Early Detection of Small-Fiber Neuropathy in Diabetes

Abstract

This study evaluated for the first time the impairment of pain sensation by measuring pain pSEP latency in diabetic patients with no clinical or electrophysiological evidence of large nerve-fiber dysfunction. The abnormalities of pSEP latencies mainly affected the lower limbs resembling a length-related
\npattern of neuropathy. Pupillary study showed a contemporary but unrelated damage of small sympathetic autonomic fibers. These findings confirm that small fibers may be selectively involved and more prone to damage in diabetic patients, strengthening the necessity for an accurate, quantitative, and noninvasive
\nsimultaneous assessment of different nerve fibers. In this view, the cortical pain pSEPs may be used to evaluate the electrophysiological integrity of A- fibers in diabetic patients, because no other accurate objective examinations are available to study the impairment of nociceptive sensitivity