caa a22 4500 445809094 CHVBK 20180317145206.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1007/s00415-011-6031-z doi (NATIONALLICENCE)springer-10.1007/s00415-011-6031-z Asymptomatic small fiber neuropathy in diabetes mellitus: investigations with intraepidermal nerve fiber density, quantitative sensory testing and laser-evoked potentials [Elektronische Daten] [Michael Ragé, Nathalie Van Acker, Michiel Knaapen, Maarten Timmers, Johannes Streffer, Michel Hermans, Christian Sindic, Theo Meert, Léon Plaghki] This study aimed at evaluating the performance of a battery of morphological and functional tests for the assessment of small nerve fiber loss in asymptomatic diabetic neuropathy (DNP). Patients diagnosed for ≥10years with type 1 (n=10) or type 2 (n=13) diabetes mellitus (DM) without conventional symptoms or signs of DNP were recruited and compared with healthy controls (n=18) and patients with overt DNP (n=5). Intraepidermal nerve fiber density (IENFd) was measured with PGP9.5 immunostaining on punch skin biopsies performed at the distal leg. Functional tests consisted of quantitative sensory testing (QST) for light-touch, cool, warm and heat pain detection thresholds and brain-evoked potentials with electrical (SEPs) and CO2 laser stimulation [laser-evoked potentials (LEPs)] of hand dorsum and distal leg using small (0.8mm2) and large (20mm2) beam sizes. Results confirmed a state of asymptomatic DNP in DM, but only at the distal leg. Defining a critical small fiber loss as a reduction of IENFd ≤−2 z scores of healthy controls, this state prevailed in type 2 (30%) over type 1 DM (10%) patients despite similar disease duration and current glycemic control. LEPs with the small laser beam performed best in terms of sensitivity (91%), specificity (83%) and area-under-the ROC curve (0.924). Although this performance was not statically different from that of warm and cold detection threshold, LEPs offer an advantage over QST given that they bypass the subjective report and are therefore unbiased by perceptual factors. Springer-Verlag, 2011 Diabetic neuropathy nationallicence Skin punch biopsy nationallicence Intraepidermal nerve fiber density nationallicence Laser-evoked potentials nationallicence Quantitative sensory testing nationallicence Ragé Michael Faculty of Medicine, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium aut Van Acker Nathalie Histogenex, Antwerp, Belgium aut Knaapen Michiel Histogenex, Antwerp, Belgium aut Timmers Maarten Experimental Medicine and External Innovation, Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium aut Streffer Johannes Experimental Medicine and External Innovation, Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium aut Hermans Michel Service d'Endocrinologie et Nutrition, Cliniques universitaires St Luc, Brussels, Belgium aut Sindic Christian Service de Neurologie, Cliniques universitaires St Luc, Brussels, Belgium aut Meert Theo Experimental Medicine and External Innovation, Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium aut Plaghki Léon Faculty of Medicine, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium aut Journal of Neurology Springer-Verlag 258/10(2011-10-01), 1852-1864 0340-5354 258:10<1852 2011 258 415 https://doi.org/10.1007/s00415-011-6031-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00415-011-6031-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ragé Michael Faculty of Medicine, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium aut NATIONALLICENCE 700 1- Van Acker Nathalie Histogenex, Antwerp, Belgium aut NATIONALLICENCE 700 1- Knaapen Michiel Histogenex, Antwerp, Belgium aut NATIONALLICENCE 700 1- Timmers Maarten Experimental Medicine and External Innovation, Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium aut NATIONALLICENCE 700 1- Streffer Johannes Experimental Medicine and External Innovation, Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium aut NATIONALLICENCE 700 1- Hermans Michel Service d'Endocrinologie et Nutrition, Cliniques universitaires St Luc, Brussels, Belgium aut NATIONALLICENCE 700 1- Sindic Christian Service de Neurologie, Cliniques universitaires St Luc, Brussels, Belgium aut NATIONALLICENCE 700 1- Meert Theo Experimental Medicine and External Innovation, Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium aut NATIONALLICENCE 700 1- Plaghki Léon Faculty of Medicine, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium aut NATIONALLICENCE 773 0- Journal of Neurology Springer-Verlag 258/10(2011-10-01), 1852-1864 0340-5354 258:10<1852 2011 258 415 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer