J Clin Neurol.  2017 Oct;13(4):366-370. 10.3988/jcn.2017.13.4.366.

Comparison of Somatic and Sudomotor Nerve Fibers in Type 2 Diabetes Mellitus

• Sohn EH
• Song KS
• Lee JY
• Lee AY

• KMID: 2392132
• DOI: http://doi.org/10.3988/jcn.2017.13.4.366

Abstract

BACKGROUND AND PURPOSE
The objective of this study was to find a sensitive method for the early detection of diabetic polyneuropathy (DPN) and determine the relationship between the functions of somatic and autonomic small nerve fibers in DPN.
METHODS
Patients with type 2 diabetes mellitus and DPN based on clinical symptoms, signs, intraepidermal nerve fiber density (IENFD), and findings in the quantitative sudomotor axon reflex test (QSART) were enrolled retrospectively. Neurological examinations and nerve conduction studies were performed on all patients. Heart-rate variability during deep breathing (DB ratio) and the Valsalva maneuver (Valsalva ratio) were used to quantify the cardiovagal function. Patients were divided into two groups: 1) normal nerve conduction, defined as small-fiber neuropathy (SFN) and 2) abnormal nerve conduction, defined as mixed-fiber neuropathy.
RESULTS
In total, 82 patients were enrolled (age: 60.7±10.7 years, mean±SD). A decreased IENFD was the most frequent abnormality across all of the patients, followed by abnormalities of the QSART and cardiovagal function. A decreased IENFD was more sensitive than the QSART, DB ratio, and Valsalva ratio for detecting diabetic SFN. The DB ratio was significantly correlated with the duration of diabetes mellitus and clinical symptoms and signs. There was no correlation between the IENFD and the findings of the QSART for the distal leg.
CONCLUSIONS
Measuring the IENFD was a more sensitive method than the QSART for the early detection of DPN. The degree of involvement of the somatic small nerve fibers and sudomotor nerve fibers was independent in DPN.

Keyword

epidermal nerve; sudomotor; diabetic polyneuropathy

MeSH Terms

Axons
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Diabetic Neuropathies
Humans
Leg
Methods
Nerve Fibers*
Neural Conduction
Neurologic Examination
Reflex
Respiration
Retrospective Studies
Valsalva Maneuver

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