title: Medial plantar and dorsal sural nerve conduction studies increase the sensitivity in the detection of neuropathy in diabetic patients.
abstract: OBJECTIVE
  Clinical utility of nerve conduction studies (NCS) of the medial plantar and dorsal sural nerves in the early detection of polyneuropathy have already been shown separately. However, at present, there is no data about the combined assessment of these two nerves in distal sensory neuropathy. In the present study, we aimed to evaluate the medial plantar and dorsal sural NCS in a group of diabetic patients with distal sensory neuropathy (DSN) and in healthy controls.
  
  
  METHODS
  Thirty healthy and 30 diabetic adult patients were included. In all subjects, peripheral motor and sensory NCS were performed bilaterally with surface electrodes on the lower limbs including medial plantar and dorsal sural nerves. In addition, motor and sensory nerves were studied unilaterally on the upper limb.
  
  
  RESULTS
  In all patients, nerve action potential (NAP) amplitudes of sural and superficial peroneal nerves were within normal ranges, but in the patient group mean value was significantly lower than in the controls. Among clinically defined 30 DSN patients, medial plantar NAP amplitude was abnormal in 18 (60%) and dorsal sural nerve amplitude was abnormal in 13 (40%) of the patients bilaterally. Additionally, the onset NCV of the dorsal sural nerve was significantly slower in patients than controls (P=0.038). Evaluation of both of these nerves increased the sensitivity up to 70% in the detection of neuropathy.
  
  
  CONCLUSIONS
  Bilateral NCS assessment of both of the medial plantar and dorsal sural nerves together increases the rate of diagnosis of diabetic distal sensory neuropathy compared to assessment of either of these nerves.
  
  
  CONCLUSIONS
  Assessment of medial plantar in addition to dorsal sural NCS together increases the sensitivity in the detection of neuropathy and allows earlier diagnosis, especially when routine NCS are normal.
authors.affiliation: Marmara University Hospital, Department of Neurology, Tophanelioglu Cad. 13/15 Altunizade, 34640 Istanbul, Turkey. kayihanu@yahoo.com
authors.forename: Kayihan
authors.initials: K
authors.lastname: Uluc
authors.forename: Baris
authors.initials: B
authors.lastname: Isak
authors.forename: Deniz
authors.initials: D
authors.lastname: Borucu
authors.forename: Cagri Mesut
authors.initials: CM
authors.lastname: Temucin
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Cetinkaya
authors.forename: Pinar Kahraman
authors.initials: PK
authors.lastname: Koytak
authors.forename: Tulin
authors.initials: T
authors.lastname: Tanridag
authors.forename: Onder
authors.initials: O
authors.lastname: Us
mesh_terms: D000200:Action Potentials / Q000502:physiology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D004576:Electromyography; D006801:Humans; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D013497:Sural Nerve / Q000503:physiopathology*; D013979:Tibial Nerve / Q000503:physiopathology*