Validation of the nerve axon reflex for the assessment of small nerve fibre dysfunction
Objective: To validate nerve–axon reflex-related vasodilatation as an objective method to evaluate C-nociceptive fibre function by comparing it with the standard diagnostic criteria. Methods: Neuropathy was evaluated in 41 patients with diabetes (26 men and 15 women) without peripheral vascular dise...
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| Veröffentlicht in: | Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2006-08, Vol.77 (8), p.927-932 |
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| creator | Caselli, A Spallone, V Marfia, G A Battista, C Pachatz, C Veves, A Uccioli, L |
| description | Objective: To validate nerve–axon reflex-related vasodilatation as an objective method to evaluate C-nociceptive fibre function by comparing it with the standard diagnostic criteria. Methods: Neuropathy was evaluated in 41 patients with diabetes (26 men and 15 women) without peripheral vascular disease by assessing the Neuropathy Symptom Score, the Neuropathy Disability Score (NDS), the vibration perception threshold (VPT), the heat detection threshold (HDT), nerve conduction parameters and standard cardiovascular tests. The neurovascular response to 1% acetylcholine (Ach) iontophoresis was measured at the forearm and at both feet by laser flowmetry. An age-matched and sex-matched control group of 10 healthy people was also included. Results: Significant correlations were observed between the neurovascular response at the foot and HDT (rs = −0.658; p |
| doi_str_mv | 10.1136/jnnp.2005.069609 |
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Methods: Neuropathy was evaluated in 41 patients with diabetes (26 men and 15 women) without peripheral vascular disease by assessing the Neuropathy Symptom Score, the Neuropathy Disability Score (NDS), the vibration perception threshold (VPT), the heat detection threshold (HDT), nerve conduction parameters and standard cardiovascular tests. The neurovascular response to 1% acetylcholine (Ach) iontophoresis was measured at the forearm and at both feet by laser flowmetry. An age-matched and sex-matched control group of 10 healthy people was also included. Results: Significant correlations were observed between the neurovascular response at the foot and HDT (rs = −0.658; p<0.0001), NDS (rs = −0.665; p<0.0001), VPT (rs = −0.548; p = 0.0005), tibial nerve conduction velocity (rs = 0.631; p = 0.0002), sural nerve amplitude (rs = 0.581; p = 0.0002) and autonomic function tests. According to the NDS, in patients with diabetes who had mild, moderate or severe neuropathy, a significantly lower neurovascular response was seen at the foot than in patients without neuropathy and controls. A neurovascular response <50% was found to be highly sensitive (90%), with a good specificity (74%), in identifying patients with diabetic neuropathy. Conclusion: Small-fibre dysfunction can be diagnosed reliably with neurovascular response assessment. This response is already reduced in the early stages of peripheral neuropathy, supporting the hypothesis that small-fibre impairment is an early event in the natural history of diabetic neuropathy.</description><identifier>ISSN: 0022-3050</identifier><identifier>EISSN: 1468-330X</identifier><identifier>DOI: 10.1136/jnnp.2005.069609</identifier><identifier>PMID: 16624842</identifier><identifier>CODEN: JNNPAU</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd</publisher><subject>acetylcholine ; Ach ; Aged ; Ankle ; area under the curve ; AUC ; Axons - pathology ; Biological and medical sciences ; Cholinergic Fibers - pathology ; Cranial nerves. Peripheral nerves. Autonomic nervous system ; Diabetes ; Diabetic Neuropathies - diagnosis ; Diabetic neuropathy ; Electrophysiology ; Female ; Glucose ; HDT ; heat detection threshold ; Humans ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Iontophoresis ; Lasers ; Local anesthesia ; Male ; Medical sciences ; Middle Aged ; NDS ; Neural Conduction ; Neurologic Examination ; Neurology ; Neuropathy Disability Score ; Neurosurgery ; Patients ; Peripheral neuropathy ; QSART ; Quantitative Sudomotor Axon Reflex Test ; receiver-operating characteristic ; Reflex, Abnormal ; ROC ; ROC Curve ; Sensitivity and Specificity ; Skin ; SNP ; sodium nitroprusside ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Temperature ; Traumas. Diseases due to physical agents ; Vasodilation ; vibration perception threshold ; VPT</subject><ispartof>Journal of neurology, neurosurgery and psychiatry, 2006-08, Vol.77 (8), p.927-932</ispartof><rights>Copyright 2006 Journal of Neurology Neurosurgery and Psychiatry</rights><rights>2006 INIST-CNRS</rights><rights>Copyright: 2006 Copyright 2006 Journal of Neurology Neurosurgery and Psychiatry</rights><rights>Copyright © 2006 BMJ Publishing Group</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b557t-626b8f55878f04ba6dbe75fd9bb2335e8c739da64571a404419ec477061aebba3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jnnp.bmj.com/content/77/8/927.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://jnnp.bmj.com/content/77/8/927.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,230,315,728,781,785,886,3197,23573,27926,27927,53793,53795,77602,77633</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17953254$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16624842$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Caselli, A</creatorcontrib><creatorcontrib>Spallone, V</creatorcontrib><creatorcontrib>Marfia, G A</creatorcontrib><creatorcontrib>Battista, C</creatorcontrib><creatorcontrib>Pachatz, C</creatorcontrib><creatorcontrib>Veves, A</creatorcontrib><creatorcontrib>Uccioli, L</creatorcontrib><title>Validation of the nerve axon reflex for the assessment of small nerve fibre dysfunction</title><title>Journal of neurology, neurosurgery and psychiatry</title><addtitle>J Neurol Neurosurg Psychiatry</addtitle><description>Objective: To validate nerve–axon reflex-related vasodilatation as an objective method to evaluate C-nociceptive fibre function by comparing it with the standard diagnostic criteria. Methods: Neuropathy was evaluated in 41 patients with diabetes (26 men and 15 women) without peripheral vascular disease by assessing the Neuropathy Symptom Score, the Neuropathy Disability Score (NDS), the vibration perception threshold (VPT), the heat detection threshold (HDT), nerve conduction parameters and standard cardiovascular tests. The neurovascular response to 1% acetylcholine (Ach) iontophoresis was measured at the forearm and at both feet by laser flowmetry. An age-matched and sex-matched control group of 10 healthy people was also included. Results: Significant correlations were observed between the neurovascular response at the foot and HDT (rs = −0.658; p<0.0001), NDS (rs = −0.665; p<0.0001), VPT (rs = −0.548; p = 0.0005), tibial nerve conduction velocity (rs = 0.631; p = 0.0002), sural nerve amplitude (rs = 0.581; p = 0.0002) and autonomic function tests. According to the NDS, in patients with diabetes who had mild, moderate or severe neuropathy, a significantly lower neurovascular response was seen at the foot than in patients without neuropathy and controls. A neurovascular response <50% was found to be highly sensitive (90%), with a good specificity (74%), in identifying patients with diabetic neuropathy. Conclusion: Small-fibre dysfunction can be diagnosed reliably with neurovascular response assessment. This response is already reduced in the early stages of peripheral neuropathy, supporting the hypothesis that small-fibre impairment is an early event in the natural history of diabetic neuropathy.