Least Criteria for the Identification of Typical Diabetic Sensorimotor-Polyneuropathy (Essay Sample)

DIABETIC PERIPHERAL NEUROPATHY
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Least criteria for the identification of typical diabetic sensorimotor-polyneuropathy
Due to lack of agreeable definition and diagnostic evaluation of neuropathy, some high profile conferences have been helping up to overcome this problem (Dyck et al. 2006: 2285). The recent consensus agreed on the following typical diabetic sensorimotor-polyneuropathy (DSPN) minimal criteria (Callaghan et al. 2012: 524).
1. Possible clinical DSPN. The following signs or symptoms are used to show potential DSPN in patients. The signs include ankle reflexes that are absent, a distal sensation that is equally reduced or that is unequivocally reduced. The symptoms include decreased sensation, positive neuropathic sensory indicators in legs, toes, or feet such as stabbing, sensitive pain, asleep numbness, burning or prickling (Rutkove 2014).
2. Probable DSPN. The combination of the following signs and symptoms of neuropathy shows the likelihood of DSPN. They include two or more symptoms or signs; ankle reflexes that are absent, a distal sensation that is decreased or unequivocally reduced or neuropathic symptoms (Callaghan et al. 2012: 526).
3. Confirmed medical DSPN. Any presence of nerves conductivity abnormalities with signs or symptoms of neuropathy ratify DSPN condition. Several methods are used to measure the rigor of DSPN. They are; nerve test score, graded approach, activities of daily functionality score etc (Callaghan et al. 2012: 527).
4. Subclinical DSPN. This is confirmed if there are no symptoms and signs of neuropathy with abnormalities in nerves conductivity.
The diagnostic checkup for neuropathy and neuropathic pain
According to American Academy of Neurology, the validation of diabetic peripheral neuropathy (DPN), signs such as nerve symptom score that is positive and recorded neurological impairment proof should be taken as an evidence of neuropathy. These validations are done using the following powerful techniques (Dyck et al. 2006: 2285);
a) Corneal confocal microscopy. This is a noninvasive strategy that is used to identify small loss in the nerve fibers of the sensory corneal in Fabry disease, diabetic neuropathy and idiopathic small fiber neuropathy (SFN). The destruction of corneal nerve fiber is connected to the loss in intraepidermal nerve fiber (IENF) and diabetic patients suffering from severe neuropathy (Tesfaye et al. 2010:2287).
b) Skin biopsy. This is an invasive technique that allows intraepidermal nerves fiber (IENF) to be morphometrically quantified and is expressed in terms of IENF number per length in millimeter (IENF/mm). The technique is not affected by height or weight of the patient.
c) Nerve biopsy. The technique is used to identify destroyed unmyelinated fiber in DPN patients with normally myelinated nerve fiber structures. This method is invasive, and it requires the use of electron microscopy and therefore it’s not recommended for use (Tesfaye et al. 2010:2288).
d) Nerve axon reflex. The stimulus effect of acetylcholine iontophoresis on C-nociceptive fibers prompts vasodilation, and this is used to measure the function of small fibers quantitatively. This method can be linked with other measurements that are used to study the functions of small fibers and therefore highly used in diabetic patients for SFN diagnosis.
Characteristics of painful peripheral neuropathy
Neuropathy pain is described by electric sensation, burning and stabbing sensation. Patients develop a sensation that is painful to the mild stimuli and hyperalgesia-a condition where patients develop elevated sensitivity to aching stimuli. This pain arises due to abnormal systems of the peripheral somatosensory in diabetic people. It’s estimated that 3-25% of diabetic patients experience neuropathic pain which persists for more than six months. Studies have also shown that the episodes of painful symptoms subside as the sensory loss worsens (Tesfaye et al. 2010:2289).
Conditions that can mimic painful diabetic peripheral neuropathy