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당뇨병 환자에서의 안쪽 발바닥 감각신경의 신경전도검사: 세 가지 다른 방법의 비교

Medial Plantar Sensory Nerve Conduction Studies in Diabetics: Comparision of Three Different Methods

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Background: The medial plantar nerve (MPN) is a distal branch of the posterior tibial nerve, and various methods of nerve conduction study for MPN have been introduced so far. Hemmi et al described a new method (Hemmi's method) for recording medial plantar sensory nerve action potentials (SNAPs), which is considered as a simple and reliable method for measuring medial plantar SNAPs. This study was aimed to establish the normal values for the MPN conduction study among Koreans and to compare the sensitivities of three different methods for MPN conduction study (Hemmi, Oh, and Saeed's method) in detecting evidence of peripheral neuropathy among diabetic patients. Methods: In 27 healthy subjects, MPN conduction study using Hemmi’s method was performed and normal values were calculated. In 54 diabetic patients who showed normal routine nerve conduction studies, three different methods for MPN conduction study were performed and diagnostic sensitivity of each method were compared. Results: In normal subjects, the mean medial plantar SNAP amplitude and conduction velocities measured by Hemmi's method were 4.3±1.0 uV and 38.3±6.8 m/s respectively. Among 54 patients with diabetes who showed normal routine nerve conduction studies, medial plantar SNAP was not obtainable in 28, 31, and 6 patients by Hemmi, Oh and Saeed's method respectively. Conclusions: In terms of the diagnostic sensitivity for detecting diabetic neuropathy, there had been no significant statistical difference between three different methods. Our study suggested that MPN conduction study using Hemmi’s method is simple and useful screening test for early diabetic neuropathy, and is comparable with Oh’s method.

Abstract

Background: The medial plantar nerve (MPN) is a distal branch of the posterior tibial nerve, and various methods of nerve conduction study for MPN have been introduced so far. Hemmi et al described a new method (Hemmi's method) for recording medial plantar sensory nerve action potentials (SNAPs), which is considered as a simple and reliable method for measuring medial plantar SNAPs. This study was aimed to establish the normal values for the MPN conduction study among Koreans and to compare the sensitivities of three different methods for MPN conduction study (Hemmi, Oh, and Saeed's method) in detecting evidence of peripheral neuropathy among diabetic patients. Methods: In 27 healthy subjects, MPN conduction study using Hemmi’s method was performed and normal values were calculated. In 54 diabetic patients who showed normal routine nerve conduction studies, three different methods for MPN conduction study were performed and diagnostic sensitivity of each method were compared. Results: In normal subjects, the mean medial plantar SNAP amplitude and conduction velocities measured by Hemmi's method were 4.3±1.0 uV and 38.3±6.8 m/s respectively. Among 54 patients with diabetes who showed normal routine nerve conduction studies, medial plantar SNAP was not obtainable in 28, 31, and 6 patients by Hemmi, Oh and Saeed's method respectively. Conclusions: In terms of the diagnostic sensitivity for detecting diabetic neuropathy, there had been no significant statistical difference between three different methods. Our study suggested that MPN conduction study using Hemmi’s method is simple and useful screening test for early diabetic neuropathy, and is comparable with Oh’s method.

참고문헌 (19)

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  3. Uluc K, "Medial plantar and dorsal sural nerve conduction sudies increase the sensitivity in the detection of neuropathy in diabetic patients", Clini Neurophysiol, 119, pp.880~885 (2008)
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  7. Oh SJ, "Medial plantar neuropathy", Neurology, 37, pp.1408~1410 (1987)
  8. Oh SJ, "Clinical electromyography: nerve conduction studies. 3rd ed", pp.282~285 (2003), Lippincott Williams & Wikins
  9. Oh SJ, "Lateral plantar neuropathy", Muscle Nerve, 22, pp.1234~1238 (1999)
  10. Weiss L, "Easy EMG: a guide to performing nerve conduction studies and electromyography", pp.13~16 (2004), Butterworth Heinemann
  11. Perkins BA, "Diabetic neuropathy: a review emphasizing diagnostic methods", Clini Neurophysiol, 114, pp.1167~1175 (2003)
  12. Løseth S, "Medial plantar nerve conduction studies in healthy controls and diabetics", Clini Neurophysiol, 118, pp.1155~1161 (2007)
  13. Turgut N, "Clinical utility of dorsal sural nerve conduction studies in healthy and diabetic children", Clini Neurophysiol, 115, pp.1452~1456 (2004)
  14. Koçer A, "A comparison of sural nerve conduction studies in patients with impaired oral glucose tolerance test", Acta Neurol Scand, 116, pp.399~405 (2007)
  15. Oh SJ, "Electrophysiological diagnosis of interdigital neuropathy of the foot", Muscle Nerve, 7, pp.218~225 (1984)
  16. Abraham RM, "Absence of the sensory action potential of the medial plantar nerve: a sensitive indicator of diabetic neuropathy", Diabet Med, 4, pp.469~474 (1987)
  17. Rivner MH, "Influence of age and height on nerve conduction", Muscle Nerve, 24, pp.1134~1141 (2001)
  18. 배종석, "정상 신경전도검사 소견을 보이는 무증상성 당뇨신경병증", 대한신경과학회지, 24(6), pp.557~563 (2006), 대한신경과학회
  19. 권석범, "당뇨병성 신경병증 환자에서 관찰되는 탈수초화의 전기생리학적 소견", 대한신경과학회지, 22(3), pp.240~248 (2004), 대한신경과학회

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