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Diabetic Neuropathy Emg

Comparison Of Efficiencies Of Michigan Neuropathy Screening Instrument, Neurothesiometer, And Electromyography For Diagnosis Of Diabetic Neuropathy

Comparison Of Efficiencies Of Michigan Neuropathy Screening Instrument, Neurothesiometer, And Electromyography For Diagnosis Of Diabetic Neuropathy

Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy 1Ankara Numune Education and Research Hospital, Department of Endocrinology, Shhiye, 06622 Ankara, Turkey 2Duzce University, Faculty of Medicine, Endocrinology and Metabolism Department, Turkey 3Ankara Numune Research and Education Hospital, Department of Neurology, Turkey Received 25 February 2013; Revised 21 April 2013; Accepted 22 April 2013 Copyright 2013 Turkan Mete et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score 2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectivel Continue reading >>

Diabetic Neuropathy - Exams And Tests

Diabetic Neuropathy - Exams And Tests

A diagnosis of diabetic neuropathy is based largely on your symptoms, medical history and physical examination. During a physical exam, your doctor may check how well you feel light touch, temperature, pain, vibration, and movement. Your doctor may also check your strength and reflexes. Electromyogram (EMG) and nerve conduction studies may be done to confirm a diagnosis. These tests measure how well and how quickly the nerves conduct electrical impulses. When nerve damage is present, the speed of nerve function slows. Problems linked with autonomic neuropathy-which affects the nerves that control internal functions-can be hard to diagnose. When new symptoms develop, more testing may be needed to diagnose the problem, identify the cause, and guide treatment. For example, a study that measures how fast your stomach empties may be done if symptoms like bloating, indigestion, or vomiting suggest gastroparesis, a condition that causes the stomach to take too long to empty. Nerve problems in people who have diabetes may be caused by other conditions, such as kidney disease, alcohol dependence, or a vitamin B12 deficiency. A variety of laboratory tests (such as a complete blood count) may be used to screen for conditions other than diabetes that could be causing symptoms. Your symptoms and medical history will determine which tests are needed. For some diseases, doctors can use screening tests to look for problems before you have any symptoms. But doctors can't test for all types of autonomic or focal neuropathy. So it is important to report to your doctor any pain, weakness, or motor problems you have. Also mention any changes in digestion, urination, sexual function, sweating, or dizziness. Your doctor will also look for signs of autonomic neuropathy during your physical exa Continue reading >>

Peripheral Neuropathy Clinical And Electrophysiological Considerations

Peripheral Neuropathy Clinical And Electrophysiological Considerations

Peripheral Neuropathy Clinical and Electrophysiological Considerations 1Department of Neurology, Johns Hopkins University School of Medicine Baltimore, Maryland 2Department of Neuroscience, Johns Hopkins University School of Medicine Baltimore, Maryland 1Department of Neurology, Johns Hopkins University School of Medicine Baltimore, Maryland 2Department of Neuroscience, Johns Hopkins University School of Medicine Baltimore, Maryland Corresponding author: Thomas E. Lloyd, [email protected] The publisher's final edited version of this article is available at Neuroimaging Clin N Am See other articles in PMC that cite the published article. This article is a primer on the pathophysiology and clinical evaluation of peripheral neuropathy for the radiologist. Magnetic resonance neurography (MRN) has utility in the diagnosis of many focal peripheral nerve lesions. When combined with history, examination, electrophysiology, and laboratory data, future advancements in high-field MRN may play an increasingly important role in the evaluation of patients with peripheral neuropathy. Keywords: neuroimaging, peripheral neuropathy, electromyography, nerve conduction study, entrapment neuropathy, hereditary neuropathy Although neuroimaging has been used routinely to help diagnose focal nerve lesions such as trauma and tumors for years, the utility of high-resolution MR Neurography in evaluation of multifocal and systemic polyneuropathies is just being investigated[ 1 ]. For the neurologist, the anatomic distribution, temporal progression, and electrophysiological properties of neuropathies guide the differential diagnosis, workup, and management of most forms of peripheral neuropathy; and, at present, MR Neurography is not part of the standard workup for patients with peripheral neuropat Continue reading >>

Internet Scientific Publications

Internet Scientific Publications

All electrophysiological studies were performed on a multiple channel EMG apparatus (Medelec Sapphire 4ME). The electrodiagnosis protocol recommended by the American Diabetes Association was used for the NCS12. Median, ulnar and peroneal motor fibers, median and ulnar sensory fibers and sural nerves were studied. The compound muscle action potentials (CMAP) were recorded with surface recording bar electrodes, which were placed over the main bulk of abductor pollicis brevis, abductor digiti minimi and extensor digitorum brevis for the median, ulnar and peroneal nerves respectively. A bipolar percutaneous stimulator was located at the wrist 7 cm proximal to the active recording electrode for median and ulnar motor NCS. Proximally the median nerve was stimulated just medial to the biceps tendon at the elbow crease and the ulnar nerve was stimulated below and above the elbow with a distance of at least 14 cm. The stimulation was delivered between the tendons of tibialis anterior and extansor hallicus longus muscles 9 cm proximal to the active recording electrode and from the fibular head for the peroneal motor NCS. A supramaximal stimulation of 0.1 ms duration was delivered for all the motor NCS. The sensory nerve action potentials (SNAP) were recorded by antidromic tecniques. The recording electrode was placed on the 3rd and the 5th digit for median and ulnar nerves respectively with stimulating 13 cm proximally from the wrist just medial to the flexor carpi radialis tendon for the median nerve and 11 cm proximally just posterior to the flexor carpi ulnaris tendon for the ulnar nerve. The recording electrode for sural nerve studies was placed behind the lateral malleolus and it was stimulated in the midcalf 14 cm proximal to the active recording electrode. All SNAP's were Continue reading >>

Diabetic Neuropathy: Your Diagnosis

Diabetic Neuropathy: Your Diagnosis

If you've been diagnosed with prediabetes or type 1 or type 2 diabetes, getting checked for diabetic peripheral neuropathy—damage to nerves in your feet, lower legs, hands and elsewhere—is critical. Having this common condition diagnosed can help you get relief from nerve pain, protect your feet from small injuries before they become more serious, help you walk more easily if nerve damage is affecting your balance or coordination, and may motivate you to keep your glucose (blood sugar) within healthy limits and follow a healthy lifestyle strategies. This could prevent or delay the development of neuropathy if you have type 1 diabetes and may prevent or slow down the worsening of neuropathy if you have type 2 diabetes. That’s why the American Diabetes Association, the American Association of Clinical Endocrinologists1 and the American College of Endocrinology recommend screening for PDN when you are first diagnosed with type 2 diabetes or five years after a diagnosis of type 1 diabetes. After that, get rescreened every year. See your doctor sooner if you develop symptoms, such as pain, tingling or numbness in your feet between screenings. If you have prediabetes, ask your doctor about a PDN screening if you have symptoms, the ADA now recommends. 2 How Peripheral Neuropathy is Diagnosed Your screening may begin with a physical exam to assess your overall health – including your blood pressure, heart rate, reflexes, muscle strength, and ability to move. Your healthcare provider will ask you questions about your health and your symptoms; he or she will also run a few tests. In addition, your doctor will rule out other causes of nerve damage such as thyroid problems, vitamin B12 deficiency, infections like Lyme disease or hepatitis B, some medications and more. 3 A k Continue reading >>

Diabetic Neuropathy Workup

Diabetic Neuropathy Workup

LYRICA is contraindicated in patients with known hypersensitivity to pregabalin or any of its other components. Angioedema and hypersensitivity reactions have occurred in patients receiving pregabalin therapy. There have been postmarketing reports of hypersensitivity in patients shortly after initiation of treatment with LYRICA. Adverse reactions included skin redness, blisters, hives, rash, dyspnea, and wheezing. Discontinue LYRICA immediately in patients with these symptoms. There have been postmarketing reports of angioedema in patients during initial and chronic treatment with LYRICA. Specific symptoms included swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx). There were reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Discontinue LYRICA immediately in patients with these symptoms. Antiepileptic drugs (AEDs) including LYRICA increase the risk of suicidal thoughts or behavior in patients taking AEDs for any indication. Monitor patients treated with any AED for any indication for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Pooled analyses showed clinical trial patients taking an AED had approximately twice the risk of suicidal thoughts or behavior than placebo-treated patients. The estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one patient for every 530 patients treated with an AED. The most common adverse reactions across all LYRICA clinical trials are dizziness, somnolence, dry mouth, edema, blurred vision, weight gain, constipation, euphoric mood, balance Continue reading >>

Diabetic Neuropathy: A Clinical And Neuropathological Study Of 107 Patients

Diabetic Neuropathy: A Clinical And Neuropathological Study Of 107 Patients

Diabetic Neuropathy: A Clinical and Neuropathological Study of 107 Patients Department of Neurology, New York University School of Medicine, New York, NY 10016, USA Received 4 February 2010; Revised 24 March 2010; Accepted 27 March 2010 Copyright 2010 David S. Younger. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. One hundred seven patients were retrospectively studied from 1992 to 2002 with diabetic neuropathy that underwent peripheral nerve biopsy. Nerve biopsy revealed the underlying histopathology, including cell and humoral-mediated immunological lesions in the majority of patients. When combined with clinical and laboratory studies, nerve biopsy has the potential to assist in the selection of patients who may benefit from immunomodulatory therapy. There are few modern series of diabetic neuropathy confirmed by nerve tissue obtained at biopsy or postmortem examination available to allow clinicopathological correlation of the different neuropathic syndromes. In 1996, Younger et al. [ 1 ] reported clinicopathological and immunohistochemical findings in 20 patients with heterogeneous forms of diabetic neuropathy. The present report continues that series to a total of 107 patients who underwent detailed clinicopathological assessment. One hundred seven consecutive patients with diabetes mellitus and peripheral neuropathy comprising distal symmetrical polyneuropathy (DSPN), proximal diabetic neuropathy (PDN) hereafter referred to as diabetic lumbosacral radiculoplexus neuropathy (DLRPN) [ 2 , 3 ], and mononeuritis multiplex (MNM) at the New York Presbyterian Hospital and New York University Langone Med Continue reading >>

Diagnosis

Diagnosis

Print Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration. Your doctor may also conduct tests that include: Filament test. Sensitivity to touch may be tested using a soft nylon fiber called a monofilament. Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It's often used to diagnose carpal tunnel syndrome. Electromyography (EMG). Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles. Quantitative sensory testing. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature. Autonomic testing. If you have symptoms of autonomic neuropathy, your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat. The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit. Treatment Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on: Slowing progression of the disease Relieving pain Managing complications and restoring function Slowing progression of the disease Consistently keeping blood sugar within a target range can help prevent or delay the progression of diabetic neuropathy and may even improve some of the symptoms you already have. Continue reading >>

Diabetic Neuropathy--a Review

Diabetic Neuropathy--a Review

Nat Clin Pract Neurol.2007;3(6):331-340. Diagnosis of Diabetic Neuropathy: Nerve Conduction Studies In symptomatic diabetic neuropathy, there is slowing of nerve conduction velocity owing to demyelination and loss of large myelinated fibers, and a decrease in nerve action potentials owing to loss of axons.[ 39 , 56 , 57 ] Purely demyelinative neuropathy is rare in patients with diabetes, and is more suggestive of a demyelinative neuropathy of inflammatory or dysglobulinemic origin.[ 58 ] Systematic electrophysiological testing is not necessary in diabetic patients with typical peripheral neuropathy. Changes in conduction velocity can be detected in asymptomatic patients, but their presence is not predictive of the onset of symptomatic neuropathy. Nerve conduction studies (NCS) are the most objective noninvasive measures of nerve function. They represent a valuable tool of evaluation of neuropathy in large clinical and epidemiological studies.[ 59 ] In clinical practice, however, NCS should not be considered a substitute for careful clinical examination, because NCS have many pitfalls and their results must be interpreted in the context of clinical data. In the case of LDDP, as in all small-fiber polyneuropathies, the main drawback of NCS is that small myelinated and unmyelinated nerve fibers, which are affected early in the disease course of diabetic neuropathy, do not contribute to the sensory action potential detected by routine NCS. The sensory action potential is altered only after involvement of larger myelinated fibers, which is often a late event in patients with diabetes. Electrophysiological data must, therefore, always be evaluated in a clinical context. Continue reading >>

