Association between asymptomatic median mononeuropathy and diabetic polyneuropathy severity in patients with diabetes mellitus

Abstract Background Asymptomatic median mononeuropathy (AMM) and diabetic polyneuropathy (DPN) often coexist and can be difficult to distinguish electrophysiologically. Moreover, the potential association between AMM and DPN has not been extensively evaluated. Objective We investigated the relation...

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Published in:	Journal of the neurological sciences Vol. 278; no. 1; pp. 41 - 43
Main Authors:	Stamboulis, Eleftherios, Voumvourakis, Konstantinos, Andrikopoulou, Athina, Koutsis, Georgios, Tentolouris, Nicholas, Kodounis, Adonis, Tsivgoulis, Georgios
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier B.V 15-03-2009 Elsevier
Subjects:	Adult Age Factors Aged Asymptomatic median mononeuropathy Biological and medical sciences Carpal tunnel syndrome Diabetic Neuropathies - epidemiology Diabetic neuropathy Female Humans Incidence Logistic Models Male Median Neuropathy - epidemiology Medical sciences Middle Aged Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Neural Conduction Neurology Non-dominant hand Severity of Illness Index Sex Factors Carpal tunnel syndrome Diabetic neuropathy Non-dominant hand Asymptomatic median mononeuropathy Endocrinopathy Human Compression Nervous system diseases Diabetes mellitus Diseases of the osteoarticular system Asymptomatic Neuropathy Polyneuropathy Hand Peripheral nerve disease
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Summary:	Abstract Background Asymptomatic median mononeuropathy (AMM) and diabetic polyneuropathy (DPN) often coexist and can be difficult to distinguish electrophysiologically. Moreover, the potential association between AMM and DPN has not been extensively evaluated. Objective We investigated the relation between AMM and DPN severity in consecutive diabetic patients. Methods The non-dominant limb was studied electrophysiologically in 100 consecutive diabetic patients with no symptoms of carpal tunnel syndrome on the non-dominant side. AMM was diagnosed based on previously validated electrophysiological criteria. DPN severity was graded according to the Michigan diabetic neuropathy score. Results AMM was discovered in 28% of the study population (Adjusted Wald 95% CI: 20%–37%). It was more common in women, displayed a tendency of being more common in patients over 50 years old and correlated with the severity of DPN and the number of abnormal nerves on nerve conduction studies. It was present in 18.1% of patients without evidence of DPN. No correlation was found with the duration and type of diabetes. In multivariate logistic regression models increasing severity of DPN was independently associated with the presence AMM (Wald test = 10.557, df = 3, p = 0.014). Patients with DPN stage III and IV had a five-fold (OR = 5.06, 95% CI = 1.49–17.19) and a four-fold (OR = 4.50, 95% CI = 1.15–17.65) respectively increased likelihood to present with AMM in comparison to DPN stage I (reference group). Conclusions Our results confirmed the high incidence of AMM in diabetic patients. AMM was present in a significant number of patients in the absence of DPN and the likelihood of AMM detection increased with increasing severity of DPN.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-510X 1878-5883
DOI:	10.1016/j.jns.2008.11.006