NEURODIAGNOSTIC ASSOCIATES
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ADVANCED NEURODIAGNOSTIC MEDICINE FOR THE PHYSICIAN
Neurology,Physiatry,Internal Medicine,
Podiatry, Rheumatology,Orthopedic,
Edochronology,Cardiology
NERVE CONDUCTION STUDIES

The most sensative test for the diabetic peripheral neuropathy, is the sensory nerve conduction studies. When you check the compound sensory nerve action potentials (SNAP), the most common (most sensative) nerves are the sural, lateral and medial plantar and saphenous, followed by the median nerve (sensory) and superficial peroneal nerve (sensory). It has been recommended that standarized procedure including temperature control and equipment calibration be utilized with EMG testing.

In the motor nerve conduction studies, the most sensative nerves in diabetic polyneuropathy are the common peroneal nerve and median nerve.It is interesting to see that patients with D.P.N. that have minimal or slightly reduced conduction velocity, generally have multiple and severe complications.In diabetic amyothropy, the findings maybe unilateral or bilateral.

Classification:

I. Without distal symmetric polyneuropathy.
II. With distal symmetric polyneuropathy.

I. The patients without distal symmetric polyneuropathy that have mild diabetes mellitus without a clear picture of peripheral neuropathy, can present with an abrupt onset associated with lower back pain, inguinal and thigh pain, knee buckling during ambulation and weakness in their thighs.

II. The patients with distal symmetric polyneuropathy present with progressive weakness (Slow progression over weeks) and a concomitant history of weight loss and peripheral vascular disease.

The electrodiagnostic studies done in the first group revealed: positive sharp waves and fibrillation potentials usually in the iliopsoas muscle, quadriceps muscles and thigh abductor muscles. These patients can also have a minimal peripheral neuropathy when we examine sensory/motor nerve conduction studies, distally.
DIABETIC NEUROPATHIES IN THE CLINICAL SETTING
Diabetes Mellitus is the most common metabolic disease in the United States. The most common classifications are Type I or insulin dependent diabetes mellitus (IDDM) and Type II non-insulin dependent diabetes mellitus (NIDDIM) .The incidence and prevalence of diabetic neuropathies depends directly on the age of the patient and the duration of the disease.The clinical criteria (Diagnosing peripheral neuropathies secondary to diabetes mellitus) are: ..................................................................



1. Decreased deep tendon reflexes (DTR'S).
2. Muscle weakness and decreased sensation...................................................

Perhaps the most common manifestation of diabetic neuropathy is decreased sensation, most commonly in a gloves and stocking distribution, mostly in the feet and distal legs, and after a while hands and fingers.
Classification of diabetic neuropathy:

I. Symmetric polyneuropathies:

a. Sensory motor
b. Sensory
c. Proximal involvement (diabetic amyothropy).
d. Autonomic

II. Focal/Miltifocal:

a. Truncal mono-poly radiculopathy
b. Brachial-lumbosacral plexopathies
c. Cranial neuropathy
d. Asymmetric polyneuropathy
e. Limb mono neuropathy
f. Diabetic amyothropy (proximal lower limb)
III. Combined Neuropathies

a. Sensory/Motor diabetic neuropathy

When a patient is complaining of a combination of weakness and decreased sensation most of the time they have a sensory/motor diabetic neuropathy.A simple test to determine if neuropathy is mild, moderate, or severe is to have the patient walk on heels and or toes. If the patient tells you he can't do it because of weakness in his legs, the neuropathy is advanced.of axonal loss and which can even produce an opinion-bulb formation....................................................................................................
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