The Importance of Thermal Threshold Test­ing in Detecting of Small Fiber Neuropathy in Type 1 Diabetes Mel­litus


Authors: V. Potočková 1;  Š. Malá 2;  A. Tomek 1;  D. Baumgartner 1;  R. Mazanec 1
Authors‘ workplace: 2. LF UK a FN v Motole, Praha Neurologická klinika 1;  2. LF UK a FN v Motole, Praha Interní klinika 2
Published in: Cesk Slov Neurol N 2016; 79/112(6): 692-697
Category: Original Paper

Overview

Background:
Thermal threshold testing represents an integral part of neurophysiological diagnostics of small fiber neuropathy. Diabetes mellitus is the most common cause of SFN. The aim of our study was to evaluate changes of thermal thresholds depending on the duration of diabetes.

Material and methods:
45 patients with type 1 diabetes mellitus (27 women, 18 men, mean age 45,1 years) were enrolled in the study. The group was divided into two subgroups according to the duration of diabetes (≤ 25 years, > 25 years). We used a thermal stimulator (Somedic) and determined cold detection thresholds (CDT) and warm detection thresholds (WDT) in thenar, tibia and dorsum of the foot. Non-randomized method of reaction time was used as an investigative algorithm.

Results:
We demonstrated a statistically significant difference between the thermal thresholds in lower extremities/tibia (CDT p < 0.001, WDT p = 0.002), dorsum of the foot (CDT, WDT p < 0.001). In diabetics, CDTs are lower and WDTs are higher in comparison with controls. An abnormality of CDT occurs earlier and more frequently. We proved statistically significant difference for the mean values of CDT (p = 0.024) and for the mean values of WDT (p = 0.049) in the dorsum of the foot between the two subgroups. Linear regression demonstrated a statistically significant relationship between the thermal thresholds in the dorsum of the foot and the duration of diabetes and determined individual regression equations.

Conclusion:
Thermal threshold testing in the distal part of the leg appears to be a good screening tool for detection of small fiber neuropathy in type 1 diabetic patients, especially in diabetics with neuropatic symptoms and normal nerve conduction studies and needle electromyography.

Key words:
type 1 diabetes mellitus – small fiber neuropathy – cold detection threshold – warm detection threshold

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Shy ME, Frohman EM, So YT, et al. Quantitative sensory testing: report of the Therapeutics and Technology As­ses­sment Subcom­mittee of the American Academy of Neurology. Neurology 2003;60(6):898– 904. doi: 10.1212/ 01.WNL.0000058546.16985.11.

2. Hoeijmakers JG, Faber CG, Lauria G, et al. Smal­l-fibre neuropathies – advances in dia­gnosis, pathophysiology and management. Nat Rev Neurol 2012;8(7):369– 79. doi: 10.1038/ nrneurol.2012.97.

3. Hovaguimian A, Gibbons CH. Dia­gnosis and Treatment of Pain in Smal­l-fiber Neuropathy. Curr Pain Headache Rep 2011;15(3):193– 200. doi: 10.1007/ s11916-011-0181-7.

4. Lauria G, Merkies ISJ, Faber CG. Small fibre neuropathy. Curr Opin Neurol 2012;25(5):542– 9. doi: 10.1097/ WCO.0b013e32835804c5.

5. Bednarik J, Vlckova-Moravcova E, Bursova S, et al. Etiology of smal­l-fiber neuropathy. J Peripher Nerv Syst 2009;14(3):177– 83. doi: 10.1111/ j.1529-8027.2009.00229.x.

6. Devigili G, Tugnoli V, Penza P, et al. The dia­gnostic criteria for small fibre neuropathy: from symp­toms to neuropathology. Brain 2008;131(7):1912– 25. doi: 10.1093/ brain/ awn093.

7. Maier C, Baron R, Töl­le TR, et al. Quantitative sensory test­ing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1,236 patients with dif­ferent neuropathic pain syndromes. Pain 2010;150(3):439– 50. doi: 10.1016/ j.pain.2010. 05.002.

8. Fruhstorfer H, Lindblom U, Schmidt WC. Method for quantitative estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatry 1976;39(11):1071– 5.

9. Dyck PJ, Zim­merman IR, O‘ Brien PC, et al. Introduction of automated systems to evaluate touch-pres­sure, vibration, and thermal cutaneous sensation in man. Ann Neurol 1978;4(6):502– 10.

10. Navar­ro X, Ken­nedy WR. Evaluation of thermal and pain sensitivity in type I diabetic patients. J Neurol Neurosurg Psychiatry 1991;54(1):60– 4.

11. Ziegler D, Mayer P, Gries FA. Evaluation of thermal, pain, and vibration sensation thresholds in newly dia­g­nosed type 1 diabetic patients. J Neurol Neurosurg Psychiatry 1988;51(11):1420– 4.

12. Herman WH, Pop-Busui R, Braf­fett BH, et al. Use of the Michigan Neuropathy Screen­ing Instrument as a measure of distal sym­metrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications. Diabet Med 2012;29(7):937– 44. doi: 10.1111/ j.1464-5491.2012.03644.x.

13. Lacigová S, Rušavý Z, Jirkovská A, et al. Doporučený postup dia­gnostiky a léčby diabetické neuropatie. [online]. Dostupné z URL: http:/ / www.diab.cz/ standardy.

14. Ziegler D, Behler M, Schroers-Teuber M, et al. Near-normoglycaemia and development of neuropathy: a 24-year prospective study from dia­gnosis of type 1 diabetes. BMJ Open 2015;5(6):e006559. doi: 10.1136/ bmjopen-2014-006559.

15. Hendriksen PH, Oey PL, Wieneke GH, et al. Subclinical diabetic polyneuropathy: early detection of involvement of dif­ferent nerve fibre types. J Neurol Neurosurg Psychiatry 1993;56(5):509– 14. doi: 10.1136/ jn­np.56.5.509

16. Vinik AI, Suwanwalaikorn S, Stansber­ry KB, et al. Quantitative measurement of cutaneous perception in diabetic neuropathy. Muscle Nerve 1995;18(6):574– 84.

17. Krøigård T, Sothynathan I, Sindrup SH. Intraindividual Variability and Long-Term Changes of Thermal Quantitative Sensory Testing. J Clin Neurophysiol 2015;32(4):352– 6. doi: 10.1097/ WNP.0000000000000193.

18. Vlčková-Moravcová E, Bednařík J. Počítačem asistované stanovení termického prahu. Cesk Slov Neurol N 2003;66/ 99(4):263– 9.

19. Chao CC, Hsieh SC, Yang WS, et al. Glycemic control is related to the severity of impaired thermal sensations in type 2 diabetes. Diabetes Metab Res Rev 2007;23(8):612– 20.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2016 Issue 6

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account