Electrodiagnostic Testing

Electrodiagnostic Testing

An electromyogram (EMG) is a test that measures the electrical activity of a muscle. It detects any signs of blocking or slowing down of responses to nerve stimulation. The test provides information about the muscle itself and shows how well it receives stimulation from the nerve. Anerve conduction velocity(NCV) test is often done at the same time as an EMG. An EMG is often used to evaluate unexplained muscle weakness, twitching or paralysis, and to find the causes of numbness, tingling and pain. EMG testing can differentiate between true weakness and reduced use because of pain or lack of motivation. It can also determine whether a muscle disorder begins in the muscle itself or is caused by a nerve disorder. In an EMG, a physician or technician inserts a very fine needle, which serves as an electrode, through the skin into the muscle. With the electrode in place, the patient is asked to slowly contract the musclefor example, by bending the armwith gradually increasing force, while the electrical activity is being recorded. The activity can be displayed visually on an oscilloscope or screen, or played audibly through a speaker. The results can provide information about the ability of the muscle to respond to nerve stimulation. The patient may feel some minor discomfort, similar to an injection, when the needle or needles are inserted. Afterward, the examined muscle may feel tender or sore for a few days, and there may be a small bruise. A nerve conduction velocity test, also called a nerve conduction study, measures how quickly electrical impulses move along a nerve. It is often done at the same time as anelectromyogram,in order to exclude or detect muscle disorders. A healthy nerve conducts signals with greater speed and strength than a damaged nerve. The speed of ner Continue reading >>

Diagnostic Approach To Peripheral Neuropathy

Diagnostic Approach To Peripheral Neuropathy

Diagnostic approach to peripheral neuropathy Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India For correspondence: UK Misra, Department of Neurology, Sanjay Gandhi PGIMS, Rae Bareily Road, Lucknow-226 014, India. E-mail: [email protected] Received 2008 May 21; Revised 2008 Jun 16; Accepted 2008 Jun 16. Copyright Annals of Indian Academy of Neurology This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Peripheral neuropathy refers to disorders of the peripheral nervous system. They have numerous causes and diverse presentations; hence, a systematic and logical approach is needed for cost-effective diagnosis, especially of treatable neuropathies. A detailed history of symptoms, family and occupational history should be obtained. General and systemic examinations provide valuable clues. Neurological examinations investigating sensory, motor and autonomic signs help to define the topography and nature of neuropathy. Large fiber neuropathy manifests with the loss of joint position and vibration sense and sensory ataxia, whereas small fiber neuropathy manifests with the impairment of pain, temperature and autonomic functions. Electrodiagnostic (EDx) tests include sensory, motor nerve conduction, F response, H reflex and needle electromyography (EMG). EDx helps in documenting the extent of sensory motor deficits, categorizing demyelinating (prolonged terminal latency, slowing of nerve conduction velocity, dispersion and conduction block) and axonal (marginal slowing of nerve conduction and small Continue reading >>

Electrophysiological Studies In Diabetic Neuropathy

Electrophysiological Studies In Diabetic Neuropathy

Electrophysiological studies in diabetic neuropathy Laboratory of Clinical Neurophysiology, University Hospital, Denmark The Institute of Neurophysiology, University of Copenhagen, Denmark 1Fellow of the Canadian Medical Research Council. This article has been cited by other articles in PMC. In 30 patients with diabetic neuropathy sensory potentials in the median nerve, motor conduction in the lateral popliteal and median nerves, and electromyographic findings in distal and proximal muscles were compared with the severity of symptoms and signs. All patients had abnormalities in at least one of the electrophysiological parameters. The sensory potentials were the most sensitive indicator of subclinical involvement; abnormalities were found in 24 patients, 12 of whom had no sensory symptoms or signs and five of whom had no other clinical or electrophysiological evidence of neuropathy in the upper extremities. This indicates that sensory nerve fibres may be affected before motor. The next most sensitive parameter was the presence of fibrillation potentials, found in more than half the distal muscles examined. Slowing in motor conduction in the lateral popliteal nerve was the only electrophysiological change correlated to the severity of the neuropathy, and no other electrophysiological parameter was correlated to the duration or the severity of the neuropathy or the diabetes. An onset of neuropathy before or simultaneously with the manifestations of the diabetes, as well as the frequent occurrence of asymptomatic changes in sensory conduction, support the evidence at hand that the neuropathy develops concomitantly with and as an integral part of the metabolic disturbance rather than as a consequence of the vascular complications of diabetes. Of three patients with clinical Continue reading >>

The Effect Of Diabetic Neuropathy And Previous Foot Ulceration In Emg And Ground Reaction Forces During Gait

