| P. Weston et al. |
Abnormal Baroreceptor—Cardiac Reflex Sensitivity is Not Detected by Conventional Tests of Autonomic Function in Patients with Insulin-Dependent Diabetes Mellitus |
Autonomic dysfunction occurs much more frequently in diabetic patients than conventional tests would suggest. Abnormal baroreceptor—cardiac reflex sensitivity in patients with insulin-dependent diabetes mellitus may in part be explained by abnormal parasympathetic function. This unrecognized abnormality may have a role in the increased incidence of sudden death seen in young diabetic subjects. |
Clinical Science, Vol 91, Issue 1, 1996 |
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| H.S.Chen et al. |
Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus |
Type 2 diabetic patients with abnormal CVR tests may have increased mortality, and those combined with postural hypotension have higher mortality than those without. Abnormal CVR tests may be important predictors of mortality in Type 2 diabetes mellitus. |
Diabetic Medicine, Vol. 18, Issue 4, April 2001, pp 268-273 |
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| A Stranieri et al |
An approach for Ewing test selection to support the clinical assessment of cardiac autonomic neuropathy |
The results show that the best single Ewing test for diagnosing CAN is the deep breathing heart rate variation test. Optimal sequences found for the cost-function equal to the number of tests guarantee that the best accuracy is achieved after any number of tests and provide an improvement in comparison with the previous ordering of tests or a random sequence. |
Arteficial Intelligence of Medicine 2013 Jul;58(3):185-93. |
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| P. Sukla et al. |
Assessment of the cardiac autonomic neuropathy among the known diabetics and age-matched controls using noninvasive cardiovascular reflex tests in a South-Indian population: A case–control study |
The objective of the study was to estimate the prevalence of cardiac autonomic neuropathy in a rural area of South India, among the known diabetics after comparing them with the age-matched healthy controls, utilizing noninvasive cardiac autonomic neuropathy reflex tests. |
Avicenna Journal of Medicine 2016; 06(03): 81-85 |
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| Lei Liu et al. |
Association between Cardiac Autonomic Neuropathy and Coronary Artery Lesions in Patients with Type 2 Diabetes |
Cardiac autonomic neuropathy might be related to the degree of coronary atheromatous burden in patients with type 2 diabetes. Screening for cardiac autonomic neuropathy might potentially be beneficial in the risk stratification of patients with type 2 diabetes. |
Dis Markers, 2020 Dec 30:2020:6659166. |
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| L Xiong et al |
Autonomic dysfunction as measured by Ewing battery test to predict poor outcome after acute ischaemic stroke |
Severe autonomic dysfunction is related to an unfavourable functional outcome in patients with acute ischaemic stroke. Findings of our study may have important implications for the risk of adverse cardiovascular events and mortality rates in stroke survivors |
Health and Medical Research Fund |
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| Tae Yang Yu, Moon-Kyu Lee |
Autonomic dysfunction, diabetes and metabolic syndrome |
One of the severe complications frequently under-recognized is cardiovascular autonomic neuropathy (CAN). The CAN Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy defined CAN as, “impairment of cardiovascular autonomic control in patients with established diabetes after excluding other causes.” CAN is the major cause of cardiovascular morbidity and overall mortality, and clinical course varies with resting tachycardia, orthostatic hypotension, exercise intolerance and silent myocardial ischemia. |
Volume12, Issue12
December 2021
Pages 2108-2111 |
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| Shruti Agashe et al |
Autonomic neuropathy |
Certain inherited diseases that put you at risk of developing autonomic neuropathy can't be prevented. But you can slow the onset or progression of symptoms by taking care of your health in general and managing your medical conditions. |
Care at Mayo Clinic |
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| Alberto Verrotti et al |
Autonomic neuropathy in diabetes mellitus |
In conclusion, DAN is a particular aspect of diabetic neuropathy, which leads to multisystemic impairment in both T1DM and T2DM patients. Cardiac system is the most seriously involved. The pathogenesis of DAN has yet to be clarified but metabolic, genetic, and hormonal factors have been reported. The final common effect seems to be hyperglycemia resulting in oxidative stress and inflammation. As nowadays no therapy is able to effectively reverse this process, prevention with strict glycemic control, multifactorial intervention, and lifestyle modification remains essential. |
Endocrinology 01 December 2014 |
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| A Verrotti, F Chiarelli et al. |
Autonomic neuropathy in diabetic children |
In the paediatric age group also, autonomic nerve dysfunction can be present in asymptomatic diabetic patients. Heart rate variation during Valsalva manoeuvre and maximum/minimum 30:15 ratio are the most sensitive indices to detect autonomic abnormalities in children. |
J Paediatr Child Health
. 1995 Dec;31(6):545-8. |
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| A J Rennings |
Autonomic neuropathy predisposes to rosiglitazone-induced vascular leakage in insulin-treated patients with type 2 diabetes: a randomised, controlled trial on thiazolidinedione-induced vascular leakage |
Rosiglitazone may increase vascular leakage in insulin-treated patients with type 2 diabetes with autonomic neuropathy. Autonomic neuropathy did not exaggerate rosiglitazone-induced fluid retention. Therefore, autonomic neuropathy should be considered as a risk factor for thiazolidinedione-induced oedema, not for thiazolidinedione-induced fluid retention. |
Diabetologia 2010 Sep;53(9):1856-66. |
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| Kotb Abbass Metwalley, Sherifa Ahmed Hamed et al. |
Cardiac autonomic function in children with type 1 diabetes |
The study concluded that both parasympathetic and sympathetic autonomic dysfunctions are common in children with T1D particularly with longer duration of diabetes and presence of microvascular complications. Limited studies evaluated CAN in children with T1D. CAN is common in children with T1D. Cardiac autonomic functions should be assessed in children with T1D particularly in presence of microvascular complications. |
Eur J Pediatr
. 2018 Jun;177(6):805-813. |
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| Emilie H. Zobel et al. |
Cardiac Autonomic Function Is Associated With Myocardial Flow Reserve in Type 1 Diabetes |
This study was undertaken to evaluate the association between measures of cardiac autonomic function and cardiac vascular function in type 1 diabetes using new and sensitive methods. Cardiac autonomic function was evaluated using heart rate variability (HRV) indices, cardiovascular autonomic reflex tests (CARTs), and cardiac I-metaiodobenzylguanidine (MIBG) imaging. Cardiac autonomic dysfunction, including loss of cardiac sympathetic integrity in type 1 diabetes, is associated with and may contribute to impaired myocardial blood flow regulation. |
Diabetes 2019;68(6):1277–1286 |
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| Shruthi Agashe et al |
Cardiac Autonomic Neuropathy in Diabetes Mellitus |
Diabetes-related CAN causes significant morbidity and mortality and is common in both type 1 and type 2 DM. CAN in DM can be subclinical or present with a wide range of symptoms, ranging from resting tachycardia to orthostatic hypotension. Although CAN in DM is difficult to diagnose in the hospital setting, multiple tests of autonomic function are available in the outpatient setting for screening and definitive diagnosis. CAN in DM can lead to significant morbidity and carries an increased risk of silent ischemia and perioperative mortality. |
NationalMethodist Debakey Cardiovasc J. 2018 Oct-Dec; 14(4): 251–256. Library of Medicine |
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| Rodica Pop-Busui, MD, PHD |
Cardiac Autonomic Neuropathy in Diabetes: A clinical perspective |
CAN is a serious chronic complication of diabetes and an independent predictor of cardiovascular disease mortality. As illustrated by the case vignette and by the evidence presented in this review, CAN is associated with a poor prognosis and poor quality of life. |
Diabetes Care. 2010 Feb; 33(2): 434–441. |
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| Aaron I. Vinik et al. |
Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events |
An improvement in ANS balance may be critical to reducing cardiovascular events and early mortality. Symptoms and signs of autonomic dysfunction, including resting HR, BP responses to standing, and time and frequency measures of HRV in response to deep breathing, standing and Valsalva maneuver, should be elicited from all patients with diabetes to allow for early detection and intervention. With the recognition of the presence of ANS imbalance or for its prevention, a rigorous regime should be implemented with lifestyle modification, physical activity, and cautious use of medications that lower blood glucose. Rather than intensifying diabetes blood glucose management, a regimen tailored to the individual risk of ANS dysfunction should be constructed. |
Front. Neurosci., 27 August 2018, Volume 12 - 2018 |
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| D J Ewing et al |
Cardiac autonomic neuropathy in diabetes: Comparison of measures of R-R interval variation |
Five different methods of analysing R-R interval (heart rate) variation were compared, using a computer technique, in 61 diabetics with a wide range of responses to autonomic function testing. Two methods differentiated best between the diabetics with and without autonomic damage: (1) the standard deviation of the mean R-R interval recorded for 5 min during quiet breathing with the subject either sitting or standing; (2) the difference between the maximum and minimum heart rates recorded over 1 min during deep breathing at six breaths per minute, again with the subject either sitting or standing. |
