P2-03. An electrophysiological severity classification system for diabetic polyneuropathy and small fiber dysfunction

Publication date: September 2017
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Chieko Suzuki, Masayuki Baba, Tomoya Kon, Yukihisa Funamizu, Tatsuya Ueno, Rie Haga, Haruo Nishijima, Akira Arai, Jinichi Nunomura, Masahiko Tomiyama, Hiroki Mizukami, Soroku Yagihashi
We reported an electrophysiological severity classification for diabetic polyneuropathy (DPN) using a nerve conduction study (NCS). This new classification system combines of the amplitude and velocity of NCS and classifies DPN into five stages. Stage 0 is the mildest stage, while Stage IV is the most severe. Here, we clarified the association of this classification system with small fiber abnormalities. We measured intra-epidermal nerve fiber densities (IENFD) and pain threshold using intra-epidermal electrical stimulation (IES) to evaluate the function of small fibers. We recruited 65 patients with diabetes, and performed NCS, skin biopsy and pain threshold using IES. The mean IENFD observed in the skin biopsies were 8.27n/mm in Stage 0, 7.79n/mm in Stage I, 4.49n/mm in Stage II, 2.85n/mm in Stage III, and 0n/mm in Stage IV. The mean pain thresholds were 0.05mA in Stage 0, 0.11mA in Stage I, 0.08mA in Stage II, 0.27mA in Stage III, and 0.59mA in Stage IV. In summary, the abnormalities of IENFD and pain threshold correlated with electrophysiological severity. The present results indicate that the large fiber dysfunction in DPN progresses in parallel with the small fiber abnormalities.



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