The Effect Of Diabetic Neuropathy And Previous Foot Ulceration In Emg And Ground Reaction Forces During Gait

Volume 23, Issue 5 , June 2008, Pages 584-592 The effect of diabetic neuropathy and previous foot ulceration in EMG and ground reaction forces during gait Author links open overlay panel Paula M.H.Akashia We aimed at investigating the influence of diabetic neuropathy and previous history of plantar ulcers on electromyography (EMG) of the thigh and calf and on vertical ground reaction forces during gait. This study involved 45 adults divided into three groups: a control group (n=16), diabetic neuropathic group (n=19) and diabetic neuropathic group with previous history of plantar ulceration (n=10). EMG of the right vastus lateralis, lateral gastrocnemius and tibialis anterior were studied during the stance phase. The peaks and time of peak occurrence were determined and a co-activation index between tibialis anterior and lateral gastrocnemius. In order to represent the effect of the changes in EMG, the first and second peaks and the minimum value of the vertical ground reaction force were also determined. Inter-group comparisons of the electromyographical and ground reaction forces variables were made using three MANCOVA (peaks and times of EMG and peaks of force) and one ANCOVA (co-activation index). The ulcerated group presented a delayed in the time of the lateral gastrocnemius and vastus lateralis peak occurrence in comparison to controls. The lateral gastrocnemius delay may be related to the lower second vertical peak in diabetic subjects. However, the delay of the vastus lateralis did not cause any significant change on the first vertical peak. The vastus lateralis and lateral gastrocnemius delay demonstrate that ulcerated diabetic neuropathic patients have a motor deficit that could compromise their ability to walk, which was partially confirmed by changes on gro Continue reading >>

Diabetic Neuropathy Diagnosis

Diabetic Neuropathy Diagnosis

Your physician will conduct a medical history, physical exam, and even a pin-prick test to determine if you have diabetic neuropathy. In diagnosing diabetic neuropathy—also called diabetic nerve damage—your doctor may run a few exams and tests. He or she will also ask you about your symptoms. All this is done to get an accurate diagnosis. It's important to understand what type of diabetic neuropathy you have (diabetic peripheral neuropathy, proximal neuropathy, autonomic neuropathy, or focal neuropathy), as well as the extent of nerve damage. When describing your symptoms, be as specific as you can. The different types of diabetic neuropathy affect different nerves and cause different symptoms. Describing the severity and location of your pain (or other symptoms) will also help your doctor make an accurate diagnosis. Exams and Tests to Diagnose Diabetic Neuropathy The doctor will most likely perform a physical exam to assess your general physical condition, including your blood pressure, heart rate, reflexes, muscle strength, and ability to move. A critical part of the physical exam is a comprehensive foot exam. (People with diabetes should have a yearly foot exam.) In diabetic peripheral neuropathy—the most common type of diabetic neuropathy—the nerves in the feet and legs are usually the most damaged. Therefore, it's critical to check your foot health by assessing the circulation, bones, muscles, and skin. A neurological exam is also important in diagnosing diabetic neuropathy. Using various tests, the doctor will be able to determine how well your nerves are working. As mentioned before, different nerves transmit different messages; some are in charge of temperature and others deal with touch or vibration. By testing these different types of nerves, your doct Continue reading >>

Electromyography (emg) And Nerve Conduction Studies (ncs) For Neuropathy Diagnosis

Electromyography (emg) And Nerve Conduction Studies (ncs) For Neuropathy Diagnosis

Electromyography (EMG) and nerve conduction studies (NCS) for Neuropathy Diagnosis This test has two parts. Nerve conduction studies are used to measure the health of your nerves. Electric shocks are administered by the nerve conduction technician to skin directly overlying the nerve. The response is measured by a second set of electrodes applied to the surface of skin. The strength of these shocks is equivalent to a strong static-electricity shock. During the EMG, the doctor will insert a very thin needle into one muscle at a time. You will be asked to relax the muscle and then contract the muscle after the needle is inserted. The needle is connected to a computer that helps the doctor determine whether your muscle is healthy or affected by a disease of the muscle or nerve. The number of muscles to be tested is highly variable and depends upon your symptoms and what is found during the actual test. Please do not apply lotion to your skin on the day of your appointment as this may interfere with nerve conduction testing. Also, let your EMG doctor know if you are taking blood thinners prior to the exam. Continue reading >>

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