Signos y síntomas versus estudios de conducción neural para el diagnóstico de polineuropatía diabética sensorial y motora
Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy
Cl vs. NPhys trial.
Dyck PJ, Overland CJ, Low PA, Litchy WJ, Davies JL, Dyck PJ, O'Brien PC; Cl vs. NPhys Trial Investigators, Albers JW, Andersen H, Bolton CF, England JD, Klein CJ, Llewelyn JG, Mauermann ML, Russell JW, Singer W, Smith AG, Tesfaye S, Vella A. Collaborators (20)
Capelle SK, Engelstad JK, Witt LV, Motl SA, Moyer SK, Spavin KA, Zafft AJ, Winkler JA, Lodermeier KA, Gehrking JA, Gehrking TL, Iodice V, Sletten DM, Newman RC, Herring S, Litchy WJ, Dyck PJ, Kimpinski K, Low PA, Hunziker ML.
Peripheral Neuropathy Research Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Muscle Nerve. 2010 Aug;42(2):157-64.
Abstract
The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Sigma5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Sigma5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Sigma5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956592/pdf/nihms237312.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956592/?tool=pubmed
Bloqueos simpáticos y alivio sostenido del dolor en un paciente con neuropatía dolorosa diabética refractaria
Sympathetic blocks provided sustained pain relief in a patient with refractory painful diabetic neuropathy.
Cheng J, Daftari A, Zhou L.
Department of Pain Management, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Case Rep Anesthesiol. 2012;2012:285328. Epub 2012 Feb 6.
Abstract
The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350298/
pdf/CRIM.ANESTHESIOLOGY2012-285328.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350298/?tool=pubmed
Evaluación de la eficacia y seguridad de gabapentina, duloxetina y pregabalina en pacientes con neuropatía diabética dolorosa periférica
Evaluation of efficacy and safety of gabapentin, duloxetine, and pregabalin in patients with painful diabetic peripheral neuropathy.
Devi P, Madhu K, Ganapathy B, Sarma G, John L, Kulkarni C.
Department of Pharmacology, St John's Medical College, Bangalore, India.
Indian J Pharmacol. 2012 Jan;44(1):51-6.
Abstract
AIM: To compare the efficacy and safety of gabapentin (GBP), duloxetine (DLX), and pregabalin (PGB) in patients with painful diabetic peripheral neuropathy (DPNP).
METHODS: A prospective, randomized, open label, 12-week study was conducted. A total of 152 patients with history of pain attributed to DPNP with a minimum 40-mm score on visual analogue scale (VAS) were randomized to receive GBP, DLX, or PGB. The primary efficacy measure was pain severity as measured on 11 point VAS. Secondary efficacy measures included sleep interference score, Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). Assessment of safety was done by recording the occurrence of adverse drug reactions. Data was analyzed using descriptive statistics, Chi square test, analysis of variance (ANOVA), and repeated measures ANOVA. RESULTS: Of total 152 patients, 50 patients received GBP, DLX each while 52 received PGB. A significant reduction in pain score (VAS), sleep interference score, PGIC, and CGIC was seen in all the three treatment groups across time (P<0.05) with no statistically significant difference between the groups. There was a significant interaction between the time and treatment groups (P<0.001) for pain score (VAS), sleep interference score, and PGIC. The improvement in pain scores (VAS) and sleep interference score was higher with PGB compared to DLX and GBP. Adverse drug reactions were mild and occurred in 9.2% of all cases. CONCLUSIONS: Monotherapy with GBP, DLX, or PGB Produced a clinically and subjectively meaningful pain relief in patients with DPNP with onset of pain relief being faster and superior with PGB.
http://www.ijp-online.com/article.asp?issn=0253-7613;year=2012;volume=44;issue=1;spage=51;epage=56;aulast=Devi
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy
Cl vs. NPhys trial.
Dyck PJ, Overland CJ, Low PA, Litchy WJ, Davies JL, Dyck PJ, O'Brien PC; Cl vs. NPhys Trial Investigators, Albers JW, Andersen H, Bolton CF, England JD, Klein CJ, Llewelyn JG, Mauermann ML, Russell JW, Singer W, Smith AG, Tesfaye S, Vella A. Collaborators (20)
Capelle SK, Engelstad JK, Witt LV, Motl SA, Moyer SK, Spavin KA, Zafft AJ, Winkler JA, Lodermeier KA, Gehrking JA, Gehrking TL, Iodice V, Sletten DM, Newman RC, Herring S, Litchy WJ, Dyck PJ, Kimpinski K, Low PA, Hunziker ML.
Peripheral Neuropathy Research Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Muscle Nerve. 2010 Aug;42(2):157-64.
Abstract
The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Sigma5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Sigma5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Sigma5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956592/pdf/nihms237312.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956592/?tool=pubmed
Bloqueos simpáticos y alivio sostenido del dolor en un paciente con neuropatía dolorosa diabética refractaria
Sympathetic blocks provided sustained pain relief in a patient with refractory painful diabetic neuropathy.
Cheng J, Daftari A, Zhou L.
Department of Pain Management, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Case Rep Anesthesiol. 2012;2012:285328. Epub 2012 Feb 6.
Abstract
The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350298/
pdf/CRIM.ANESTHESIOLOGY2012-285328.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350298/?tool=pubmed
Evaluación de la eficacia y seguridad de gabapentina, duloxetina y pregabalina en pacientes con neuropatía diabética dolorosa periférica
Evaluation of efficacy and safety of gabapentin, duloxetine, and pregabalin in patients with painful diabetic peripheral neuropathy.
Devi P, Madhu K, Ganapathy B, Sarma G, John L, Kulkarni C.
Department of Pharmacology, St John's Medical College, Bangalore, India.
Indian J Pharmacol. 2012 Jan;44(1):51-6.
Abstract
AIM: To compare the efficacy and safety of gabapentin (GBP), duloxetine (DLX), and pregabalin (PGB) in patients with painful diabetic peripheral neuropathy (DPNP).
METHODS: A prospective, randomized, open label, 12-week study was conducted. A total of 152 patients with history of pain attributed to DPNP with a minimum 40-mm score on visual analogue scale (VAS) were randomized to receive GBP, DLX, or PGB. The primary efficacy measure was pain severity as measured on 11 point VAS. Secondary efficacy measures included sleep interference score, Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). Assessment of safety was done by recording the occurrence of adverse drug reactions. Data was analyzed using descriptive statistics, Chi square test, analysis of variance (ANOVA), and repeated measures ANOVA. RESULTS: Of total 152 patients, 50 patients received GBP, DLX each while 52 received PGB. A significant reduction in pain score (VAS), sleep interference score, PGIC, and CGIC was seen in all the three treatment groups across time (P<0.05) with no statistically significant difference between the groups. There was a significant interaction between the time and treatment groups (P<0.001) for pain score (VAS), sleep interference score, and PGIC. The improvement in pain scores (VAS) and sleep interference score was higher with PGB compared to DLX and GBP. Adverse drug reactions were mild and occurred in 9.2% of all cases. CONCLUSIONS: Monotherapy with GBP, DLX, or PGB Produced a clinically and subjectively meaningful pain relief in patients with DPNP with onset of pain relief being faster and superior with PGB.
http://www.ijp-online.com/article.asp?issn=0253-7613;year=2012;volume=44;issue=1;spage=51;epage=56;aulast=Devi
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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