- Publikační typ
- abstrakt z konference MeSH
Different sensory profiles in diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) may be associated with pain and the responsiveness to analgesia. We aimed to characterize sensory phenotypes of patients with painful and painless diabetic neuropathy and to assess demographic, clinical, metabolic, and electrophysiological parameters related to the presence of neuropathic pain in a large cohort of well-defined DSPN subjects. This observational cross-sectional multi-center cohort study (performed as part of the ncRNAPain EU consortium) of 232 subjects with nonpainful (n = 74) and painful (n = 158) DSPN associated with diabetes mellitus of type 1 and 2 (median age 63 years, range 21-87 years; 92 women) comprised detailed history taking, laboratory tests, neurological examination, quantitative sensory testing, nerve conduction studies, and neuropathy severity scores. All parameters were analyzed with regard to the presence and severity of neuropathic pain. Neuropathic pain was positively correlated with the severity of neuropathy and thermal hyposensitivity (P < 0.001). A minority of patients with painful DSPN (14.6%) had a sensory profile, indicating thermal hypersensitivity that was associated with less severe neuropathy. Neuropathic pain was further linked to female sex and higher cognitive appraisal of pain as assessed by the pain catastrophizing scale (P < 0.001), while parameters related to diabetes showed no influence on neuropathic pain with the exception of laboratory signs of nephropathy. This study confirms the value of comprehensive DSPN phenotyping and underlines the importance of the severity of neuropathy for the presence of pain. Different sensory phenotypes might be useful for stratification of patients with painful DSPN for analgesic treatment and drug trials.
- MeSH
- diabetické neuropatie diagnóza MeSH
- dospělí MeSH
- fenotyp * MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- neuralgie diagnóza MeSH
- neurologické vyšetření metody MeSH
- polyneuropatie diagnóza MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) has previously been used as a biomarker of myelopathy in patients with degenerative cervical cord compression (DCCC). However, many factors may affect the diffusion properties of the spinal cord. This prospective study seeks to identify sources of variability in spinal cord DTI parameters in both DCCC patients and healthy subjects. METHODS: The study group included 130 patients with DCCC confirmed by magnetic resonance imaging and 71 control subjects without signs of DCCC. DTI data of the cervical spine were acquired in all subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured at different levels of the spinal cord (SCLs). Statistical data analysis was then used to determine diffusion parameters in terms of age, sex, SCL, and spinal cord compression. RESULTS: Significant variations in FA and ADC values emerged when several spinal cord levels were mutually compared in the control group. FA values correlated significantly with age in the DCCC group and sex had a significant influence on ADC values in both groups. The two diffusion parameters in the DCCC group differed significantly between patients with clinical signs of mild-to-moderate myelopathy compared with asymptomatic patients, and correlated with measurements of spinal canal morphology. CONCLUSIONS: Diffusion parameters of the cervical spinal cord were thus shown to respond significantly to spinal cord compression, but were subject to interaction with several other factors including sex, age, and SCL. These findings may be important to the interpretation of DTI measurements in individual patients.
- MeSH
- komprese míchy diagnostické zobrazování MeSH
- krční mícha diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- zobrazování difuzních tenzorů * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Konfokální mikroskopie rohovky (Corneal Confocal Microscopy; CCM) je neinvazivní metoda morfologického vyšetření rohovky umožňující m.j. vizualizaci korneálních nervových vláken, která jsou tenká, málo myelinizovaná či nemyelizovaná. CCM je tedy diagnostická metoda neuropatie tenkých vláken, resp. obecně periferních neuropatií. Cílem práce bylo zavedení vyšetření CCM do klinické neurologické praxe v České republice, nastavení vhodných normativních dat a stanovení reprodukovatelnosti vyšetření. Soubor a metodika: CCM byla vyšetřena v souborech 71 zdravých dobrovolníků a 54 pacientů s diabetickou polyneuropatií (Diabetic Polyneuropathy; DPN). Ze zjištěných dat byly stanoveny normy pro tři oddělené věkové kategorie. Nálezy byly vyhodnoceny automatickou i manuální analýzou (a to nezávisle dvěma hodnotiteli) ke stanovení spolehlivosti vyšetření. Výsledky: Vyšetření CCM bylo časově a metodicky nenáročné a bylo naprostou většinou pacientů dobře tolerováno. Stanovená věkově stratifikovaná normativní data vykazují velmi dobrou použitelnost ve sledovaných souborech pacientů. U pacientů s DPN byly prokázány signifikantní změny všech sledovaných CCM parametrů oproti zdravým kontrolám. Při hodnocení CCM snímků manuální analýzou byla prokázána velmi dobrá shoda dvou hodnotitelů. Při hodnocení automatickým softwarem však byly hodnoty všech sledovaných CCM parametrů signifikantně nižší. Závěr: Prezentovaná studie v souhrnu prokázala jednoduchost, bezpečnost a dobrou spolehlivost vyšetření rohovkové inervace pomocí konfokální mikroskopie rohovky na poměrně rozsáhlém souboru zdravých kontrol a skupině pacientů s DPN a poukázala rovněž na rozdílnost automatického a manuálního hodnocení.
Corneal confocal microscopy (CCM) is a novel noninvasive method enabling morphological evaluation of corneal structures including nerve fibers. These fibers are almost exclusively of A-delta and C type, i.e. small unmyelinated and poorly myelinated. CCM is thus used as a diagnostic tool for peripheral neuropathies and in particular small fiber neuropathy. The aim of this study was to introduce this method into clinical practice in the Czech Republic, to set-up appropriate normative data and to verify reproducibility of the method. Material and methods: A group of 71 healthy controls was examined using the CCM. The data were used to set normal values in three distinct age-related groups and compare these with CCM findings in a group of 54 patients with diabetic polyneuropathy (DPN). Fully-automated as well as expert manual analysis (by two evaluators) were used for quantification of nerve fiber densities, length and branches to verify reliability of the results. Results: CCM evaluation was easy, well-tolerated and time-efficient in the majority of patients/controls. Age-related normal values showed very good applicability in evaluated groups of healthy individuals and DPN patients. Compared to healthy controls, DPN patients showed highly significant changes of all the evaluated CCM parameters. Results by the two evaluators of the expert manual analysis showed very good reliability, while results from the automated analysis showed significantly lower values on the majority of the CCM parameters. Conclusion: The present study proved on a rather large cohort of healthy controls and a smaller sample of DPN patients that CCM is a easy to use, safe and reliable approach to evaluating corneal innervation. The data also highlighted the differences between automated analysis expert manual CCM analysis.
PURPOSE: Intraepidermal nerve fiber density (IENFD) is useful in the evaluation of small-fiber neuropathy (SFN). Recent guidelines recommend extending the spectrum of controls for IENFD assessment by evaluation of patients whose clinical picture mimics that of SFN. The aim of this study was to broaden the spectrum of IENFD controls by the assessment of patients with cervical spondylotic myelopathy (CSM) and painful feet. METHODS: Evaluation of IENFD from skin biopsy samples and quantitative sensory testing (QST) were performed in a cohort of 14 CSM patients (eight men, median age: 58; range: 46-63 years), with painful feet, exhibiting no clinical or electrophysiological signs of large-fiber polyneuropathy, and no risk factors for peripheral neuropathies. RESULTS: Quantitative sensory testing abnormalities were found in all but two of the CSM patients (86%), while the IENFD values were within reference range. The mean IENFD value (6.87 +/- 2.78 fibers/mm) did not differ from that of an age- and sex-matched cohort of healthy volunteers (7.97 +/- 2.21 fibers/mm, P > 0.05). CONCLUSIONS: The study confirmed normal skin biopsy findings in patients with CSM as one of the clinical conditions mimicking SFN and provided further support for the use of IENFD assessment in case of suspicion of SFN.
- MeSH
- bolest diagnóza MeSH
- jehlová biopsie * MeSH
- kohortové studie MeSH
- kůže chemie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci míchy MeSH
- nemoci periferního nervového systému diagnóza patofyziologie MeSH
- nervová vlákna * fyziologie MeSH
- noha (od hlezna dolů) patofyziologie MeSH
- spondylóza komplikace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
STUDY DESIGN: Cross-sectional population-based observational study. OBJECTIVE: To estimate the prevalence of nonmyelopathic spondylotic cervical cord compression (NMSCCC) and cervical spondylotic myelopathy (CSM) in a population older than 40 years and to evaluate the magnetic resonance imaging (MRI) characteristics of these conditions. SUMMARY OF BACKGROUND DATA: The prevalence of neither NMSCCC nor CSM is known and there exists no commonly accepted quantitative MRI definition of cervical cord compression. METHODS: A group of 183 randomly recruited volunteers, 93 women, median age 66 years, range 40-80 years, underwent MRI examination of the cervical spine and spinal cord on a 1.5 T device using conventional sequences from disc levels C2/C3 to C6/C7. The imaging criterion for cervical cord compression was defined as a change in spinal cord contour at the level of an intervertebral disc on axial or sagittal MRI scan. RESULTS: MRI signs of cervical cord compression were found in 108 individuals (59.0%; 95% CI: 51.5%-66.2%); their numbers increased with age from 31.6% in the fifth decade to 66.8% in the eighth. Clinical signs of symptomatic CSM were found in two cases (1.1%), and 75 cases (41.0%) were without compression. An anteroposterior cervical canal diameter at the level of intervertebral disc (CDdisc) of less than 9.9 mm was associated with the highest probability of NMSCCC-odds ratio (OR) = 32.5, followed by a compression ratio of ≤0.5: OR = 11.1. CONCLUSION: The prevalence of NMSCCC in a population older than 40 years is higher than previously reported and increases with age. CDdisc and compression ratio had the highest capacity to discriminate between subjects with and without asymptomatic compression, and their cut-off values could be used to objectify criteria for cervical cord compression. LEVEL OF EVIDENCE: 2.
- MeSH
- dospělí MeSH
- komprese míchy komplikace diagnostické zobrazování epidemiologie MeSH
- krční mícha diagnostické zobrazování chirurgie MeSH
- krční obratle patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- páteřní kanál diagnostické zobrazování MeSH
- prevalence MeSH
- průřezové studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spondylóza diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: The aim of this prospective cross-sectional observational comparative study was to determine the prevalence of spondylotic cervical cord compression (SCCC) and symptomatic cervical spondylotic myelopathy (CSM) in patients with symptomatic lumbar spinal stenosis (LSS) in comparison with a general population sample and to seek to identify predictors for the development of CSM. METHODS: A group of 78 patients with LSS (48 men, median age 66 years) was compared with a randomly selected age- and sex-matched group of 78 volunteers (38 men, median age 66 years). We evaluated magnetic resonance imaging findings from the cervical spine and neurological examination. RESULTS: The presence of SCCC was demonstrated in 84.6% of patients with LSS, but also in 57.7% of a sample of volunteers randomly recruited from the general population. Clinically symptomatic CSM was found in 16.7% of LSS patients in comparison with 1.3% of volunteers (p = 0.001). Multivariable logistic regression proposed the Oswestry Disability Index of 43% or more as the only independent predictor of symptomatic CSM in LSS patients (OR 9.41, p = 0.008). CONCLUSIONS: The presence of symptomatic LSS increases the risk of SCCC; the prevalence of SCCC is higher in patients with symptomatic LSS in comparison with the general population, with an evident predominance of more serious types of MRI-detected compression and a clinically symptomatic form (CSM). Symptomatic CSM is more likely in LSS patients with higher disability as assessed by the Oswestry Disability Index.
- MeSH
- bederní obratle patologie MeSH
- dospělí MeSH
- komprese míchy patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- neurologické vyšetření MeSH
- posuzování pracovní neschopnosti MeSH
- prospektivní studie MeSH
- průřezové studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spinální stenóza patologie MeSH
- spondylóza patologie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
