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Early detection of diabetic polyneuropathy using paired stimulation studies of the sensory nerves

Lee, Ahry MD1; Kwon, Hee-Kyu MD, PhD1

American Journal of Physical Medicine & Rehabilitation: May 23, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001229
Research Article: PDF Only

Objective This study seeks to use the RRP, a sensitive parameter for detecting early change in peripheral polyneuropathies, as a tool for early detection of diabetic polyneuropathy (DPN).

Design The RRP of the median and sural sensory nerves were measured in 57 diabetic patients (male 31, female 26) and 23 healthy controls (male 16, female 7). The shortest inter-stimulus interval, where the latency of the response to the second stimulus recovers to normal, was defined as the RRP.

Results The RRP of the median and sural nerves were significantly longer in diabetic patients (3.6 msec, p<0.001 and 3.8 msec, p<0.001, respectively) than in the control group (3.0 msec in both nerves). RRP values of both nerves were also significantly prolonged compared with the control group, even in diabetic patients without DPN based on conventional conduction studies (3.3 msec, p=0.002 for median nerve; 3.5 msec, p<0.001 for sural nerve) or without any clinical symptoms and signs (3.3 msec, p=0.007 for median nerve; 3.5 msec, p=0.001 for sural nerve).

Conclusion The RRP was prolonged in diabetic patients even before other electrophysiologic abnormalities or clinical findings appeared. These results suggest that the RRP can be a possible early indicator of DPN.

1 Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital

Corresponding author: Hee-Kyu Kwon, M.D., Ph.D Address: Department of Physical Medicine and Rehabilitation, Department of Medicine, Graduate School, Korea University, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. E-mail:

Disclosure statements: There is no conflicts of interest and no funding was provided for the study.

The abstract of the study was presented at the 46th Annual Meeting of the Korean Academy of Rehabilitation Medicine on Oct. 27th, 2018, in Seoul, Korea.

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