Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1970 Aug;33(4):442–452. doi: 10.1136/jnnp.33.4.442

Electrophysiological studies in diabetic neuropathy

Albert Lamontagne 1,2,1, Fritz Buchthal 1,2
PMCID: PMC493498  PMID: 5505671

Abstract

In 30 patients with diabetic neuropathy sensory potentials in the median nerve, motor conduction in the lateral popliteal and median nerves, and electromyographic findings in distal and proximal muscles were compared with the severity of symptoms and signs. All patients had abnormalities in at least one of the electrophysiological parameters. The sensory potentials were the most sensitive indicator of subclinical involvement; abnormalities were found in 24 patients, 12 of whom had no sensory symptoms or signs and five of whom had no other clinical or electrophysiological evidence of neuropathy in the upper extremities. This indicates that sensory nerve fibres may be affected before motor. The next most sensitive parameter was the presence of fibrillation potentials, found in more than half the distal muscles examined. Slowing in motor conduction in the lateral popliteal nerve was the only electrophysiological change correlated to the severity of the neuropathy, and no other electrophysiological parameter was correlated to the duration or the severity of the neuropathy or the diabetes. An onset of neuropathy before or simultaneously with the manifestations of the diabetes, as well as the frequent occurrence of asymptomatic changes in sensory conduction, support the evidence at hand that the neuropathy develops concomitantly with and as an integral part of the metabolic disturbance rather than as a consequence of the vascular complications of diabetes. Of three patients with clinical signs or symptoms of a diabetic amyotrophy, two had asymptomatic electrophysiological abnormalities in distal nerves and muscles, consistent with widespread involvement of the peripheral nerves. The third patient had electromyographic changes in the medial vastus muscles suggestive of a myopathy. Motor and sensory conduction in distal and proximal nerves were normal.

