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Cutaneous Silent Periods in Type II Diabetes Mellitus

Year 2019, Volume: 4 Issue: 2, 210 - 220, 30.06.2019
https://doi.org/10.26453/otjhs.484278

Abstract

We aimed to test whether cutaneous silent
period (CSP) is superior or not to the other electrophysiological tests and
also to clinical examination to show small fiber involvement and also to show A
Delta fiber anomalies in diabetic sensory motor neuropathy. We tested 51 DM
Type II patients and 19 normal healthy subjects. Motor and sensory conduction
velocities, tibial nerve F wave responses, H reflexes and CSP recordings were
done in two lower an done upper extremity. According to the abnormalities
observed in H reflex latencies, tibial nerve conduction velocities, minimal
Tibial F wave latencies and sural nerve action potential amplitudes in patients
group, patients with no abnormality were grouped into A, and if there were two
abnormalities into B, and if there were three or more abnormalities into C.
Groups were compared with each other and with control subjects. The onset
latency of CSP especially in C group was significantly longer in patients group
when compared with controls (p=0.008). However, the duration and the ending
latencies of CSP were not different. In tibial nerve motor conduction
velocities in control subjects were significantly different from B and C group
(p=0.008, p=0.000 respectively). Tibial F wave latency (p=0.008,  p=0.000) and H reflex latency (p=0.002 ,
p=0.000) were significantly late in B and C groups. These findings observed in
onset latencies suggest us that A delta fibers were also involved in DM. While
in mild or moderate sensory neuropathy, CSP abnormalities could not be found,
in severe neuropathy the onset latency 
of CSP was significantly late. 

References

  • 1. Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. Handb Clin Neurol. 2014;126:3-22.
  • 2. Said G. Diabetic neuropathy--a review. Nat Clin Pract Neurol. 2007;3(6):331-40.
  • 3. Öge AE, Yayla V. Uyandırılmış Potansiyeller. Klinik Nörofizyoloji İncelemeleri in; Öge AE, Baykan B. ed. Nöroloji. 2. Baskı. İstanbul: Nobel Tıp Kitabevleri. 2011;143-153.
  • 4. Leis AA, Kofler M, Stetkarova I, Stokic DS . The cutaneous silent period is preserved in cervical radiculopathy: significance for the diagnosis of cervical myelopathy Eur Spine J. 2011;20(2):236-9.
  • 5. Floeter MK. Cutaneous silent periods Muscle & Nerve.2003:331-401.
  • 6. Snell Richard S.Clinical Neuroanatomy 7 thed ,USA. Lippincott Wiliams Wilkins.2010.
  • 7. Shin J.Oh. Clinical electromyograph. Nerve conduction studies. Third edition. Lippincott Wiliams Wilkins. 2003.
  • 8. Yoon TS , Han SJ, Lee JE, Park DS, Jun AY. Changes in the cutaneous silent period by paired stimulation. Neurophysiol Clin. 2011;41(2):67-72.
  • 9. Manconi FM, Syed NA, Floeter MK. Mechanisms underlying spinal motor neuron excitability during the cutaneous silent periods in humans. Muscle Nerve. 1998;21:1256-1264.
  • 10. Stetkarova I, Kofler M, Majerova V. Cutaneous silent periods in multiple system atrophy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):327-32.
  • 11. Stetkarova I, Kofler M, Leis AA. Cutaneous and mixed nerve silent periods in syringomyelia. Clinical Neurophysiology. 2001;112(1):78-85.
  • 12. Tiric-Campara M, Denislic M, Tupkovic et al. Cutaneous silent period in the assessment of small nerve fibers in patients on hemodialysis. Med Glas (Zenica). 2014;11(2):270-5.
  • 13. Syed NA, Sandbrink F, Luciano CA, et al.Cutaneous silent periods in patients with Fabry disease. Muscle Nerve. 2000;23(8):1179-86.
  • 14. Koo YS, Park HR, Joo BE et al. Utility of the cutaneous silent period in the evaluation of carpal tunnel syndrome. Clin Neurophysiol. 2010;121(9):1584-1588.
  • 15. Duarte JM, D'Onofrio HM, Rolón JI, Bertotti AC. The impairment of A-delta fibers in median nerve compression at the wrist, using the cutaneous silent period . Medicana (B Aires). 2016;76(4):219-22.
  • 16. Lopergolo D, Isak B, Gabriele M, et al.Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin neuruphsiol. 2015;126(9):1780-9.
  • 17. Kim BJ, Kim NH, Kim SG, et al. Utility of the cutaneous silent period in patients with diabetes mellitus. J neurol sci. 2010;15;293(1-2):1-5.
  • 18. Sahin O, Yildiz S, Yildiz N. Cutaneous silent period in fibromyalgia. Neurol res. 2011;33(4):339-43.
  • 19. Eckert NR, Poston B, Riley ZA. Differential processing of nociceptive input within upper limb muscles. Plos One. 2018;25;13(4):e0196129.

Tip II Diabetes Mellitus’ta Kutanöz Sessiz Periyod

Year 2019, Volume: 4 Issue: 2, 210 - 220, 30.06.2019
https://doi.org/10.26453/otjhs.484278

Abstract



Diabetik sensorimotor 
polinöropatide   küçük lif
tutulumunu göstermekte kutanöz sessiz periyodun (KSP) diğer elektrofizyolojik
yöntemlere ve klinik muayeneye bir üstünlük taşıyıp taşımadığı, tutulan liflere
ek olarak A-Delta liflerindeki anormalliği göstermekte ne
düzeyde katkı sağlayacağının araştırılması planlandı. 51 Diabetes Mellitus (DM)
Tip II'li olgu ve 19 adet normal olgu incelendi. İki alt ve bir üst
ekstremitede motor ve duysal iletiler, Tibial F yanıt, H refleksi ve KSP kaydı
yapıldı. Hasta grubu H refleks latans, tibial ileti hızı, minimal Tibial F
yanıt latansı ve sural sinir duysal yanıt amplitüdlerinde rastlanan anormalliklere
göre normaller A Grubu, iki testinde pozitif sonuç alınanlar B grubu ve üç ya
da dört testte patoloji saptananlar C grubu olarak sınıflandırıldı. Grupların
kendi aralarında ve kontrollerle sonuçları karşılaştırıldı. Sonuç olarak KSP
başlangıç latansının hasta grubunda, özellikle de C grubu kontrollerle
karşılaştırıldığında anlamlı olarak geciktiği tespit edildi (p=0,008). KSP
süresi ve bitiş latansında buna benzer bir değişiklik saptanmadı. Tibial sinir
motor yanıt ileti hızı  kontroller ile B
ve C grubu arasında anlamlı fark vardı (p=0,008 ve p=0,000). B ve C grubunda
Tibial F yanıt latansı sırasıyla 
(p=0,008 ve p=0,000 ) ve  H
refleks latansı da sırasıyla (p=0,002 ve p=0,000) istatistiksel anlamlı uzun
saptandı. Başlangıç latansındaki bu gecikmenin diabette diğer duysal uyarıları
taşıyan liflerle birlikte belirgin A-Delta tutulumunu gösteriyor olabileceğini
düşündürmüştür. Hafif ve orta düzeyde polinöropatisi olanlarda KSP anormalliği
gözlenmezken ciddi polinöropatisi olanlarda KSP başlangıç latansının anlamlı
uzun olduğu görülmüştür.

References

  • 1. Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. Handb Clin Neurol. 2014;126:3-22.
  • 2. Said G. Diabetic neuropathy--a review. Nat Clin Pract Neurol. 2007;3(6):331-40.
  • 3. Öge AE, Yayla V. Uyandırılmış Potansiyeller. Klinik Nörofizyoloji İncelemeleri in; Öge AE, Baykan B. ed. Nöroloji. 2. Baskı. İstanbul: Nobel Tıp Kitabevleri. 2011;143-153.
  • 4. Leis AA, Kofler M, Stetkarova I, Stokic DS . The cutaneous silent period is preserved in cervical radiculopathy: significance for the diagnosis of cervical myelopathy Eur Spine J. 2011;20(2):236-9.
  • 5. Floeter MK. Cutaneous silent periods Muscle & Nerve.2003:331-401.
  • 6. Snell Richard S.Clinical Neuroanatomy 7 thed ,USA. Lippincott Wiliams Wilkins.2010.
  • 7. Shin J.Oh. Clinical electromyograph. Nerve conduction studies. Third edition. Lippincott Wiliams Wilkins. 2003.
  • 8. Yoon TS , Han SJ, Lee JE, Park DS, Jun AY. Changes in the cutaneous silent period by paired stimulation. Neurophysiol Clin. 2011;41(2):67-72.
  • 9. Manconi FM, Syed NA, Floeter MK. Mechanisms underlying spinal motor neuron excitability during the cutaneous silent periods in humans. Muscle Nerve. 1998;21:1256-1264.
  • 10. Stetkarova I, Kofler M, Majerova V. Cutaneous silent periods in multiple system atrophy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):327-32.
  • 11. Stetkarova I, Kofler M, Leis AA. Cutaneous and mixed nerve silent periods in syringomyelia. Clinical Neurophysiology. 2001;112(1):78-85.
  • 12. Tiric-Campara M, Denislic M, Tupkovic et al. Cutaneous silent period in the assessment of small nerve fibers in patients on hemodialysis. Med Glas (Zenica). 2014;11(2):270-5.
  • 13. Syed NA, Sandbrink F, Luciano CA, et al.Cutaneous silent periods in patients with Fabry disease. Muscle Nerve. 2000;23(8):1179-86.
  • 14. Koo YS, Park HR, Joo BE et al. Utility of the cutaneous silent period in the evaluation of carpal tunnel syndrome. Clin Neurophysiol. 2010;121(9):1584-1588.
  • 15. Duarte JM, D'Onofrio HM, Rolón JI, Bertotti AC. The impairment of A-delta fibers in median nerve compression at the wrist, using the cutaneous silent period . Medicana (B Aires). 2016;76(4):219-22.
  • 16. Lopergolo D, Isak B, Gabriele M, et al.Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin neuruphsiol. 2015;126(9):1780-9.
  • 17. Kim BJ, Kim NH, Kim SG, et al. Utility of the cutaneous silent period in patients with diabetes mellitus. J neurol sci. 2010;15;293(1-2):1-5.
  • 18. Sahin O, Yildiz S, Yildiz N. Cutaneous silent period in fibromyalgia. Neurol res. 2011;33(4):339-43.
  • 19. Eckert NR, Poston B, Riley ZA. Differential processing of nociceptive input within upper limb muscles. Plos One. 2018;25;13(4):e0196129.
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research article
Authors

Sibel Üstün Özek 0000-0003-1165-2648

Serpil Kuyucu Yıldız This is me 0000-0002-9647-4432

Nebil Yıldız This is me 0000-0002-1845-0902

Publication Date June 30, 2019
Submission Date November 16, 2018
Acceptance Date January 22, 2019
Published in Issue Year 2019 Volume: 4 Issue: 2

Cite

AMA Üstün Özek S, Kuyucu Yıldız S, Yıldız N. Tip II Diabetes Mellitus’ta Kutanöz Sessiz Periyod. OTJHS. June 2019;4(2):210-220. doi:10.26453/otjhs.484278

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