Evaluation of central neuropathy in type 2 diabetes mellitus: a case control study

Authors

  • R. Balakrishnan Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • K. Ramadoss Department of Neurology, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
  • E. Prasanna Venkatesan Consultant Neurologist, Manipal Hospitals, Salem, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20191012

Keywords:

Central neuropathy, Diabetes mellitus, Glycaemic control, Peripheral neuropathy, Retinopathy, Visual evoked potentials

Abstract

Background: Diabetes mellitus (DM) is a global pandemic affecting almost every organ in the body. Peripheral nervous system involvement in diabetes is well known but there are not many studies on central nervous system involvement. Visual evoked potential (VEP) is a sensitive, non-invasive test to detect central demyelination of optic nerve. The objective was to compare the visual evoked potentials in type-2 DM patients with that of healthy controls and to find out if any correlation is there with the duration and glycaemic control of the disease and to compare incidence of peripheral and central neuropathy in DM patients.

Methods: Author included 50 DM patients and 50 age and sex matched controls. Patients with previous stroke, demyelination, diabetic retinopathy and other ophthalmological disorders were excluded. VEP was recorded using pattern reversal stimulation with EMG RMS MARK II machine and p100 latency was measured.

Results: P100 latencies (ms) was significantly prolonged in diabetics with mean±SD of (111.24±5.28 ms) as compared to controls (101.30±1.66 ms) with p value <0.003. Also, there was significant correlation between duration of DM and P100 latency prolongation, but no significant correlation was present when compared with glycaemic control.

Conclusions: Central neuropathy is very common in DM. It is related to duration of DM and not HbA1c unlike PNP which is related to both. Central neuropathy occurs even prior to development of retinopathy or PNP. Hence, VEP is a non-invasive and sensitive screening tool for early neurological involvement in DM.

References

Sami W, Ansari T, Butt NS, Ab Hamid MR. Effect of diet on type 2 diabetes mellitus: A review. Int J of Heal Sci. 2017;11(2):65.

Adams R, Victor M. Brown R. Special Techniques for Neurologic Diagnosis. In: Adams and Victor's Principles of Neurology. 8th Ed. McGraw-Hill Companies; 2005.

Ashok S, Ramu M, Deepa R, Mohan V. Prevalence of neuropathy in type 2 diabetic patients attending a diabetes centre in South India. JAPI. 2002;50:546-50.

Bansal V, Kalita J, Misra UK. Diabetic neuropathy. Postgrad Med J. 2006;82(964):95-100.

Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diab. 2008;26(2):77-82.

Kim B, Feldman EL. Insulin resistance in the nervous system. Trends Endocrinol Metab. 2012;23(3):133-41.

Magrinelli F, Briani C, Romano M, Ruggero S, Toffanin E, Triolo G, et al. The association between serum cytokines and damage to large and small nerve fibers in diabetic peripheral neuropathy. J Diab Res. 2015;23:133-141.

Simeon Locke. Nervous System in Diabetes. In Joslin’s Diabetes. Lea and Febiger, Philadelphia; 1971:562-564.

Walsh P, Kane N, Butler S. The clinical role of evoked potentials. J Neurol, Neurosurg Psychiatry. 2005;76(2):16-22.

World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation: part 1, diagnosis and classification of diabetes mellitus. Geneva: WHO. Available at: http://www.who.int/iris/handle/10665/66040. Accessed 2 January 2017.

Dolu H, Ulas UH, Bolu E, Ozkardes A, Odabasi Z, Ozata M, et al. Evaluation of central neuropathy in type II diabetes mellitus by multimodal evoked potentials. Acta Neuro Belg. 2003;103(4):206-11.

Szabela DA, Loba J, Pałenga-Pydyn D, Tybor K, Ruxer J, Split W. Klin Oczna. 2005;107(7-9):498-501.

Li P, Yang Y. Pattern reversal visual evoked potentials analysis in patients with noninsulin-dependent diabetes mellitus. Bull Human Med Uni. 2001;26(3):283-4.

Algan M, Ziegler O, Gehin P, Got I, Raspiller A, Weber M, et al. Visual evoked potentials in diabetic patients. Diab Care. 1989;12(3):227-9.

Comi G. Evoked potentials in diabetes mellitus. Clinical Neurosci. 1997;4(6):374-9.

Imam M, Shehata OH. Subclinical central neuropathy in type 2 diabetes mellitus. Bull Alex Fac Med. 2009;45(1):65-73.

Ziegler O, Guerci B, Algan M, Lonchamp P, Weber M, Drouin P. Improved visual evoked potential latencies in poorly controlled diabetic patients after short-term strict metabolic control. Diab Care. 1994 ;17(10):1141-7.

Ghirlanda G, Di Leo MA, Caputo S, Falsini B, Porciatti V, Marietti G, et al. Detection of inner retina dysfunction by steady-state focal electroretinogram pattern and flicker in early IDDM. Diab. 1991 Sep 1;40(9):1122-7.

Jens W, Ahmed A (2016) Peripheral Nervous System Involvement in Diabetes and Role of Rehabilitation. Int J Neurorehabilitation. 3:233.

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Published

2019-03-27

How to Cite

Balakrishnan, R., Ramadoss, K., & Prasanna Venkatesan, E. (2019). Evaluation of central neuropathy in type 2 diabetes mellitus: a case control study. International Journal of Research in Medical Sciences, 7(4), 1022–1025. https://doi.org/10.18203/2320-6012.ijrms20191012

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Original Research Articles