Full text

PDF
444

Images in this article

448Image
on p.448

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BUCHTHAL F., PINELLI P. Action potentials in muscular atrophy of neurogenic origin. Neurology. 1953 Aug;3(8):591–603. doi: 10.1212/wnl.3.8.591. [DOI] [PubMed] [Google Scholar]
  2. Buchthal F., Rosenfalck A. Causes of abnormal sensory potentials in neuropathy. Electroencephalogr Clin Neurophysiol. 1968 Oct;25(4):405–406. [PubMed] [Google Scholar]
  3. Buchthal F., Rosenfalck P. Spontaneous electrical activity of human muscle. Electroencephalogr Clin Neurophysiol. 1966 Apr;20(4):321–336. doi: 10.1016/0013-4694(66)90001-0. [DOI] [PubMed] [Google Scholar]
  4. CALVERLEY J. R., MULDER D. W. Femoral neuropathy. Neurology. 1960 Nov;10:963–967. doi: 10.1212/wnl.10.11.963. [DOI] [PubMed] [Google Scholar]
  5. CARUSO G., BUCHTHAL F. REFRACTORY PERIOD OF MUSCLE AND ELECTROMYOGRAPHIC FINDINGS IN RELATIVES OF PATIENTS WITH MUSCULAR DYSTROPHY. Brain. 1965 Mar;88:29–50. doi: 10.1093/brain/88.1.29. [DOI] [PubMed] [Google Scholar]
  6. Chopra J. S., Hurwitz L. J. Femoral nerve conduction in diabetes and chronic occlusive vascular disease. J Neurol Neurosurg Psychiatry. 1968 Feb;31(1):28–33. doi: 10.1136/jnnp.31.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chopra J. S., Hurwitz L. J., Montgomery D. A. The pathogenesis of sural nerve changes in diabetes mellitus. Brain. 1969;92(2):391–418. doi: 10.1093/brain/92.2.391. [DOI] [PubMed] [Google Scholar]
  8. DOLMAN C. L. The morbid anatomy of diabetic neuropathy. Neurology. 1963 Feb;13:135–142. doi: 10.1212/wnl.13.2.135. [DOI] [PubMed] [Google Scholar]
  9. DOWNIE A. W., NEWELL D. J. Sensory nerve conduction in patients with diabetes mellitus and controls. Neurology. 1961 Oct;11:876–882. doi: 10.1212/wnl.11.10.876. [DOI] [PubMed] [Google Scholar]
  10. ELLENBERG M. CLINICAL CONCEPT OF PREDIABETES. N Y State J Med. 1964 Dec 1;64:2885–2891. [PubMed] [Google Scholar]
  11. ELLENBERG M. Diabetic neuropathy presenting as the initial clinical manifestation of diabetes. Ann Intern Med. 1958 Sep;49(3):620–631. doi: 10.7326/0003-4819-49-3-620. [DOI] [PubMed] [Google Scholar]
  12. FAGERBERG S. E., PETERSEN I., STEG G., WILHELMSEN L. MOTOR DISTURBANCES IN DIABETES MELLITUS. A CLINICAL STUDY USING ELECTROMYOGRAPHY AND NERVE CONDUCTION VELOCITY DETERMINATION. Acta Med Scand. 1963 Dec;174:711–716. [PubMed] [Google Scholar]
  13. GAMSTORP I. CONDUCTION VELOCITY OF PERIPHERAL MOTOR NERVES IN MENTAL RETARDATION, DIABETES AND VARIOUS NEUROLOGICAL DISEASES IN CHILDHOOD. Acta Paediatr. 1964 Sep;53:408–416. doi: 10.1111/j.1651-2227.1964.tb07799.x. [DOI] [PubMed] [Google Scholar]
  14. GARLAND H. Diabetic amyotrophy. Br J Clin Pract. 1961 Jan;15:9–13. [PubMed] [Google Scholar]
  15. GARLAND H. Diabetic amyotrophy. Br Med J. 1955 Nov 26;2(4951):1287–1290. doi: 10.1136/bmj.2.4951.1287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. GASSEL M. M., TROJABORG W. CLINICAL AND ELECTROPHYSIOLOGICAL STUDY OF THE PATTERN OF CONDUCTION TIMES IN THE DISTRIBUTION OF THE SCIATIC NERVE. J Neurol Neurosurg Psychiatry. 1964 Aug;27:351–357. doi: 10.1136/jnnp.27.4.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. GILLIATT R. W., WILLISON R. G. Peripheral nerve conduction in diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1962 Feb;25:11–18. doi: 10.1136/jnnp.25.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. GREENBAUM D. OBSERVATIONS ON THE HOMOGENEOUS NATURE AND PATHOGENESIS OF DIABETIC NEUROPATHY. Brain. 1964 Jun;87:215–232. doi: 10.1093/brain/87.2.215. [DOI] [PubMed] [Google Scholar]
  19. GREENBAUM D., RICHARDSON P. C., SALMON M. V., URICH H. PATHOLOGICAL OBSERVATIONS ON SIX CASES OF DIABETIC NEUROPATHY. Brain. 1964 Jun;87:201–214. doi: 10.1093/brain/87.2.201. [DOI] [PubMed] [Google Scholar]
  20. GREGERSEN G. MOTOR-NERVE FUNCTION AND DURATION OF DIABETES. Lancet. 1964 Oct 3;2(7362):733–733. doi: 10.1016/s0140-6736(64)92550-4. [DOI] [PubMed] [Google Scholar]
  21. Gregersen G. Diabetic neuropathy: influence of age, sex, metabolic control, and duration of diabetes on motor conduction velocity. Neurology. 1967 Oct;17(10):972–980. doi: 10.1212/wnl.17.10.972. [DOI] [PubMed] [Google Scholar]
  22. LAWRENCE D. G., LOCKE S. Motor nerve conduction velocity in diabetes. Arch Neurol. 1961 Nov;5:483–489. doi: 10.1001/archneur.1961.00450170021003. [DOI] [PubMed] [Google Scholar]
  23. LOCKE S., LAWRENCE D. G., LEGG M. A. Diabetic amyotrophy. Am J Med. 1963 Jun;34:775–785. doi: 10.1016/0002-9343(63)90086-x. [DOI] [PubMed] [Google Scholar]
  24. MARTIN M. M. Diabetic neuropathy; a clinical study of 150 cases. Brain. 1953;76(4):594–624. doi: 10.1093/brain/76.4.594. [DOI] [PubMed] [Google Scholar]
  25. MAYER R. F. NERVE CONDUCTION STUDIES IN MAN. Neurology. 1963 Dec;13:1021–1030. doi: 10.1212/wnl.13.12.1021. [DOI] [PubMed] [Google Scholar]
  26. MULDER D. W., LAMBERT E. H., BASTRON J. A., SPRAGUE R. G. The neuropathies associated with diabetes mellitus. A clinical and electromyographic study of 103 unselected diabetic patients. Neurology. 1961 Apr;11(4):275–284. doi: 10.1212/wnl.11.4.275. [DOI] [PubMed] [Google Scholar]
  27. Slomić A., Rosenfalck A., Buchthal F. Electrical and mechanical responses of normal and myasthenic muscle. Brain Res. 1968 Aug 5;10(1):1–78. doi: 10.1016/0006-8993(68)90227-8. [DOI] [PubMed] [Google Scholar]
  28. THAGE O., TROJABORG W., BUCHTHAL F. Electromyographic findings in polyneuropathy. Neurology. 1963 Apr;13:273–278. doi: 10.1212/wnl.13.4.273. [DOI] [PubMed] [Google Scholar]
  29. TROJABORG W. MOTOR NERVE CONDUCTION VELOCITIES IN NORMAL SUBJECTS WITH PARTICULAR REFERENCE TO THE CONDUCTION IN PROXIMAL AND DISTAL SEGMENTS OF MEDIAN AND ULNAR NERVE. Electroencephalogr Clin Neurophysiol. 1964 Sep;17:314–321. doi: 10.1016/0013-4694(64)90132-4. [DOI] [PubMed] [Google Scholar]
  30. WIESENDANGER M., BISCHOFF A. [Electromyographic changes in diabetic neuropathy]. Bull Schweiz Akad Med Wiss. 1962 Oct;18:233–246. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES