Properties of cutaneous afferents in diabetic neuropathy. 1989

R Mackel
Department of Neurology, Cornell University Medical College, New York.

The technique of percutaneous microneurography was used to study the response properties of 68 cutaneous afferents in 8 diabetic patients and, for comparison, of 104 afferents in 12 normal control subjects. The diabetic patients were neurologically asymptomatic or had a mild sensory neuropathy. Three afferent categories were studied in the diabetic subjects (rapidly adapting type RA and slowly adapting SAI and SAII) in response to mechanical skin stimulation and abnormal responsiveness was encountered in all categories. Distinct abnormalities were seen in about 30% of the RA and in 20% of the SAI type nerve fibres. The abnormalities consisted of the generation of only single action potentials to above threshold stimuli (RA), and of high fatiguability to repetitive stimulation (SAI). A more subtle abnormality was additionally encountered in the slowly adapting SAI and SAII groups. This consisted of low discharge rates to sustained skin indentation, with values statistically significantly different from normal. Absolute mechanical response thresholds and receptive field configurations were similar between diabetic and normal units. The conduction velocities of individual nerve fibres were measured in response to intradermal electrical stimulation. They were similar to normal, regardless of whether the afferents displayed normal or abnormal responsiveness to physiological stimulation of the receptive fields. The data indicate that different cutaneous afferent categories are affected by the disease, and are limited in their ability to transmit trains of action potentials. As a consequence, physiological stimuli may be abnormally encoded in diabetic units. Two hypotheses, one morphological and one biophysical, are proposed for explaining the present findings. The results altogether provide a physiological basis for understanding nerve fibre dysfunction and sensory disturbances in human diabetic neuropathy.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009412 Nerve Fibers Slender processes of NEURONS, including the AXONS and their glial envelopes (MYELIN SHEATH). Nerve fibers conduct nerve impulses to and from the CENTRAL NERVOUS SYSTEM. Cerebellar Mossy Fibers,Mossy Fibers, Cerebellar,Cerebellar Mossy Fiber,Mossy Fiber, Cerebellar,Nerve Fiber
D009431 Neural Conduction The propagation of the NERVE IMPULSE along the nerve away from the site of an excitation stimulus. Nerve Conduction,Conduction, Nerve,Conduction, Neural,Conductions, Nerve,Conductions, Neural,Nerve Conductions,Neural Conductions
D009475 Neurons, Afferent Neurons which conduct NERVE IMPULSES to the CENTRAL NERVOUS SYSTEM. Afferent Neurons,Afferent Neuron,Neuron, Afferent
D010812 Physical Stimulation Act of eliciting a response from a person or organism through physical contact. Stimulation, Physical,Physical Stimulations,Stimulations, Physical
D003929 Diabetic Neuropathies Peripheral, autonomic, and cranial nerve disorders that are associated with DIABETES MELLITUS. These conditions usually result from diabetic microvascular injury involving small blood vessels that supply nerves (VASA NERVORUM). Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy (see OCULOMOTOR NERVE DISEASES); MONONEUROPATHY; mononeuropathy multiplex; diabetic amyotrophy; a painful POLYNEUROPATHY; autonomic neuropathy; and thoracoabdominal neuropathy. (From Adams et al., Principles of Neurology, 6th ed, p1325) Diabetic Amyotrophy,Diabetic Autonomic Neuropathy,Diabetic Neuralgia,Diabetic Polyneuropathy,Neuralgia, Diabetic,Asymmetric Diabetic Proximal Motor Neuropathy,Diabetic Asymmetric Polyneuropathy,Diabetic Mononeuropathy,Diabetic Mononeuropathy Simplex,Diabetic Neuropathy, Painful,Mononeuropathy, Diabetic,Symmetric Diabetic Proximal Motor Neuropathy,Amyotrophies, Diabetic,Amyotrophy, Diabetic,Asymmetric Polyneuropathies, Diabetic,Asymmetric Polyneuropathy, Diabetic,Autonomic Neuropathies, Diabetic,Autonomic Neuropathy, Diabetic,Diabetic Amyotrophies,Diabetic Asymmetric Polyneuropathies,Diabetic Autonomic Neuropathies,Diabetic Mononeuropathies,Diabetic Mononeuropathy Simplices,Diabetic Neuralgias,Diabetic Neuropathies, Painful,Diabetic Neuropathy,Diabetic Polyneuropathies,Mononeuropathies, Diabetic,Mononeuropathy Simplex, Diabetic,Mononeuropathy Simplices, Diabetic,Neuralgias, Diabetic,Neuropathies, Diabetic,Neuropathies, Diabetic Autonomic,Neuropathies, Painful Diabetic,Neuropathy, Diabetic,Neuropathy, Diabetic Autonomic,Neuropathy, Painful Diabetic,Painful Diabetic Neuropathies,Painful Diabetic Neuropathy,Polyneuropathies, Diabetic,Polyneuropathies, Diabetic Asymmetric,Polyneuropathy, Diabetic,Polyneuropathy, Diabetic Asymmetric,Simplex, Diabetic Mononeuropathy,Simplices, Diabetic Mononeuropathy
D004056 Differential Threshold The smallest difference which can be discriminated between two stimuli or one which is barely above the threshold. Difference Limen,Just-Noticeable Difference,Weber-Fechner Law,Difference Limens,Difference, Just-Noticeable,Differences, Just-Noticeable,Differential Thresholds,Just Noticeable Difference,Just-Noticeable Differences,Law, Weber-Fechner,Limen, Difference,Limens, Difference,Threshold, Differential,Thresholds, Differential,Weber Fechner Law
D004558 Electric Stimulation Use of electric potential or currents to elicit biological responses. Stimulation, Electric,Electrical Stimulation,Electric Stimulations,Electrical Stimulations,Stimulation, Electrical,Stimulations, Electric,Stimulations, Electrical
D004594 Electrophysiology The study of the generation and behavior of electrical charges in living organisms particularly the nervous system and the effects of electricity on living organisms.

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