Comparing Screening Tools and Electrophysiological Findings of Sural and Peroneal Nerves in the Diagnosis of Neuropathy in Patients with Diabetes: A Cross-sectional Study

Hamid Reza Fateh; Mostafa Azimi; Seyed Pezhman  Madani

doi:10.18502/jimc.v5i3.10939

Hamid Reza Fateh Department of Physical Medicine and Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Mostafa Azimi Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Seyed Pezhman Madani Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v5i3.10939

Keywords: Diabetes mellitus, Diabetic neuropathies, Electrodiagnosis, Michigan, Neural conduction, Peroneal nerve, Sural nerve, United Kingdom

Abstract

Background: Some clinical scoring systems as the quantitative tools have been developed to assess the presence and severity of Diabetic Peripheral Neuropathy (DPN) based on both the patient’s complaints and the physicians’ findings. This study was aimed at assessing the presence and severity of sural and peroneal nerve neuropathies using Michigan Neuropathy Screening Instrument (MNSI) and United Kingdom Screening Test (UKST) questionnaire compared with electrodiagnosis assessments.

Methods: 148 patients with Diabetes Mellitus (DM) including 80 females and 68 males with a mean age of 57.6, 19 type 1DM and 129 type 2 DM were recruited in this study. The findings of the electrophysiological study such as peroneal and sural nerves’ conduction delay, velocity and amplitude were gathered. The patients were also assessed regarding the clinical neuropathy status using the two instruments of MNSI and UK.

Results: The mean neuropathy score of MNSI and UKST were 2.2 (1.7) and 4.1 (3.0), respectively. Each instrument detected the DPN in 47.3% and 64.9% of the patients, respectively. Also, based on the nerve conduction studies (NCS), the neuropathy of sural and peroneal nerves was found in 54.1% and 79.7%, respectively. Unlike the peroneal nerve, there was a significant agreement between the electrodiagnosis assessment and the screening tools in the diagnosis of sural nerve neuropathy.

Conclusion: Given that NCS is a practical, simple, and non-invasive approach and also can determine the level of damage and regeneration in peripheral nerves, sural nerve conduction study is suggested as a convenient option for screening and diagnosing the diabetic neuropathy.