Medial plantar and dorsal sural nerve conduction studies increase the sensitivity in the detection of neuropathy in diabetic patients.
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.
Uluc
Kayihan
K
Marmara University Hospital, Department of Neurology, Tophanelioglu Cad. 13/15 Altunizade, 34640 Istanbul, Turkey. kayihanu@yahoo.com
Isak
Baris
B
Borucu
Deniz
D
Temucin
Cagri Mesut
CM
Cetinkaya
Yilmaz
Y
Koytak
Pinar Kahraman
PK
Tanridag
Tulin
T
Us
Onder
O
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*