were found in the vitamin D-deficient subgroup (p=0.024).

Conclusion: Given the neuroprotective action of
vitamin D and the involvement of vitamin D deficiency in several neurological
diseases as well as evidence that it might be an independent risk factor and a
potential biomarker for neuropathy, we believe that patients presenting with
mononeuropathy or polyneuropathy to a healthcare facility should be screened
for vitamin D deficiency. 

Keywords

25-hydroxyvitamin D, median nerve, conduction

References

• 1. Buell JS, Dawson-Hughes B. Vitamin D and neurocognitive dysfunction: preventing “D“ecline? Mol. Aspects Med. 2008;29:415–22.
• 2. Prabhakar P, Majumdar V, Kulkarni GB, Christopher R. Genetic variants of vitamin D receptor and susceptibility to ischemic stroke. Biochem Biophys Res. Commun. 2015;456:631–6.
• 3. Prakash S, Mehta NC, Dabhi AS, Lakhani O, Khilari M, Shah ND. The prevalence of headache may be related with the latitude: A possible role of Vitamin D insufficiency? J Headache Pain. 2010;11:301–7.
• 4. Andıran N, Çelik N, Akça H, Doğan G. Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol. 2012;4:25–9.
• 5. Katz JN, Simmons BP. Carpal tunnel syndrome. N Eng J Med. 2002; 346:1807-12.
• 6. D’Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 2000; 283:3110-7.
• 7. Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T. Current concepts of carpal tunnel syndrome. Pathophysiology, treatment and evaluation. J Orthop Sci. 2010;15:1-13.
• 8. Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg. 2002;48:269–73.
• 9. Bland JD. Carpal tunnel syndrome. Curr Opin Neurol. 2005;18:581-5.
• 10. Alemdar M. Carpal Tunnel syndrome: Anatomy, symptoms, diagnostic tools and treatment: Review. Turkiye Klinikleri J Neur. 2009;4:19-32.
• 11. Taniura H, Ito M, Sanada N, et al. Chronic vitamin D3 treatment protects against neurotoxicity by glutamate in association with upregulation of vitamin D receptor mRNA expression in cultured rat cortical neurons. J Neurosci Res 2006;83:1179-89.
• 12. Veenstra TD, Prüfer K, Koenigsberger C, et al. 1,25-Dihydroxyvitamin D3 receptors in the central nervous system of the rat embryo. Brain Res 1998;804:193- 205.
• 13. Ibi M, Sawada H, Nakanishi M, et al. Protective effects of 1 alpha,25-(OH) (2)D(3) against the neurotoxicity of glutamate and reactive oxygen species in mesencephalic culture. Neuropharmacology 2001;40:761-71.
• 14. Wang T, Bengtsson G, Kärnefelt I, et al. Provitamins and vitamins D2 and D3 in Cladina spp. over a latitudinal gradient: possible correlation with UV levels. J Photochem Photobiol B. 2001;62:118-22.
• 15. Shehab D, Al-Jarallah K, Mojiminiyi OA, Al Mohamedy H, Abdella NA. Does Vitamin D deficiency play a role in peripheral neuropathy in Type 2 diabetes? Diabet Med. 2012;29:43–9.
• 16. Alamdari A, Mozafari R, Tafakhori A, et al. An inverse association between serum vitamin D levels with the presence and severity of impaired nerve conduction velocity and large fiber peripheral neuropathy in diabetic subjects. Neurol Sci. 2015;36:1121–6.
• 17. Esteghamati A, Fotouhi A, Faghihi-Kashani S, Hafezi-Nejad N, Heidari B, Sheikhbahaei S, et al. Non-linear contribution of serum vitamin D to symptomatic diabetic neuropathy: A case-control study. Diabetes Res Clin Pract. 2016;111:44–50.
• 18. Buell JS, Dawson-Hughes B. Vitamin D and neurocognitive dysfunction: preventing “D“ecline? Mol Aspects Med. 2008;29:415–22.
• 19. Prabhakar P, Majumdar V, Kulkarni GB, Christopher R. Genetic variants of vitamin D receptor and susceptibility to ischemic stroke. Biochem Biophys Res Commun. 2015;456:631–6.
• 20. Prakash S, Mehta NC, Dabhi AS, Lakhani O, Khilari M, Shah ND. The prevalence of headache may be related with the latitude: A possible role of Vitamin D insufficiency? J Headache Pain. 2010;11:301–7.
• 21. Andıran N, Çelik N, Akça H, Doğan G. Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol. 2012;4:25–9.
• 22. Demiryurek BE, Gundogdu AA. The effect of vitamin D levels on pain in carpal tunnel syndrome. Orthop Traumatol Surg Res. 2017;103:919-22.
• 23. Gürsoy AE, Bilgen HR, Dürüyen H, Altıntaş Ö, Kolukisa M, Asil T. The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci. 2016;37:1055-61.
• 24. Tanik N, Balbaloğlu Ö, Ucar M, et al. Does vitamin D deficiency trigger carpal tunnel syndrome? J Back Musculoskelet Rehabil. 2016;29:835-9.
• 25. He R, Hu Y, Zeng H, et al. Vitamin D deficiency increases the risk of peripheral neuropathy in Chinese patients with type 2 diabetes. Diabetes Metab Res Rev. 2017;33:21-6.
• 26. Lee SH, Gong HS, Kim DH, et al. Evaluation of vitamin D levels in women with carpal tunnel syndrome. J Hand Surg Eur. 2016;41:643-7.