</description><subject>acetylcholine</subject><subject>Ach</subject><subject>Aged</subject><subject>Ankle</subject><subject>area under the curve</subject><subject>AUC</subject><subject>Axons - pathology</subject><subject>Biological and medical sciences</subject><subject>Cholinergic Fibers - pathology</subject><subject>Cranial nerves. Peripheral nerves. Autonomic nervous system</subject><subject>Diabetes</subject><subject>Diabetic Neuropathies - diagnosis</subject><subject>Diabetic neuropathy</subject><subject>Electrophysiology</subject><subject>Female</subject><subject>Glucose</subject><subject>HDT</subject><subject>heat detection threshold</subject><subject>Humans</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Iontophoresis</subject><subject>Lasers</subject><subject>Local anesthesia</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>NDS</subject><subject>Neural Conduction</subject><subject>Neurologic Examination</subject><subject>Neurology</subject><subject>Neuropathy Disability Score</subject><subject>Neurosurgery</subject><subject>Patients</subject><subject>Peripheral neuropathy</subject><subject>QSART</subject><subject>Quantitative Sudomotor Axon Reflex Test</subject><subject>receiver-operating characteristic</subject><subject>Reflex, Abnormal</subject><subject>ROC</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Skin</subject><subject>SNP</subject><subject>sodium nitroprusside</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Temperature</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Vasodilation</subject><subject>vibration perception threshold</subject><subject>VPT</subject><issn>0022-3050</issn><issn>1468-330X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqFkc9rFDEUx4Modq3ePcmA6EVmze9kLoIsthWKItSueAnJTGJnnUnWZKZs_3szztCql-byIO_zvnzf-wLwHME1QoS_3Xm_X2MI2RryisPqAVghymVJCPz2EKwgxLgkkMEj8CSlHZyerB6DI8Q5ppLiFdhe6q5t9NAGXwRXDFe28DZe20If8k-0rrOHwoX4p6NTsin11g8Tm3rddQvtWhNt0dwkN_p6EnsKHjndJftsqcfg68mHi81Zef759OPm_XlpGBNDyTE30jEmhXSQGs0bYwVzTWUMJoRZWQtSNZpTJpCmkFJU2ZoKATnS1hhNjsG7WXc_mt42dfYWdaf2se11vFFBt-rfjm-v1I9wrTAUghOWBV4vAjH8Gm0aVN-m2nad9jaMSXHJGcZI3guiinBBZJXBl_-BuzBGn6-gkJAIUwQhyhScqTqGlPKhbz0jqKZw1RSumsJVc7h55MXfu94NLGlm4NUC6FTrzkXt6zbdcaJiBDOauXLm2jTYw21fx58qryCY-nS5Ud-3Z9sTcnGqvmT-zcybfne_zd9alssy</recordid><startdate>20060801</startdate><enddate>20060801</enddate><creator>Caselli, A</creator><creator>Spallone, V</creator><creator>Marfia, G A</creator><creator>Battista, C</creator><creator>Pachatz, C</creator><creator>Veves, A</creator><creator>Uccioli, L</creator><general>BMJ Publishing Group Ltd</general><general>BMJ</general><general>BMJ Publishing Group LTD</general><general>BMJ Group</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7TK</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20060801</creationdate><title>Validation of the nerve axon reflex for the assessment of small nerve fibre dysfunction</title><author>Caselli, A ; Spallone, V ; Marfia, G A ; Battista, C ; Pachatz, C ; Veves, A ; Uccioli, L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b557t-626b8f55878f04ba6dbe75fd9bb2335e8c739da64571a404419ec477061aebba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>acetylcholine</topic><topic>Ach</topic><topic>Aged</topic><topic>Ankle</topic><topic>area under the curve</topic><topic>AUC</topic><topic>Axons - pathology</topic><topic>Biological and medical sciences</topic><topic>Cholinergic Fibers - pathology</topic><topic>Cranial nerves. Peripheral nerves. Autonomic nervous system</topic><topic>Diabetes</topic><topic>Diabetic Neuropathies - diagnosis</topic><topic>Diabetic neuropathy</topic><topic>Electrophysiology</topic><topic>Female</topic><topic>Glucose</topic><topic>HDT</topic><topic>heat detection threshold</topic><topic>Humans</topic><topic>Injuries of the nervous system and the skull. Diseases due to physical agents</topic><topic>Iontophoresis</topic><topic>Lasers</topic><topic>Local anesthesia</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>NDS</topic><topic>Neural Conduction</topic><topic>Neurologic Examination</topic><topic>Neurology</topic><topic>Neuropathy Disability Score</topic><topic>Neurosurgery</topic><topic>Patients</topic><topic>Peripheral neuropathy</topic><topic>QSART</topic><topic>Quantitative Sudomotor Axon Reflex Test</topic><topic>receiver-operating characteristic</topic><topic>Reflex, Abnormal</topic><topic>ROC</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Skin</topic><topic>SNP</topic><topic>sodium nitroprusside</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Temperature</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Vasodilation</topic><topic>vibration