Eugenio Calandriello

Neuromuscular Dysfunction in Diabetes: Role of Nerve Impairment and Training Status.

PURPOSE The purpose of this study was to investigate the effect of diabetes, motor nerve impairment, and training status on neuromuscular function by concurrent assessment of the torque-velocity relationship and muscle fiber conduction velocity (MFCV). METHODS Four groups were studied (n = 12 each): sedentary patients with diabetes in the first (lower) and fourth (higher) quartile of motor nerve conduction velocity (D1 and D4, respectively), trained diabetic (TD) patients, and nondiabetic sedentary control (C) subjects. Maximal isometric and isokinetic contractions were assessed over a wide range of angular velocities for the elbow flexors and knee extensors to evaluate the torque-velocity relationship. Simultaneously, MFCV was estimated from surface electromyography of the vastus lateralis and biceps brachii. RESULTS Isometric strength was similar among groups. The dynamic strength of elbow flexors was reduced in patients with diabetes at the higher contraction speeds. The strength of knee extensors was lower in sedentary patients with diabetes at all velocities considered, with significantly lower values in D1 than that in D4 at 60°, 90°, and 120°·s(-1), whereas it was similar between TD and C subjects, especially at low contraction velocities. At the vastus lateralis, but not the biceps brachii, MFCV was lower in D1 and D4 as compared with TD and C subjects, showing similar values. CONCLUSIONS Muscle weakness in diabetes affects also the upper limb, although to a lower extent than the lower limb, is only partly related to motor nerve impairment, and is dependent on contraction velocity. Exercise training might counteract diabetes-induced alterations in muscle fiber contractile properties and MFCV.

Pre-symptomatic neurological involvement in Behcet's disease: the diagnostic role of magnetic transcranial stimulation.

Twenty Behcets disease (BD) patients with or without neurologic signs and symptoms were studied by means of magnetic transcranial stimulation. The most frequent abnormalities were an increase of motor evoked potential latency and a delay of central motor conduction time (CMCT). In 5 out of 9 BD patients with pyramidal signs central motor conduction changes were present. Furthermore, 2 out of 7 patients without neurologic signs and symptoms showed an increased threshold and a prolonged CMCT. The data obtained suggest that this technique is useful not only to confirm the neurologic impairment but also to reveal subclinical or pre-symptomatic central motor involvement in BD subjects.

Neurophysiological Evaluation of Bell’s Palsy: Electroneurography and Transcranial Magnetic Stimulation

Electroneurography (ENOG) is currently the most useful electrophysiological test of facial nerve function [1, 2].

Exercise Training Can Modify The Natural History Of Diabetic Peripheral Neuropathy: 2464 4:00 PM - 4:15 PM

BACKGROUND Diabetes is the most important cause of peripheral neuropathy (DPN). No definitive treatment for DPN has been established, and very few data on the role of exercise training on DPN have been reported. AIM OF THE STUDY We sought to examine the effects of long-term exercise training on the development of DPN in both Types 1 and 2 diabetic patients. PARTICIPANTS AND METHODS Seventy-eight diabetic patients without signs and symptoms of peripheral DPN were enrolled, randomized, and subdivided in two groups: 31 diabetic participants [15 f, 16 m; 49+/-15.5 years old; body mass index (BMI)=27.9+/-4.7], who performed a prescribed and supervised 4 h/week brisk walking on a treadmill at 50% to 85% of the heart rate reserve (exercise group: EXE), and a control group of 47 diabetic participants (CON; 24 f, 23 m; 52.9+/-13.4 years old; BMI=30.9+/-8.4). Vibration perception threshold (VPT), nerve distal latency (DL), nerve conduction velocity (NCV), and nerve action potential amplitude (NAPA) in the lower limbs were measured. RESULTS We found significant differences on Delta (delta) in NCV for both peroneal and sural motor nerve between the EXE and CON groups during the study period (P<.001, for both). The percentage of diabetic patients that developed motor neuropathy and sensory neuropathy during the 4 years of the study was significantly higher in the CON than the EXE group (17% vs. 0.0%, P<.05, and 29.8% vs. 6.45%, P<.05, respectively). In addition, the percentage of diabetic patients who developed increased VPT (25 V) during the study was significantly higher in the CON than the EXE group (21.3% vs. 12.9%, P<.05). Change on Hallux VPT from baseline to the end of the study was significantly different between the EXE and CON groups (P<.05); no significant change in Malleolus VPT between the two groups occurred. CONCLUSIONS This study suggests, for the first time, that long-term aerobic exercise training can prevent the onset or modify the natural history of DPN.

Bell’s Palsy and Magnetic Stimulation: Longitudinal Study

Neurophysiological investigation of unilateral facial palsy is routinely based upon studies of the excitability and conduction velocity of the facial nerve in its intracranial course. For lesions of the facial nerve lying proximally, electrical stimulation of the nerve at the stylomastoid foramen can only reveal effects caused by anterograde degeneration of the nerve fibres [2–3]. Transcranial magnetic stimulation of the motor cortex or of peripheral nerves has been used to evoke responses in limb muscles. Recently, this technique has also been applied to stimulate the intracranial portion of the facial nerve. Brief magnetic pulses generated by a coil held over the ipsilateral scalp elicit a cortical magnetic action potential (cMAP) of similar morphology to that obtained with routine electroneurography (ENoG) [1,6–8]. The aim of this study was to investigate whether the technique of magnetic stimulation could be helpful in the neurophysiological assessment of facial palsy and of prognosis for recovery of facial nerve function.