Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J Clin Neurophysiol. 2021 Jul 1;38(4):299-305. doi: 10.1097/WNP.0000000000000691.
Comprehensive evaluation of the upstream sensory processing in diabetic symmetrical polyneuropathy (DSPN) is sparse. The authors investigated the spinal nociceptive withdrawal reflex and the related elicited somatosensory evoked cortical potentials. They hypothesized that DSPN induces alterations in spinal and supraspinal sensory-motor processing compared with age- and gender-matched healthy controls.
In this study, 48 patients with type 1 diabetes and DSPN were compared with 21 healthy controls. Perception and reflex thresholds were determined and subjects received electrical stimulations on the plantar site of the foot at three stimulation intensities to evoke a nociceptive withdrawal reflex. Electromyogram and EEG were recorded for analysis.
Patients with DSPN had higher perception (P < 0.001) and reflex (P = 0.012) thresholds. Fewer patients completed the recording session compared with healthy controls (34/48 vs. 21/21; P = 0.004). Diabetic symmetrical polyneuropathy reduced the odds ratio of a successful elicited nociceptive withdrawal reflex (odds ratio = 0.045; P = 0.014). Diabetic symmetrical polyneuropathy changed the evoked potentials (F = 2.86; P = 0.025), and post hoc test revealed reduction of amplitude (-3.72 mV; P = 0.021) and prolonged latencies (15.1 ms; P = 0.013) of the N1 peak.
The study revealed that patients with type 1 diabetes and DSPN have significantly changed spinal and supraspinal processing of the somatosensory input. This implies that DSPN induces widespread differences in the central nervous system processing of afferent A-δ and A-β fiber input. These differences in processing may potentially lead to identification of subgroups with different stages of small fiber neuropathy and ultimately differentiated treatments.
全面评估糖尿病对称性多发性神经病（DSPN）的上行感觉处理较为少见。作者研究了脊髓伤害性回避反射和相关诱发的体感皮质诱发电位。他们假设与年龄和性别匹配的健康对照组相比，DSPN 会引起脊髓和脊髓上感觉运动处理的改变。
在这项研究中，将 48 例 1 型糖尿病伴 DSPN 的患者与 21 例健康对照者进行比较。测定感知和反射阈值，并用三种刺激强度对足部足底部位进行电刺激以诱发伤害性回避反射。记录肌电图和脑电图进行分析。
与健康对照组相比，DSPN 患者的感知（P<0.001）和反射（P=0.012）阈值更高。与健康对照组相比，完成记录的患者更少（34/48 比 21/21；P=0.004）。糖尿病对称性多发性神经病降低了诱发伤害性回避反射成功的比值比（比值比=0.045；P=0.014）。糖尿病对称性多发性神经病改变了诱发电位（F=2.86；P=0.025），事后检验显示 N1 峰的振幅降低（-3.72 mV；P=0.021）和潜伏期延长（15.1 ms；P=0.013）。
本研究表明，1 型糖尿病伴 DSPN 患者的躯体感觉输入的脊髓和脊髓上处理有明显改变。这意味着 DSPN 会导致中枢神经系统对传入 A-δ 和 A-β 纤维输入的处理产生广泛差异。这些处理差异可能潜在地导致识别具有不同小纤维神经病阶段的亚组，并最终进行差异化治疗。
