Treatment of Diabetic Neuropathy in Dubai

Treatment of Diabetic Neuropathy in Dubai

Burning, tingling, or a loss of sensation in your hand, feet, or limbs may be a sign of diabetic peripheral neuropathy

What is the peripheral nervous system?

Your peripheral nervous system connects your brain and spinal cord (central nervous system) to the rest of your body. It’s made up of three types of nerves, including:

• Sensory nerves that carry information to your brain about sensations, such as touch ,pain, ,movement of joints, balance, pressure and vibration
• Motor nerves that carry messages from your brain to your muscles to control movement
• Autonomic nerves that regulate bodily functions, such as heart rate and digestion

All these nerves play an important role in keeping you healthy and functioning properly.

What is neuropathy?

Neuropathy happens when the neurons, or nerve cells, in your peripheral nervous system become damaged or destroyed. This causes problems with the way your body and brain communicate with one another. This condition can affect only one nerve or many. Carpal tunnel syndrome is an example of neuropathy that affects only one nerve.

What are the symptoms of neuropathy?

Neuropathy symptoms vary depending on the type and location of the nerve damage. Signs and symptoms of peripheral neuropathy may include:

• Sharp, throbbing, burning, or freezing pain
• Gradual numbness that may begin as tingling
• Extreme sensitivity to touch
• Decreased strength and muscle coordination
• Abnormal blood pressure or heart rate
• Sexual dysfunction
• Nausea or vomiting
• Muscle twitching or spasms
• Loss of muscle control
• Dizziness or fainting

Assessment and diagnosis

The diagnosis of PDN is primarily clinical, based on a history of neuropathic pain and confirmatory examination findings, establishing deficits associated with neuropathy. Although one might argue that confirming neuropathy using tests which assess large fiber deficits (loss of sensation, monofilament exam, reflexes) are not relevant to painful symptoms which are driven principally by small fiber damage. Patients report intermittent or continuous symptoms of pain described as burning, stabbing, tingling, numb, hot, cold or itching in a distal-to-proximal ‘glove-and-stocking’ distribution, usually beginning in the feet. The pain is typically symmetrical and worsens at night. Abnormal sensory perception, such as reduced or heightened perception of hot, cold, touch or pin-prick sensation (allodynia), may be present on examination

Role of Nerve Conduction Studies and Electromyography in Diagnosis ,Quantification and Treatment

Neurophysiology is a discipline within the health sciences which deals with the measurement and assessment of nervous system function rather than the anatomy of the nervous system. It helps to diagnose and monitor the progress of nervous disorders. The finding of a neurophysiological evaluation in conjunction with an appropriate clinical history and clinical examination of a patient would provide what can be called an electro clinical diagnosis. The electro clinical diagnosis will either provide the definitive diagnosis or narrow the range of probabilities and guide one in the direction of the appropriate line of further investigation. Two common electrodiagnostictests for peripheral neuropathy are: Electromyography (EMG) and the Nerve Conduction Velocity (NCV) Test.Electrodiagnostic findings provide a higher level of specificity for the diagnosis of polyneuropathy and should be included as part of the work‐up. Nerve conduction studies (NCS) are the most informative part of the electrodiagnosticevaluation which commonly include both NCS andelectromyogram (EMG). For NCS, small pads are taped to the skin, deliver mild electric shocks and detect electric signals generated by nerves. Further, due to the objectivity, reliability and sensitivity in the measurement of peripheral nerve function, NCS have long been a minimal criterion or a gold standard test for confirming the diagnosis of peripheral neuropathies. Routine NCS include evaluation of motor function of the median, ulnar, peroneal, and tibial nerves, and sensory function of median, ulnar, radial, and sural nerves. Recommended attributes encompass amplitude, distal latency, distance, conduction velocity, F‐wave latency and other measurements (American Diabetes Association 1992).

Treatment of Diabetic Neuropathy in Dubai

Diabetic neuropathy (DN) is a debilitating consequence of diabetes that may be present in as many 50 to 70% patients with diabetes. The objective assessment of DN is done with neurophysiology like studying the nerve conduction parameters of various sensory and motor nerves. No single treatment exists to reverse neuropathic changes or to provide total pain relief. Treatment of DN is based on three major approaches: intensive glycemic control and risk factor management, treatments based on pathogenic mechanisms, and symptomatic pain management. Clinical guidelines recommend pain relief in DN through the use of antidepressants such as amitriptyline and duloxetine, the γ-aminobutyric acid analogues gabapentin and pregabalin, and topical agents such as capsaicin. Of these medications, duloxetine and pregabalin were approved by the US Food and Drug Administration (FDA) in 2004 and tapentadol extended release was approved in 2012 for the treatment of PDN. Proposed pathogenic treatments include α-lipoic acid (stems reactive oxygen species formation), benfotiamine (prevents vascular damage in diabetes) and aldose-reductase inhibitors (reduces flux through the polyol pathway). There is a growing need for studies to evaluate the most potent drugs or combinations for the management of PDN to maximize pain relief and improve quality of life.