Chapter I. Diabetic Peripheral Neuropathy

Distal Sensorimotor Neuropathy: Improvements in Diagnosis

Prashanth R. J. Vas¹, Sanjeev Sharma², Gerry Rayman²

Manuscript submitted April 17, 2015; resubmitted April 29, 2015; accepted April 30, 2015.

Keywords: diabetic neuropathy, small fiber neuropathy, axon reflex test, nerve conduction, nerve fiber density, laser Doppler imager flare, corneal confocal microscopy, electromyography, sudomotor function

Abstract

Neurological complications of diabetes are common, affecting up to 50% of people with diabetes. In these patients, diabetic sensorimotor neuropathy (DSPN) is by far the most frequent complication. Detecting DSPN has traditionally been a clinical exercise that is based on signs and symptoms. However, the appearance of morphometric and neurophysiological techniques along with composite scoring systems and new screening tools has induced a paradigm change in the detection and stratification of DSPN and our understanding of its natural history and etiopathogenesis. These newer techniques have provided further evidence that changes in small nerve fiber structure and function precede large fiber changes in diabetes. Although useful, the challenge for the use of these new techniques will be their sensitivity and specificity when widely adopted and ultimately, their ability to demonstrate improvement when pathogenic mechanisms are corrected. Concurrently, we have also witnessed an emergence of simpler screening tools or methods that are mainly aimed at quicker detection of large fiber neuropathy in the outpatient setting. In this review, we have focused on techniques and tools that receive particular attention in the current literature, their use in research and potential use in the clinical environment.

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