perception threshold</topic><topic>VPT</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caselli, A</creatorcontrib><creatorcontrib>Spallone, V</creatorcontrib><creatorcontrib>Marfia, G A</creatorcontrib><creatorcontrib>Battista, C</creatorcontrib><creatorcontrib>Pachatz, C</creatorcontrib><creatorcontrib>Veves, A</creatorcontrib><creatorcontrib>Uccioli, L</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Source</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>ProQuest Science Journals</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caselli, A</au><au>Spallone, V</au><au>Marfia, G A</au><au>Battista, C</au><au>Pachatz, C</au><au>Veves, A</au><au>Uccioli, L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of the nerve axon reflex for the assessment of small nerve fibre dysfunction</atitle><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle><addtitle>J Neurol Neurosurg Psychiatry</addtitle><date>2006-08-01</date><risdate>2006</risdate><volume>77</volume><issue>8</issue><spage>927</spage><epage>932</epage><pages>927-932</pages><issn>0022-3050</issn><eissn>1468-330X</eissn><coden>JNNPAU</coden><abstract>Objective: To validate nerve–axon reflex-related vasodilatation as an objective method to evaluate C-nociceptive fibre function by comparing it with the standard diagnostic criteria. Methods: Neuropathy was evaluated in 41 patients with diabetes (26 men and 15 women) without peripheral vascular disease by assessing the Neuropathy Symptom Score, the Neuropathy Disability Score (NDS), the vibration perception threshold (VPT), the heat detection threshold (HDT), nerve conduction parameters and standard cardiovascular tests. The neurovascular response to 1% acetylcholine (Ach) iontophoresis was measured at the forearm and at both feet by laser flowmetry. An age-matched and sex-matched control group of 10 healthy people was also included. Results: Significant correlations were observed between the neurovascular response at the foot and HDT (rs = −0.658; p<0.0001), NDS (rs = −0.665; p<0.0001), VPT (rs = −0.548; p = 0.0005), tibial nerve conduction velocity (rs = 0.631; p = 0.0002), sural nerve amplitude (rs = 0.581; p = 0.0002) and autonomic function tests. According to the NDS, in patients with diabetes who had mild, moderate or severe neuropathy, a significantly lower neurovascular response was seen at the foot than in patients without neuropathy and controls. A neurovascular response <50% was found to be highly sensitive (90%), with a good specificity (74%), in identifying patients with diabetic neuropathy. Conclusion: Small-fibre dysfunction can be diagnosed reliably with neurovascular response assessment. This response is already reduced in the early stages of peripheral neuropathy, supporting the hypothesis that small-fibre impairment is an early event in the natural history of diabetic neuropathy.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd</pub><pmid>16624842</pmid><doi>10.1136/jnnp.2005.069609</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | acetylcholine Ach Aged Ankle area under the curve AUC Axons - pathology Biological and medical sciences Cholinergic Fibers - pathology Cranial nerves. Peripheral nerves. Autonomic nervous system Diabetes Diabetic Neuropathies - diagnosis Diabetic neuropathy Electrophysiology Female Glucose HDT heat detection threshold Humans Injuries of the nervous system and the skull. Diseases due to physical agents Iontophoresis Lasers Local anesthesia Male Medical sciences Middle Aged NDS Neural Conduction Neurologic Examination Neurology Neuropathy Disability Score Neurosurgery Patients Peripheral neuropathy QSART Quantitative Sudomotor Axon Reflex Test receiver-operating characteristic Reflex, Abnormal ROC ROC Curve Sensitivity and Specificity Skin SNP sodium nitroprusside Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Temperature Traumas. Diseases due to physical agents Vasodilation vibration perception threshold VPT |
| title | Validation of the nerve axon reflex for the assessment of small nerve fibre dysfunction |
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