Springer Volume 21, pages 18–24, (1981) |
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| Scott M. Williams |
Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review |
CAN is a major cause of morbidity and cardiovascular mortality in patients with established diabetes. The aetiology of CAN is multifactorial. However, the association of CAN with an elevated BMI, obesity and the MetS offers the potential for lifestyle-based interventions to reduce its prevalence at a reversible stage. The early stages of CAN manifesting as ANS dysfunction on HRV testing begin to develop in people with pre-DM and MetS. Lifestyle interventions may improve CAN directly through modulation of the SNS and PNS innervation but also reverse the underlying pathophysiology of MetS, pre-DM and obesity. This therapeutic strategy should be targeted in CAN and remain the foundation of a holistic treatment pathway which also results in increased exercise tolerance and quality of life. |
Diabetes Therapy, Vol. 10, pp 1995-2021, 2019 |
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| Gerasimos Dimitropoulos et al |
Cardiac autonomic neuropathy in patients with diabetes mellitus |
CAN is associated with significant increase in morbidity and mortality and plays an important role in the development of diabetic cardiomyopathy and silent ischaemia. CAN might play a role in the pathogenesis of diabetes-related microvascular complications and the development of lower limb complications. However, before CAN is symptomatic and evident clinically, patients might have sub-clinical CAN for several years. The time scale for the progression from sub-clinical to clinically evident CAN is unknown. Recent guidelines have recommended screening for CAN in patients with diabetes and issued guidance regarding the criteria used to diagnose CAN. |
World J Diabetes. Feb 15, 2014; 5(1): 17-39 |
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| Scott Williams et al |
Cardiac Autonomic Neuropathy in Type 1 and 2 Diabetes: Epidemiology, Pathophysiology, and Management |
In conclusion, DAN is a particular aspect of diabetic neuropathy, which leads to multisystemic impairment in both T1DM and T2DM patients. Cardiac system is the most seriously involved. |
Clinical Therapeutists VOLUME 44, ISSUE 10, P1394-1416, OCTOBER 2022 |
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| Anca Moţăţăianu, Smaranda Maier et al. |
Cardiac autonomic neuropathy in type 1 and type 2 diabetes patients |
This study indicated that CAN is a more frequent complication in T1DM. Apart from glycaemic control, the existence of CAN is associated with potentially modifiable cardiovascular risk only in T2DM patients. The presence of other micro- and macrovascular complications increases the probability of having CAN in both types of DM (but more pronounced in T2DM). |
BMC Neurology, Volume 18, article number 126, (2018) |
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| Hossein Fakhrzadeh et al. |
Cardiac Autonomic Neuropathy Measured by Heart Rate Variability and Markers of Subclinical Atherosclerosis in Early Type 2 Diabetes |
In conclusion, we found that autonomic dysfunction, especially parasympathetic neuropathy, was present since early stages in T2DM. This was strongly related to subclinical atherosclerosis markers in these patients. Specifically decreased total power as a global measure of parasympathic neuropathy was independently associated with increased CIMT. |
Clinical Study | Open Access, Volume 2012 | Article ID 168264 |
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| Anne Sofie Astrup, MD; Lise Tarnow, DMSC et al. |
Cardiac Autonomic Neuropathy Predicts Cardiovascular Morbidity and Mortality in Type 1 Diabetic Patients With Diabetic Nephropathy |
In the present study, we evaluated HRV as a risk factor in type 1 diabetic subjects with and without diabetic nephropathy prospectively followed for 10 years. In this study, the influence of CAN could be determined in a large, well-defined cohort of type 1 diabetic subjects with and without diabetic nephropathy, which gives us a new understanding of the negative influence of CAN in patients already known to be at high risk. In high-risk individuals with diabetic nephropathy, we found autonomic dysfunction, determined as abnormal HRV, to be a predictor of cardiovascular mortality and morbidity. We also show that autonomic dysfunction is not a promoter of progression of decline in kidney function. |
Diabetes Care 2006;29(2):334–339 |
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| Andrzej Bissinger |
Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That? |
Methods based on heart rate variability enable the diagnosis of CAN even at a preclinical stage. These methods are simple and widely available for use in everyday clinical practice. According to the recently published Toronto Consensus Panel on Diabetic Neuropathy, all diabetic patients should be screened for CAN. Because diabetes mellitus often coexists with heart diseases and the most common methods used for diagnosis of CAN are based on ECG, not only diabetologists but also cardiologists should be responsible for diagnosis of CAN. |
Journal of Diabetes Research/, 2017, volume 2017 |
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| Martin J Stevens at al |
Cardiovascular Autonomic Neuropathy |
Epidemiologic data indicate a varied prevalence of CAN in type 1 and 2 diabetes, with prevalences of 17% to 73%) depending on clinical and demographic factors. Insulin resistance, which underpins type 2 diabetes and metabolic syndrome, has a direct role in the pathogenesis of CAN. Lifestyle interventions, including dietary measures and tailored exercise programs, have been beneficial in improving cardiac autonomic function primarily measured through heart rate variability. For optimization in type 2 diabetes, both lifestyle and targeted pharmacologic interventions are required to achieve glycemic/metabolic targets, and weight loss is required to prevent or reverse early CAN or prevent the progression to definite and severe CAN. |
Springer pp 389–412 |
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| Vincenza Spallone, Dan Ziegler et al. |
Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management |
CAN is the impairment of cardiovascular autonomic control in the setting of diabetes after exclusion of other causes. The prevalence of confirmed CAN is around 20%, and increases up to 65% with age and diabetes duration. CAN is a risk marker of mortality and cardiovascular morbidity, and possibly a progression promoter of diabetic nephropathy. |
Diabetic Neuropathy: A Comprehensive Update With an Eye to the Future: Review Article,
Volume27, Issue7
October 2011
Pages 639-653 |
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| Alice Duque et al. |
Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications |
Several tests can be used for CAN diagnosis, such as heart rate variability (HRV), cardiovascular autonomic reflex tests, and myocardial scintigraphy. Currently, it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV, which is a non-invasive test with a lower operating cost. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition. |
World J Diabetes. 2021 Jun 15; 12(6): 855–867. |
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| Ahmad Osailan |
Cardiovascular autonomic neuropathy in people with type 2 diabetes mellitus; investigation of its association with classical cardiovascular risk factors using cardiovascular autonomic reflex tests: a cross-sectional study |
Tthe study was aimed to assess CAN (Cardiovascular autonomic neuropathy) using five cardiovascular autonomic reflex tests (represented by Ewing’s score) and explore the factors associated with CAN in people with type 2DM. CAN was associated with two CVD (cardiovascular disease) parameters, including resting SBP (systolic blood pressure) and CRF (cardiorespiratory fitness) , which may indicate the importance of controlling these two factors to prevent or reduce CAN in people with type 2DM. |
The Egyptian Heart Journal, 73, Article number: 44 (2021) |
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| Varela-Tapia CL et al |
Cardiovascular autonomic neuropathy in recovered COVID-19 patients: case report |
Cardiovascular autonomic neuropathy was diagnosed in recovered COVID-19 patients. Remaining symptoms: weakness in four limbs and dyspnea on small efforts. Conclusions: Our two cases highlight that the virus is capable of not only damaging the lungs, but also the nervous system. Analysis of cardiac abnormalities in patients recovering from COVID-19 suggests that the disease may have been a trigger for cardiac autonomic neuropathy. |
Revista Mexicana de Medicina Fisica y Rehabilitacion, 2023; 35 (1-2) |
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| Shangming Zhang et al |
Chemotherapy-induced peripheral neuropathy and rehabilitation: A review |
CIPN is an underdiagnosed clinical entity that has a significant impact on QoL and may compromise chemotherapy treatment efficacy. CIPN is predominantly sensory rather than motor or autonomic dysfunction that may resolve after treatment cessation but can continue for years or be permanent. Despite tremendous efforts, no agents have been established to prevent CIPN. Pre-chemotherapy testing is recommended for patients with these risk factors. |
Seminars in Oncology
Volume 48, Issue 3, June 2021, Pages 193-207 |
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| Kalliopi Pafili, Grigorios Trypsianis et al. |
Clinical Tools for Peripheral Neuropathy to Exclude Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Mellitus |
Cardiovascular autonomic neuropathy (CAN) is defined as the impairment of cardiovascular autonomic control in humans with diabetes mellitus after exclusion of other causes. CAN may lead to life-threatening complications including coronary ischaemia, silent myocardial infarction, arrhythmias and sudden cardiac death.
Cardiovascular autonomic reflex function tests (CARTs), as proposed by Ewing in 1970, are considered the gold standard for the diagnosis and staging of CAN [3]. Nonetheless, new evidence has shown a diminished diagnostic utility of the handgrip test, and so it has been abolished by expert groups in the most recent guidelines. |
Diabetes Ther. 2020 Apr; 11(4): 979–986. |
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| Emilia Borowik et al. |
Clinical usefulness of baroreflex sensitivity test in the detection of cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus |
The study confirms the value of baroreflex sensitivity in the early detection of CAN among patients with type 2 diabetes. We recommended cutoff points for BRS to detect CAN among patients with type 2 diabetes mellitus. |
Pol. Merkur Lekarski, 015 Nov;39(233):277-80. |
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| Papachristou, Stella et al. |
Correlation Between Skin Advanced Glycation End Products and Cardiac Autonomic Neuropathy Among Subjects with Type 2 Diabetes Mellitus. |
Advanced glycation end products (AGEs) are frequently increased in the skin of subjects with type 2 diabetes mellitus (T2DM). Diagnosis of CAN, sympathetic and parasympathetic nervous system impairment was based on the four standardised cardiovascular reflex tests (CARTs). Among T2DM subjects, skin AGEs appear to increase in the presence of CAN. This holds true both for sympathetic and parasympathetic nervous system impairment. |
Experimental & Clinical Endocrinology & Diabetes; Dec2022, Vol. 130 Issue 12, p767-772, 6p |
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| K. Pafili et al. |
Correlation of cardiac autonomic neuropathy with small and large peripheral nerve function in type 2 diabetes mellitus |
CAN and parasympathetic dysfunction correlate with peripheral neuropathy, especially when the latter is assessed through VPT and measures of small fibre function as evaluated by pinprick sensation and temperature perception. The latter additionally correlate with sympathetic nervous system impairment. |
Diabetes Res Clin Pract., 2019 Oct:156:107844. |
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| Muhamad M Dhumad et al |
Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus |
CAN is common among people with diabetes (52.82%), the poorer the glycemic control and the longer the duration of the disease, the higher the incidence of CAN in T2DM. Age, duration of disease, WHR, and HbA1c are well correlated with the severity of CAN. Parasympathetic impairment is more sensitive to the detection of autonomic dysfunction. |
Scientific Reports volume 11, Article number: 3576 (2021) |
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| Akif Serhat Balcıoğlu and Haldun Müderrisoğlu |
Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment |
Although very common and serious, CAN is a frequently overlooked complication of diabetes. Related with intraoperative and perioperative cardiovascular instability, abnormal blood pressure profile, orthostatic hypotension, silent myocardial ischemia, arrhythmias, diabetic cardiomyopathy, and stroke, CAN is associated with significant increases in morbidity and mortality. Patients may have subclinical CAN for several years before it becomes clinically apparent. Because the progression of cardiovascular denervation is partly reversible or can be slowed down in the early stages of the disease, recent guidelines strongly recommend screening for CAN in patients with diabetes |
World J Diabetes. 2015 Feb 15; 6(1): 80–91. |
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| Aaron I. et al. |
Diabetic Autonomic Neuropathy |
Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes. Cardiovascular autonomic neuropathy (CAN) is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests rather than just on one test. Proceedings from a consensus conference in 1992 recommended that three tests (R-R variation, Valsalva maneuver, and postural blood pressure testing) be used for longitudinal testing of the cardiovascular autonomic system. Testing of diabetic individuals for cardiovascular autonomic dysfunction should be part of their standard of care. |
Diabetes Care 2003;26(5):1553–1579 |
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| Aaron L Winik |
Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease |
Diabetic CAN is a serious complication found in one-quarter of type 1 and one-third of type 2 diabetic patients. It is associated with increased mortality and silent myocardial ischemia, and with a poor prognosis. Autonomic dysfunction has been shown to be a predictor of cardiovascular risk and sudden death in patients with type 2 diabetes. It might be attributable to a functional abnormality or to organic structural damage to the different components of the autonomic nervous system. There is now strong evidence of inflammation with activation of inflammatory cytokines in patients with diabetes. These changes correlate with abnormalities in sympathetic-vagal balance. Several investigations have shown the neuroregulatory role for the autonomic nervous system, being a key instrument in the inflammatory process. |
Journal of Diabetes Research 29 January 2013 |
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| Aaron I. Vinik and Dan Ziegler |
Diabetic Cardiovascular Autonomic Neuropathy |
Diabetic CAN, a serious complication found in one fourth of type 1 and one third of type 2 diabetic patients, is associated with increased mortality and silent myocardial ischemia and may even predict the development of stroke. CAN is associated with a poor prognosis and may result in severe orthostasis, postural hypotension, exercise intolerance, enhanced intraoperative instability, and an increased incidence of silent MI and ischemia. |
Circulation. 2007;115:387–397 |
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| Akinci, Gulcin et al. |
Diabetic neuropathy in children and youth: New and emerging risk factors. |
Childhood onset diabetes constitutes a high risk for developing DN due to disease longevity. DN signs are usually subclinical in youth with diabetes, but can be detected if sensitive tools are used. Early DN recognition is important. If left undiagnosed, subclinical DN progresses to overt neuropathy with risk of neuropathic pain, foot injury/ulceration, and limb amputation risk—symptoms associated with increased morbidity/mortality and high economic cost. Therefore, we urge clinicians to screen for and be vigilant of DN complications in young patients with diabetes. Data from T1D studies show a clear association between DN and poor glycemic control and longer lifetime exposure to hyperglycemia; thus, achieving glycemic control still remains the main strategy to prevent DN occurrence or progression. |
Pediatric diabetes [Pediatr Diabetes] 2021 Mar; Vol. 22 (2), pp. 132-147. |
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| Herbert F Jellinek et al |
Diagnostic Accuracy of Random ECG in Primary Care for Early, Asymptomatic Cardiac Autonomic Neuropathy |
Consultation length in general practice is characterized by many factors but, in general, the available time of the general practitioner or health care professional is decreasing, while chronic diseases such as obesity, diabetes, cardiovascular disease, and mental health require increasing consultation times. |
Journal of Diabetes Research Volume 11 Issue 6 |
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| Jun Chen et al. |
Diagnostic performance analysis for diabetic cardiovascular autonomic neuropathy based on short-term heart rate variability using Bayesian methods: preliminary analysis |
We conducted a cross-sectional study to perform diagnostic test in Chinese diabetic patients. A dataset contained 56 subjects who completed both the short-term HRV test and Ewing’s test. |
Diabetology & Metabolic Syndrome, 7, Article number: 74 (2015) |
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| Chaitali A Chindhalore et al |
Effect of Ramipril on Cardiac Autonomic Neuropathy in Patients With Type II Diabetes Mellitus |
Ramipril improves parasympathetic component more as compared to sympathetic component of DCAN in type II DM. Ramipril could be a promising option having favorable long-term outcomes in diabetic patients especially when treatment begins at subclinical stage. |
Pharmacology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND, 03/15/2023 |
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| Yu Peng et al |
Evaluation of the Degree of Agreement of Four Methods for Diagnosing Diabetic Autonomic Neuropathy |
There are many methods to evaluate autonomic nerve function in clinical practice, but the results of the different methods are often inconsistent. Even Ewing's test and HRV results, the two methods recommended by the ADA guidelines for diagnosing DCAN, are often inconsistent in the same patient. Past studies have compared two different methods for assessing autonomic nerve function, but only Singh et al. (20) compared the results of COMPASS-31, SSR, Ewing's test, and HRV. The authors divided the patients with diabetes into a definite DCAN, early DCAN, and a no DCAN group using the COMPASS-31 results and then compared the results of the four methods in these three groups. In our study, we also evaluated the autonomic nerve function of diabetic patients with these four methods, but we focused on evaluating the degree of agreement of the four methods in diagnosing DAN. |
Original Research Volume 12 - 2021 |
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| Iwona Cygankiewicz, Wojciech Zareba |
Heart rate variability |
Both bedside analysis of simple markers of HRV, as well as more sophisticated HRV analyses including time, frequency domain and nonlinear analysis have been proven to detect early autonomic involvement in several neurological disorders. Furthermore, altered HRV parameters were shown to be related with cardiovascular risk, including sudden cardiac risk, in patients with neurological diseases. This chapter aims to review clinical and prognostic application of HRV analysis in diabetes, stroke, multiple sclerosis, muscular dystrophies, Parkinson's disease and epilepsy. |
Handbook of Clinical Neurology, 2013:117:379-93. |
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| Rudolf Metelka |
Heart rate variability - current diagnosis of the cardiac autonomic neuropathy. A review |
Heart rate variability is making a valuable contribution to the diagnosis of cardiovascular autonomic dysfunction and CAN. It can be assessed from short-term and long-term ECG recordings. It is one of the few methods that allow outpatient CAN diagnosis, monitoring the progress, therapeutic effect and evaluation of patient prognosis. It is used as an independent prognostic factor in combination with other recognized risk factors in risk stratifying after myocardial infarction. It is a unique method of CAN diagnosis particularly in diabetology. Its diagnostic and prognostic potential in other medical fields is being intensively explored. |
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Sep; 158(3):327-338. |
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| Ahsan K. Khandoker et al. |
Heart rate variability and complexity in people with diabetes associated cardiac autonomic neuropathy |
Cardiac autonomic neuropathy (CAN) in diabetes has been called a “silent killer”, because so few patients realize that they suffer from it, and yet its effect can be lethal. Early sub clinical detection of CAN and intervention are of prime importance for risk stratification in preventing sudden death due to silent myocardial infarction. This study presents the usefulness of heart rate variability (HRV) and complexity analyses from short term ECG recordings as a screening tool for CAN. Our results demonstrated the potential utility of nonlinear HRV parameters in identifying asymptomatic CAN. |
Published in: 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society |
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| Marcelo Risk et al. |
Heart Rate Variability Measurement in Diabetic Neuropathy: Review of Methods |
This system performs metronomic breathing (MT), the Valsalva Test (VT), and the Stand Test (ST). HRV is the most reliable measurement of autonomic function; when controlled maneuvers like MT, VT, and ST are performed, high reproducibility is obtained, with results comparable to that observed for nerve conduction studies. Such reproducibility makes autonomic function testing more feasible as a test component in multicenter studies of different neurological disorders. |
Diabetes Technology & TherapeuticsVol. 3, No. 1 |
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| Vijay Viswanathan et al. |
High prevalence and early onset of cardiac autonomic neuropathy among South Indian Type 2 diabetic patients with nephropathy |
This study was conducted to assess the adverse effects of diabetic nephropathy on cardio vascular autonomic neuropathy (CAN) in South Indian Type 2 diabetic patients. The present study showed that the presence of nephropathy was associated with the risk of cardiac autonomic neuropathy in Type 2 diabetic patients and it probably had an earlier onset also in them. |
Diabetes Research and Clinical Practice, Volume 48, Issue 3, June 2000, Pages 211-216 |
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| G. Bönhof et al. |
High-intensity interval training for 12 weeks improves cardiovascular autonomic function but not somatosensory nerve function and structure in overweight men with type 2 diabetes. |
It remains unclear whether and which modality of exercise training as a component of lifestyle intervention may exert favourable effects on somatosensory and autonomic nerve tests in people with type 2 diabetes. Cardiovascular autonomic and somatosensory nerve function were assessed before and after a supervised high-intensity interval training (HIIT) intervention programme over 12 weeks. Study endpoints included clinical scores, nerve conduction studies, quantitative sensory testing, IENFD, heart rate variability, postural change in systolic blood pressure and spontaneous baroreflex sensitivity (BRS). Since no favourable effects on somatic nerve function and structure were observed, cardiovascular autonomic function appears to be more amenable to this short-term intervention, possibly due to improved cardiorespiratory fitness. |
Diabetologia; Jun2022, Vol. 65 Issue 6, p1048-1057, |
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| J. Gerritsen et al. |
Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study |
Measures of baroreflex sensitivity, heart rate variability (HRV), and the classical Ewing test parameters are currently used for the diagnosis of diabetic autonomic neuropathy and for mortality risk stratification after myocardial infarction. Impaired autonomic function is associated with all-cause and cardiovascular mortality. Moreover, the results of the present study suggest that cardiac autonomic dysfunction in patients already at risk (diabetes, hypertension, or history of cardiovascular disease) may be especially hazardous. |
Diabetes Care., 2001 Oct;24(10):1793-8. |
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| Lindsay A. Zilliox, James W. Russell |
Is there cardiac autonomic neuropathy in prediabetes? |
CAN remains underdiagnosed in IGT, although the available evidence suggests that symptoms of autonomic dysfunction are frequent in subjects with IGT. There is also concomitant evidence that autonomic testing shows both CAN and sudomotor dysfunction. It is important to recognize both that the subject has IGT and that the symptoms relate to autonomic dysfunction. This allows early intervention to improve metabolic control before the subject converts to T2DM |
Autonomic Neuroscience, Volume 229, December 2020 |
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| Lukasz Pavlinszky et al |
Is treatment of type 1 diabetes mellitus (insulin therapy, metabolic control) optimal for preventing cardiovascular autonomic neuropathy? |
The presented results draw attention to the high prevalence of CAN among T1DM patients. The study reveals the need for more intensive monitoring and treatment of hyperlipidaemia, despite good glycaemic control, especially in those over the age of 40 years. |
Endokrynol Pol. 2019;70(4):323-329. doi: 10.5603/EP.a2019.0011. Epub 2019 Mar 7. |
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CardiScan |
| M. Ducher et al |
Limits of clinical tests to screen autonomic function in diabetes type 1 |
Alteration in Ewing's score given by clinical tests may not reflect an alteration of cardiac autonomic function in asymptomatic type 1 diabetic patients, because spectral indices of sympathetic and parasympathetic (including BRS) function were within normal range. Our results strongly suggest to confront results provided by both methodologies before concluding to an autonomic cardiac impairment in asymptomatic diabetic patients. |
Diabetes Metab., 2001 Nov;27(5 Pt 1):545-50. |
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CardiScan |
| Ziegler D., et al |
Neuropathy in prediabetes. |
This review should help in raising the awareness of and translating the current knowledge on neuropathies in people with prediabetes into clinical practice and public health. The current recommendation that adults who are overweight or obese should be screened for prediabetes and referred to or offered preventive interventions should ultimately culminate in preventing not only CVD but also prediabetic neuropathy. |
Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2023 Nov; Vol. 39 (8), pp. E3693 |
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CardiScan |
| Tallat Naz et al. |
Noninvasive exploration of Cardiac Autonomic Neuropathy by heart rate and blood pressure variability analysis in Type 2 Diabetic patients |
CAN was highly prevalent in diabetic population that may lead to nephropathy and retinopathy in future. It is highly recommended to use sensitive and simple CARTs in clinics for early detection and early treatment of CAN. |
Pak. J. Med. Sci., 021 Jul-Aug;37(4):1020-1024. |
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CardiScan |
| Mesut Sahin et al. |
Performing Only One Cardiovascular Reflex Test Has a High Positive Predictive Value for Diagnosing Autonomic Neuropathy in Patients with Chronic Renal Failure on Hemodialysis |
Patients with CRF on hemodialysis frequently have autonomic neuropathy. For the diagnosis and follow-up of patients, five cardiovascular autonomic reflex tests are generally used. In this study, it was determined that performing only one test instead of all five tests has a high sensitivity and is more practicable in terms of determining autonomic neuropathy. |
Renal Failure, Vol. 28., (5) 2006 |
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CardiScan |
| Jae-Seung Yun, Yong-Moon Park et al. |
Progression of cardiovascular autonomic neuropathy and cardiovascular disease in type 2 diabetes |
CAN stage progression was associated with an increased risk of CVD in this type 2 diabetes cohort. Patients with rapid CAN progression had the greatest risk of CVD. Thus, regular screening and risk management of CAN progression is necessary to prevent CVD. |
Cardiovasc Diabetol. 2018; 17: 109. |
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CardiScan |
| H. Schmid et al. |
Proliferative diabetic retinopathy is related to cardiovascular autonomic neuropathy in non-insulin-dependent diabetes mellitus |
The aim of the study was to define the relationship between the presence of proliferative diabetic retinopathy and nephropathy with objectively defined autonomic neuropathy in non-insulin-dependent diabetes mellitus (NIDDM) patients. A cohort of NIDDM patients was classified, according to five cardiovascular autonomic tests described by Ewing, as: (1) no involvement--no abnormal tests (n = 17); (2) cardiovascular autonomic neuropathy--two out of five abnormal tests (n = 18). The results showed a striking relationship between cardiovascular autonomic neuropathy and proliferative diabetic retinopathy. |
Diabetes Res Clin Pract., 1995 Sep;29(3):163-8. |
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CardiScan |
| Guo, Simin et al |
Quantitative sensory testing can effectively predict cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus. |
The thermal detection thresholds, including cold, warm, and heat pain detection thresholds, in quantitative sensory testing were found to be significantly related to the results of CARTs (cardiovascular reflex tests). Some thermal detection thresholds were independent risk factors for cardiovascular autonomic neuropathy. Therefore, this study showed that quantitative sensory testing has a reliable predictive ability for the occurrence and development of cardiovascular autonomic neuropathy. |
Acta diabetologica [Acta Diabetol] 2021 Nov; Vol. 58 (11), pp. 1541-1549. |
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CardiScan |
| V. Spallone et al. |
Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy |
Despite its prevalence, clinical and prognostic impact, diabetic autonomic neuropathy, is widely under-diagnosed. The need for training and expertise to perform the cardiovascular tests (usually the task of diabetologists) is one possible reason. The availability of computer-assisted systems has allowed a wider diffusion of testing, but has also highlighted the need for an adequate knowledge of physiopathological backgrounds for their correct application and interpretation. The recommendations presented here were developed by the Neuropathy Study Group of the Italian Society of Diabetology and then endorsed by the Italian Association for the Study of Neurovegetative System, to promote the widespread adoption of good clinical practice in diabetic cardiovascular autonomic testing by outlining main evidence-based aspects. |
Nutrition, Metabolism and Cardiovascular Diseases, Volume 21, Issue 1, January 2011, Pages 69-78 |
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CardiScan |
| G. Comi et al. |
Reproducibility of cardiovascular autonomic tests in diabetics with and without autonomic dysfunction and in normal controls |
The present study evaluates the reproducibility of five cardiovascular reflex tests, deep breathing (DB), Valsalva maneuver (VM), sustained hand-grip (SHG), postural hypotension (PH) and lying to standing (LS) in normal subjects and in insulin dependent (type I) diabetic patients. The intraindividual variability of PH was significantly increased in diabetics with autonomic neuropathy compared with diabetics without autonomic neuropathy and with normal controls. There was no difference among the three groups in the reproducibility of SHG. In normal subjects the intraindividual variability only exceptionally produced a shift from normal to abnormal values or vice versa; in diabetics with autonomic neuropathy this shift was more frequent. |
Acta Diabetol Lat., 1986 Oct-Dec;23(4):323-9. |
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CardiScan |
| D. Knüttgen et al. |
Respiratory sinus arrhythmia as predictor of blood pressure stability during anaesthetic induction in diabetics |
Diabetics with cardiovascular autonomous neuropathy (CAN) can show severe hypotension during the course of anaesthesia. To improve the safety of anaesthesia, pre-operative evaluation of this concomitant disorder is recommended. To evaluate their cardiovascular reflex status, the following tests were performed one day before surgery: determination of heart rate variation (HRV) under deep respiration (6 breaths/min), and the response of heart rate (max/min 30:15 ratio) and blood pressure after getting up from a supine position. Patients at risk of hypotension can be identified reliably and quickly during pre-operative screening with the help of a single, simple test procedure. |
Anasthesiol Intensivmed Notfallmed Schmerzther., 2006 Apr;41(4):233-40. |
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CardiScan |
| Peter Kempler at al. |
Review: Autonomic neuropathy: a marker of cardiovascular risk |
Severe autonomic neuropathy may be responsible for spontaneous respiratory arrest and unexplained sudden death. A relationship between the presence and/or severity of CAN and corrected QT interval prolongation is well documented. Better understanding of the prognostic importance of autonomic neuropathy followed the use of simple non-invasive cardiovascular reflex tests. These most commonly include heart rate variation in response to deep breathing, standing, the Valsalva maneouvre and blood pressure response to standing and sustained handgrip. Near normoglycaemia is now generally accepted as the primary approach to the prevention of diabetic neuropathy, but is not achievable in most patients. Our experience of the use of the antioxidant alpha-lipoic acid in the treatment of cardiac autonomic neuropathy is described. |
The British Journal of Diabetes & Vascular Disease, Volume 3 Issue 2, March 2003 |
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CardiScan |
| Massimo Chessa, Gianfranco Butera et al. |
Role of heart rate variability in the early diagnosis of diabetic autonomic neuropathy in children |
HRV analysis can detect early subclinical alterations of the autonomic nervous system in asymptomatic patients with IDDM, which seem to consist mainly in a parasympathetic impairment. Autonomic dysfunction is associated both with the duration and an inadequate metabolic control of the disease. |
Herz
. 2002 Dec;27(8):785-90. |
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CardiScan |
| Kalliopi Pafili et al |
Simplified Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Using Ewing's Battery |
The 30:15 ratio has the best diagnostic accuracy, primarily in the exclusion of CAN, by virtue of its very high sensitivity and NPV. If this ratio is positive for CAN, the VR, the rise in diastolic blood pressure, and the E/I/VR may be useful to increase diagnostic accuracy. This procedure is a simplified diagnostic approach that merits further evaluation to enable wider screening for CAN. |
Rev Diabet Stud. 2015 Spring-Summer; 12(1-2): 213–219. |
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CardiScan |
| M. Lishner et al. |
Spectral analysis of heart rate fluctuations. A non-invasive, sensitive method for the early diagnosis of autonomic neuropathy in diabetes mellitus |
A marked reduction in the power of heart rate (HR) fluctuations, at all frequencies, was found in the diabetic patients as compared to controls. This indicates a depression of both parasympathetic and sympathetic activity. The difference was especially pronounced in subjects below age 65. The lowest activity was found in diabetics with concomitant peripheral neuropathy. The method described here is simple, objective, quantitative and very sensitive. It may facilitate the screening of diabetic patients for autonomic neuropathy and enable a convenient quantitative follow-up. |
J. Auton. Nerv Syst., 1987 May;19(2):119-25. |
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CardiScan |
| Min-Young Chun et al. |
The Association between Symptoms of Autonomic Neuropathy and the Heart Rate Variability in Diabetics |
The HRV may be used as a tool to detect diabetic autonomic neuropathy by augmentation with position change. |
Korean J Fam Med. 2011 Jul; 32(5): 292–298. |
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CardiScan |
| Elena Strobescu, Mariana Graur |
The cardiovascular reflex tests in autonomic cardiac neuropathy diagnosis |
The deep inspiration and expiration remains the preferable test according to its sensibility, specificity and predictive value. I found that handgrip test has, beside the known limitations (arterial hypertension, heart failure, valvular disease, emphysema, advanced diabetic retinopathy, drugs like digitalis, beta-receptor blockers, antihypertensives, sedatives, etc.) one more linked by the hand muscular force. Orthostatic hypertension has too many false results so the interpretation must be done with much precaution. |
Rev Med Chir Soc Med Nat Iasi, 2002 Oct-Dec;106(4):746-52. |
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CardiScan |
| Johan Roikjer et al. |
The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain |
To investigate the co-existence of diabetic peripheral neuropathy (DPN), painful diabetic peripheral neuropathy (PDPN), and cardiac autonomic neuropathy (CAN) and to establish a model to predict CAN based on peripheral measurements. This study suggests that CAN predominantly co-exists with concomitant DPN. |
Acta Diabetologica, Volume 60, pages 777–785, (2023 |
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CardiScan |
| A Jirkovska et al |
The Ewing test for autonomic neuropathy and spectral analysis of heartrate variability aid in the diagnosis of Charcot's osteoarthropathy |
Examination of autonomic neuropathy significantly improves the diagnosis of Charcot's osteoarthropathy. In addition to the classical Ewing tests spectral analysis of heart rate variability proved also a suitable method for its evaluation. |
Vnitr Lek 1999, 45(7):403-408 |
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CardiScan |
| D. J. Ewing et al. |
The Natural History of Diabetic Autonomic Neuropathy |
Seventy-three diabetics (62 males and 11 females) who complained of symptoms suggestive of autonomic neuropathy were followed prospectively for up to five years. Autonomic function testing repeated during the follow-up period showed that some normal tests later became abnormal, but once tests were abnormal, they usually remained abnormal. Autonomic function testing using simple cardiovascular reflexes give a good guide to the prognosis of diabetic autonomic neuropathy. |
QJM: An International Journal of Medicine, Volume 49, Issue 1, WINTER 1980, Pages 95–108, |
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CardiScan |
| Andra-Elena Nica et al |
The Relationship between the Ewing Test, Sudoscan Cardiovascular Autonomic Neuropathy Score and Cardiovascular Risk Score Calculated with SCORE2-Diabetes |
Our study confirms the significant role of sudomotor dysfunction, as measured by Sudoscan, in identifying T2DM patients at high cardiovascular risk. The use of the Ewing Test and Sudoscan scores offers a promising adjunctive tool in the cardiovascular risk assessment of this population. These findings underscore the need for incorporating novel diagnostic tools into standard practice to enhance the early detection and management of cardiovascular risk among diabetic patients. |
Medicina 2024, 60(5), 828 |
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CardiScan |
| Ewing et al. |
The value of cardiovascular autonomic function tests: 10 years experience in diabetes |
Two hundred thirty-seven diabetic subjects had the tests repeated greater than or equal to 3 mo apart: 26% worsened, 71% were unchanged, and only 3% improved. The worsening followed a sequential pattern with first heart rate and later additional blood pressure abnormalities. Comparison between a single test (heart rate response to deep breathing) and the full battery in 360 subjects showed that one test alone does not distinguish the degree or severity of autonomic damage. These tests provide a useful framework to assess autonomic neuropathy simply, quickly, and noninvasively. |
Diabetes Care, 1985 Sep-Oct;8(5):491-8. |
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CardiScan |
| Dan Tiegler et al. |
Time- and frequency-domain estimation of early diabetic cardiovascular autonomic neuropathy |
Subjects with no evidence of cardiovascular autonomic neuropathy on the basis of the conventional tests showed an altered relationship between BP and HR. This baroreceptor-HR reflex dysfunction could represent an early stage of cardiovascular autonomic neuropathy undetected by the conventional tests. The areas under the receiver operating characteristic plots indicated that the high-frequency peak of pulse interval was highly discriminant in the supine and standing positions. The cross-spectral analysis showed the best discrimination for the gain in the high-frequency range. For the sequence analysis, the slope was the best discriminant factor for any degree of cardiovascular autonomic neuropathy. In conclusion, these estimates of baroreceptor-HR function may provide a powerful tool for assessing cardiovascular autonomic neuropathy at any stage, including the early stage, which is not detected by the conventional tests. |
Clinical Autonomic Research, Volume 11, pages 369–376, (2001) |
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CardiScan |
| Vincenza Spallone |
Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet |
Cardiovascular autonomic reflex tests (CARTs) measure heart rate and BP response to provocative physiological manoeuvres, and still represent the gold standard in autonomic testing as stated by the Toronto Consensus and recognized by neurological scientific societies. The Toronto Consensus recommends that diagnosis of CAN be based on the use of CARTs, i.e., heart rate response to deep breathing, standing, Valsalva manoeuvre, and BP response to standing. CAN detection can help both the clinician and the patient, although cost-effective studies are still lacking. CAN (cardiac autonomous neuropathy) under-diagnosis can be addressed through a mix of education, flexibility, adaptability to local resources and to the individual’s risk profile, in addition to searching for more affordable testing. New data support the efficacy of CAN prevention at an early stage, but CAN still needs more effective prevention and disease modifying treatment. CAN’s clinical forms are treatable. In conclusion, CAN still needs to be fully dealt with in practice, knowledge, education, as well as in research. |
Diabetes Metab J 2019;43:3-30 |
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CardiScan |
| K. Kun ezt al. |
Combination of Ewing test, heart rate variability, and heart rate turbulence analysis for early diagnosis of diabetic cardiac autonomic neuropathy |
Parameters used for evaluating parasympathetic functions in Ewing test, HR variability, and HR turbulence were found to significantly decrease in CAN+ group. The combination of SDNN and TS showed greater diagnostic value than Ewing test, HRV analysis, or HRT analysis alone. |
Medicine 96(45):p e8296, November 2017. |
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CardiScan |
| D J Ewing et al |
The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes |
Comparison between a single test (heart rate response to deep breathing) and the full battery in 360 subjects showed that one test alone does not distinguish the degree or severity of autonomic damage. These tests provide a useful framework to assess autonomic neuropathy simply, quickly, and noninvasively. |
Diabetes Care 1985;8(5):491–498 |
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CardiScan |
| C.S. Yajnik et al. |
Screening of cardiovascular autonomic neuropathy in patients with diabetes using non-invasive quick and simple assessment of sudomotor function |
SUDOSCAN, which allows quick quantitative assessment of sudomotor function, may be used for early screening of CAN in everyday clinical practice before resorting to the more sophisticated and specific, but ultimately more time-consuming, Ewing tests. |
Diabetes & Metabolism Volume 39, Issue 2, April 2013, Pages 126-131 |
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| Meijer, Johannes Wilhelmus Gerardus |
The diabetic foot syndrome, diagnosis and consequences |
Cardiac autonomic neuropathy (CAN) tests, recommended as one of the diagnostic categories for diabetic polyneuropathy (PNP), may be more a reflection of cardiovascular abnormalities than of PNP in diabetes. Aim To test the agreement between several CAN tests and other neuropathy, and vascular categories over a broad range of diabetic patients. CAN tests are weakly related to MF, VPT and DNEscore, and even less to DNS-score for diabetic PNP. Some CAN tests might both reflect microvascular angiopathy and diabetic PNP. |
University of Groningen, Citation for published version (APA): Meijer, J. W. G. (2002). The diabetic foot syndrome, diagnosis and consequences. s.n. |
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CardiScan |
| M. Ducher et al. |
Limits of clinical tests to screen autonomic function in diabetes type 1 |
From clinical tests (standing up, deep breathing, Valsalva maneuver, handgrip test), autonomic function was scored according to Ewing's methodology. Analysis of resting beat to beat blood pressure provided autonomic indices of the cardiac function (spectral analysis or Z analysis). Alteration in Ewing's score given by clinical tests may not reflect an alteration of cardiac autonomic function in asymptomatic type I diabetic patients, because spectral indices of sympathetic and parasympathetic (including BRS) function were within normal range. Our results strongly suggest to confront results provided by both methodologies before concluding to an autonomic cardiac impairment in asymptomatic diabetic patients. |
JPNS, Vol. 7., Issue 2, p 138, 2002 |
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CardiScan |
| A E Körei et al. |
Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus? |
Our data confirm that the handgrip test should no longer be part of the cardiovascular autonomic testing being highly dependent on hypertensive status and baseline diastolic BP. Exaggerated exercise pressor response is proposed as putative mechanism for the inverse association between abnormal results of the handgrip test and hypertension. Adequate CARTs are important to allow their use in clinical trials and for the prevention of DM-associated complications by initiating early treatment. |
Current Vascular Pharmacology, Volume 15, Number 1 |
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CardiScan |
| Jens Tank et al. |
Spontaneous Baroreflex Sensitivity and Heart Rate Variability Are Not Superior to Classic Autonomic Testing in Older Patients with Type 2 Diabetes |
BRS and HRV did not detect CAN in older diabetic patients better than classic autonomic testing. |
The American Journal of the Medical Sciences, Vol322, Issue1, pp24-30, 2001 |
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CardiScan |
| M S Rendell, J J Katims, R Richter et al. |
A comparison of nerve conduction velocities and current perception thresholds as correlates of clinical severity of diabetic sensory neuropathy. |
CPTs proved the more effective as predictors of both symptomatic and physical impairment. Nerve conduction velocities (NCVs) appear to lack the resolving power necessary to evaluate subtle differences in clinical state of diabetic sensory neuropathy. The supplementary use of current perception testing may improve the quantitative assessment of this condition. |
J Neurol Neurosurg Psychiatry. 1989 Apr; 52(4): 502–511 |
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SensoriScan |
| Cherniak, 1996 |
A Comparison of Traditional Electrodiagnostic Studies, Electroneurometry, and Vibrometry in the Diagnosis of Carpal Tunnel Syndrome |
Electroneurometry was characterized by high sensitivity and low specificity, while the opposite relationship prevailed with vibrometry. These associations were highly dependent on the methods used to select normal values from a reference population |
The Journal of Hand Surgery Volume 21, Issue 1, January 1996, Pages 122-131 |
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SensoriScan |
| Akiyo Nishimura a, Taku Ogura a, Hitoshi Hase et al. |
A correlative electrophysiologic study of nerve fiber involvement in carpal tunnel syndrome using current perception thresholds |
CPT showed abnormalities appear progressively from ‘higher to lower’ frequency stimulations relative to the increasing severity of carpal tunnel syndrome. |
Clinical Neurophysiology
Volume 115, Issue 8, August 2004, Pages 1921-1924 |
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SensoriScan |
| Nishimura, 2004 |
A correlative electrophysiologic study of nerve fiber involvement in carpal tunnel syndrome using current perception thresholds |
CPT showed abnormalities appear progressively from ‘higher to lower’ frequency stimulations relative to the increasing severity of CTS. |
Clinical Neurophysiology |
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SensoriScan |
| Yamashita, Toshihiko MD*; Kanaya, Kunihito MD*; Sekine, Masatoshi MD et al. |
A Quantitative Analysis of Sensory Function in Lumbar Radiculopathy Using Current Perception Threshold Testing |
Current perception threshold testing showed that the functions of A-beta, A-delta, and C fibers deteriorated in patients with lumbar radiculopathy. This technique may be useful for quantifying sensory nerve dysfunction in patients with radiculopathy. |
Spine 27(14):p 1567-1570, July 15, 2002. |
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SensoriScan |
| S.Y Lee et al. |
A Quantitative Measure of Pain with Current Perception Threshold, Pain Equivalent Current, and Quantified Pain Degree: A Retrospective Study |
CPT and QPD measured using the PainVisionTM system could be used to estimate pain intensity and the presence of pain. These parameters would be considered useful for predicting pain itself and its intensity. |
J. Clin. Med. August 2023.12(17):5476 |
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SensoriScan |
| Xia W, Fu H, Liu H et al. |
A test-retest reliability study of assessing small cutaneous fibers by measuring current perception threshold with pin electrodes. |
The reliability of CPT measurement using circular pin electrodes is fair, and need consistence of measurements in longitudinal studies. |
Plos one, 17 Nov 2020, 15(11):e0242490 |
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SensoriScan |
| Chin-Hsiao Tseng |
Abnormal current perception thresholds measured by neurometer among residents in blackfoot disease-hyperendemic villages in Taiwan |
In conclusion, abnormal CPT was observed in seemingly normal subjects without clinical neuropathy in the arseniasis-hyperendemic villages in Taiwan. |
Toxicology Letters
Volume 146, Issue 1, 15 December 2003, Pages 27-36 |
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SensoriScan |
| Chin-Hsiao Tseng et al. |
Aging and Current Perception Threshold Measured by Neurometer in Normal Taiwanese Adults |
The results of our study suggest that age is an independent predictorfor CPT in normal adults. Therefore, the effect of ageshould be considered when using CPT in clinical settings. Further studies to clarify the effect of age on CPT in otherethnic groups seem to be necessary |
Journal of the American Geriatrics Society |
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SensoriScan |
| G.V. Inceu, G. Roman, I.A. Veresiu |
Assessment of Nerve Fibers Dysfunction Through Current Perception Threshold Measurement in Diabetic Peripheral Neuropathy |
Authors found higher R-CPT values in patients with higher diabetes duration and we obtained positive and significant correlation between duration of diabetes and R-CPT values for all three frequencies of alternative current. |
International Conference on Advancements of Medicine and Health Care through Technology; 12th - 15th October 2016, Cluj-Napoca, Romania pp 25–30 |
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SensoriScan |
| G. V. Inceu & I. A. Veresiu |
Assessment of Peripheral Diabetic Neuropathy: New versus Conventional Methods |
Also CPT measurement with the Neurometer has been shown to be clinically valuable in detecting peripheral nerve dysfunction. Applying 5Hz current detected the most patients with diabetic neuropathy compared to the other two frequencies, finding that confirm the well-known fact that diabetes mellitus is a small fiber disease. |
International Conference on Advancements of Medicine and Health Care through Technology; 5th – 7th June 2014, Cluj-Napoca, Romania pp 177–180 |
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SensoriScan |
| R. Matsutomo, K. Takebayashi, Y. Aso |
Assessment of Peripheral Neuropathy Using Measurement of the Current Perception Threshold with the Neurometer® in Patients with Type 2 Diabetes Mellitus |
The CPT at 2000 Hz was significantly higher in diabetic patients than in controls, and showed a significant negative correlation with motor and sensory nerve conduction velocities. Significantly higher CPT values were obtained in patients with proliferative diabetic retinopathy and macroalbuminuria. These data suggest that CPT is useful in detecting abnormalities of myelinated as opposed to unmyelinated nerve fibres in patients with type 2 diabetes. |
Journal of International Medical Research
Volume 33, Issue 4
Pages: 442 - 453 |
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SensoriScan |
| Sheng-long Lv, Chen Fang et al. |
Assessment of Peripheral Neuropathy Using Measurement of the Current Perception Threshold with the Neurometer® in patients with type 1 diabetes mellitus |
Data suggest that CPT is useful in early detection of peripheral neuropathy in patients with type 1 diabetes mellitus. Patients with diabetic peripheral neuropathy, the lower limb nerve is more vulnerable than the upper limb nerve. |
Diabetes Research and Clinical Practice
Volume 109, Issue 1, July 2015, Pages 130-134 |
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SensoriScan |
| Nather et al. |
Assessment of sensory neuropathy in patients with diabetic foot problems |
Comparison of the three different modalities of testing in this study showed that there was no difference between neuropathy detected by PPT compared to neuropathy detected by 5.07/10 g SWMT. However, Neurometer measurements detected a statistically higher proportion of feet with sensory neuropathy compared to detection by PPT or by 5.07/10 g SWMT. |
Diabetic Foot & Ankle, 2011; 2 |
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SensoriScan |
| Xia Zhang 1, Chen Fang 2, Xiang Li et al. |
Clinical characteristics and risk factors of diabetic peripheral neuropathy of type 1 diabetes mellitus patients |
CPT can be combined with traditional nerve conduction velocity examination, which will help the diagnosis of diabetic peripherial neuropathy of type 1 diabetes mellitus earlier and more comprehensively |
Diabetes Res Clin Pract
. 2017 Jul:129:97-104 |
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SensoriScan |
| T. Mori, K. Ishida, S. Mukumoto et al. |
Comparison of skin barrier function and sensory nerve electric current perception threshold between IgE‐high extrinsic and IgE‐normal intrinsic types of atopic dermatitis |
Although there was no statistically significant difference in CPT among extrinsic AD, intrinsic AD and normal controls, CPT was significantly correlated with skin surface hydration and inversely with TEWL in intrinsic AD and normal controls, but not extrinsic AD. Finally, CPT was correlated with the visual analogue scale of itch in the nonlesional skin of patients with extrinsic but not intrinsic AD. |
British Journal of Dermatology, Volume 162, Issue 1, 1 January 2010, Pages 83–90 |
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SensoriScan |
| Weseley, 1988 |
Current Perception threshold - Preferred Test for Evaluation of Peripheral Nerve Integrity |
We recommend CPT technique because it is sensitive , not painful, and may be performed during dialysis resulting in a high degree of patient compliance. |
ASAIO Transactions 1988 Jul-Sep;34(3):188-93. |
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SensoriScan |
| Oishi, M (Oishi, M) ; Mochizuki, Y (Mochizuki, Y) ; Suzuki, Y (Suzuki, Y) et al. |
Current perception threshold and sympathetic skin response in diabetic and alcoholic polyneuropathies |
Conclusion Since both current perception threshold to 5 Hz stimulation and sympathetic skin response are related to C fibers, these two are considered to be impaired concurrently in diabetic and alcoholic polyneuropathies |
Intern Med
. 2002 Oct;41(10):819-22. |
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SensoriScan |
| Kyung Seok Park, Yong Chul Kwon1, Minjung Youn et al. |
Current perception threshold in diabetic sensory polyneuropathy with normal routine nerve conduction study |
Our data suggest that the CPT test, especially at a stimuli frequency of 5 Hz, may be a useful screening tool for diabetic polyneuropathy in patients who show no abnor-malities in routine nerve conduction studies. |
Annals of Clinical Neurophysiology 19(2):125 |
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SensoriScan |
| Jefferson J. Katims M.D.,Ashok S. Patil M.D., M.P.H., M.S.,Marc Rendell M.D. et al. |
Current Perception Threshold Screening for Carpal Tunnel Syndrome |
The noninvasive, nonaversive CPT technique provided sensitive and easily obtained quantitative measures. Regular use of this procedure in the occupational setting may assist in preventing the development of advanced carpal tunnel syndrome for it provides early detection of median nerve abnormalities. |
Archives of Environmental Health: An International Journal
Volume 46, 1991 - Issue 4 |
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SensoriScan |
| Ran Zhang, Xi Zhang, Yaping Chen et al. |
Current perception threshold testing in chronic ankle instability |
The present study revealed increased sensory thresholds in 250-Hz- and 5-Hz-related sensory nerve fibres in the injured and uninjured ankles of patients with CAI. This increase may indicate dysfunction of A-delta and C fibres. Sex, age and BMI did not significantly impact CPT values. There were correlations between CPT values at different frequencies, especially 250 Hz and 5 Hz |
BMC Musculoskelet Disord
. 2021 May 18;22(1):453. |
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SensoriScan |
| Long-Sun Ro MD, PhD, Sien-Tsong Chen MD, Lok-Ming Tang MD et al. |
Current perception threshold testing in Fabry's disease |
Our results showed that CPT testing at low frequencies (5 and 250 Hz) was significantly more sensitive than at a higher frequency (2 kHz) and nerve conduction studies in detecting sensory neuropathy in patients with Fabry's disease |
Muscle&Nerve Volume 22, Issue 11, November 1999, Pages 1531-1537 |
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SensoriScan |
| Katims JJ, Rouvelas P , Sadler BT et al. |
Current perception threshold. Reproducibility and comparison with nerve conduction in evaluation of carpal tunnel syndrome |
The unique ability of the CPT exam to quantify hyperesthesia may account for its superior carpal tunnel syndrome detection sensitivity. These findings demonstrate that repeated CPT determinations are consistent and are diagnostic for carpal tunnel syndrome. |
ASAIO Transactions, 01 Jul 1989, 35(3):280-284 |
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SensoriScan |
| D L Menkes, M R Swenson, H W Sander |
Current perception threshold: an adjunctive test for detection of acquired demyelinating polyneuropathies |
CPT testing can distinguish demyelinating from axonal polyneuropathies. It may be particularly helpful in patients with predominantly sensory symptoms in whom EMG/NCS data may be equivocal, or in patients who decline EMG/NCS studies |
Electromyogr Clin Neurophysiol
. 2000 Jun;40(4):205-10. |
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SensoriScan |
| E A Masson, A Veves, D Fernando, A J Boulton |
Current perception thresholds: a new, quick, and reproducible method for the assessment of peripheral neuropathy in diabetes mellitus |
Comparisons with results of conventional tests of nerve function show that high frequency detection thresholds correlate best with tests of large fibre function (r = 0.42-0.69, p less than 0.001), and low frequency detection thresholds correlate with tests of small fibre function (r = 0.34-0.46, p less than 0.005). It is concluded that the device may be a simple and comprehensive way of assessing peripheral nerve function. |
Diabetologia
. 1989 Oct;32(10):724-8. |
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SensoriScan |
| Weseley SA , Sadler B, Katims JJ |
Current perception: preferred test for evaluation of peripheral nerve integrity |
CPT was shown to be a superior technique to NCT, as it is quick (tested during HD) and painless. |
ASAIO Transactions, 01 Jul 1988, 34(3):188-193 |
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| Sztanek F, Balogh B , Molnár Á et al. |
Diabetic neuropathy and other diabetic complications at the Diabetic Neuropathy Center of the University of Debrecen |
Peripheral neurological examination using the Neurometer® is appropriate for controlling the distal sensorimotor neuropathy status and the establishment of the severity of neuropathy determines the quality of life in diabetic patients. |
Orvosi Hetilap, 01 Jul 2020, 161(30):1243-1251 |
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| Veves, 1994 |
Differences in Peripheral and Autonomic Nerve Function Measurements in Painful and Painless Neuropathy |
We conclude that no difference could be found in the function of small and large nerve fibers between painful and painless diabetic neuropathy using conventional tests currently used. The CPT evaluation failed to quantify painful symptoms, but it compared favorably with other quantitative sensory tests in quantifying peripheral neuropathy |
DIABETES CARE, 1994 Oct;17(10):1200-2 |
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| Z. Uddin, J.C. MacDermid, V. Galea et al. |
Does Current Perception Threshold Test Can Differentiate Categories of Mechanical Neck Disorder? |
CPT test was capable of differentiate MND categories. CPT might be a potential tool for evaluating neurological involvement or hypersensitivity in neck pain. |
Value in Health
Volume 15, Issue 4, June 2012, Page A62 |
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| Kenneth M Aló MD, Herbert N Chado MD |
Effect of Spinal Cord Stimulation on Sensory Nerve Conduction Threshold Functional Measures |
Spinal cord stimulation (SCS) modulates segmental large afferent fiber input as reflected by a statistically significant increase in large fiber CPTs (2000 Hz) at the symptomatic site post-SCS. A statistically significant increase in small fiber (5 Hz) CPTs at the control site suggests a central sensory (suprasegmental) modulating effect on nociceptive fiber activity |
Neuromodulation: Technology at the Neural Interface
Volume 3, Issue 3, August 2000, Pages 145-154 |
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| AS Nawfar, NBM Yakob |
Effects of monochromatic infrared energy therapy on diabetic feet with peripheral sensory neuropathy: a randomised controlled trial |
Neuropathy was screened using the Michigan neuropathy scoring instrument, followed by an assessment of the current perception threshold using a neurometer at frequencies of 2,000 Hz, 250 Hz and 5 Hz. No improvement of neuropathy was observed following MIRE treatment in the neuropathic feet of diabetic patients. |
Singapore Med J., 2011 Sep;52(9):669-72. |
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| Sakai, Tetsuya MD; Tomiyasu, Shiro MD; Yamada, Hiroyuki MD et al. |
Evaluation of Allodynia and Pain Associated With Postherpetic Neuralgia Using Current Perception Threshold Testing |
The intensity of dynamic allodynia in postherpetic neuralgia correlates with the preserved functions of Aβ, Aδ, and C fibers. In contrast, the intensity of ongoing pain does not correlate with either the preserved function of C fibers or the intensity of dynamic allodynia. Therefore, it is suggested that postherpetic neuralgia might be a pain syndrome including both peripheral and central mechanisms. |
The Clinical Journal of Pain 22(4):p 359-362, May 2006. |
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| Akiyo Nishimura, Taku Ogura, Hitoshi Hase et al. |
Evaluation of sensory function after median nerve decompression in carpal tunnel syndrome using the current perception threshold test |
The recovery level for sensory function after carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome (CTS) was assessed with the current perception threshold (CPT) test. Seventeen CTS patients (21 hands) were followed, and the CPTs at the index finger of each patient was measured preoperatively and at 1, 3, and 6 months postoperatively. After carpal tunnel release, there was significant recovery of CPT at all stimulation frequencies, indicating improvement of all sensory functions including sensations of temperature, pain, touch, and vibration |
Journal of Orthopaedic Science, Published: July 2003
Volume 8, pages 500–504, (2003) |
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| H. Ham, S. M. An, E. J. Lee et al. |
Itching sensation and neuronal sensitivity of the skin |
The CPT value (5 Hz) can be used for scanning for itching sensations when a cosmetic or its ingredients possibly cause the sensation |
Skin Research & Technology, Volume 22, Issue 1, 2016, Pages 104-107 |
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| Hung Youl Seok, Yong Won Cho |
Long-term dopamine agonist treatment fails to restore altered central sensory processing in restless legs syndrome: Evidence from current perception threshold measurements |
Our study demonstrated that long-term treatment with dopamine agonists effectively reduces restless leg syndrome (RLS) symptoms, but does not reverse the altered central sensory processing observed on CPT testing in RLS patients. CPT values did not show significant changes for all stimulus frequencies after treatment. |
Sleep Medicine
Volume 113, January 2024, Pages 1-5 |
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| M S Rendell, D J Dovgan, T F Bergman et al. |
Mapping Diabetic Sensory Neuropathy by Current Perception Threshold Testing |
CPTs for diabetic subjects at the three frequencies were higher at most locations than for the nondiabetic volunteers. However, CPTs were no different from normal values in diabetic subjects without evidence of neuropathy. CPT testing appears to be a useful technique for assessment of diabetic sensory neuropathy. |
Diabetes Care
. 1989 Oct;12(9):636-40. |
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| GEORGETA VICTORIA INCEU, IOAN ANDREI VERESIU |
MEASUREMENT OF CURRENT PERCEPTION THRESHOLDS USING THE NEUROMETER® – APPLICABILITY IN DIABETIC NEUROPATHY |
Current evidence shows that neurometer method provides a useful, noninvasive evaluation technique of patients with peripheral nervous system disorders, being able to detect neuropathy in the earliest and asymptomatic stages. The neurometer CPT can independently evaluate three sub-types of nerve fibers (Aβ, Aδ and C fibers) by using different frequencies of an alternating current, providing
improved detection sensitivity over other methods testing. |
Clujul Med. 2015; 88(4): 449–452. |
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| J J Katims, E H Naviasky, L K Ng et al. |
New screening device for assessment of peripheral neuropathy |
The test identified the diabetic peripheral neuropathy with an overall sensitivity of 94%. This new diagnostic technique is quick, simple to perform, noninvasive and nonaversive and provides a sensitive quantitative measure of sensory function. This diagnostic stimulator will be useful for screening occupationally related toxic and entrapment neuropathies in which sensory impairment is an early finding. |
J Occup Med
. 1986 Dec;28(12):1219-21. |
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| Zsuzsanna Putz, MD; Ádám G Tabák, MD, PHD; Nelli Tóth, MD et al. |
Noninvasive Evaluation of Neural Impairment in Subjects With Impaired Glucose Tolerance |
Assessment of both CPT at 5 Hz and heat detection threshold seems to detect small-fiber neuropathy among IGT subjects |
Diabetes Care 2009;32(1):181–183 |
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| D. Akagi, H. Arita, T. Komiyama et al. |
Objective Assessment of Nerve Injury after Greater Saphenous Vein Stripping |
The aim of this study was to evaluate postoperative sensory changes by quantitative assessment of current perception threshold (CPT), and to clarify the relation between CPT and symptoms. (...) CPT evaluation provides an objective indication of neurological symptoms in the lower limb following varicose vein surgery. |
European Journal of Vascular and Endovascular Surgery
Volume 33, Issue 5, May 2007, Pages 625-630 |
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| Akiyo Nishimura, Taku Ogura, Hitoshi Hase et al. |
Objective evaluation of sensory function in patients with carpal tunnel syndrome using the current perception threshold |
Based on these results we concluded that the CPT test is a reliable quantitative sensory function test. |
Journal of Orthopaedic Science
Volume 8, Issue 5, September 2003, Pages 625-628 |
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| Prithvi P Raj et al. |
Painless Electrodiagnostic Current Perception Threshold and Pain Tolerance Threshold Values in CRPS Subjects and Healthy Controls: A Multicenter Study |
In studied CRPS patients an abnormal PTT was detected with higher sensitivity than an abnormal CPT. Assessing PTT may become a useful electrodiagnostic quantitative sensory test for diagnosing and following the course of neuropathic pain conditions. |
Pain Practice, 2001 Jan;1(1):53-60 |
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| Joong Hyun Park, Jong Chul Won |
Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold |
NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia. |
Diabetes Metab J
. 2018 Dec;42(6):519-528. |
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| L. Barkai, P. Kempler, I. Vámosi et al. |
Peripheral sensory nerve dysfunction in children and adolescents with Type 1 diabetes mellitus |
In conclusion, evidence of peripheral sensory nerve dysfunction is not rare in children and adolescents with diabetes and can be demonstrated by CPT testing in asymptomatic patients. |
Diabetic Medicine, Volume 15, Issue 3, March 1998.
Pages 228-233 |
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| Kiyoshi Takekuma, Fujiko Ando, Naoakira Niino et al. |
Prevalence of hyperesthesia detected by current perception threshold test in subjects with glucose metabolic impairments in a community |
Recent studies reported that hyperesthesia may be an indicator of early diabetic polyneuropathy. Using the current perception threshold (CPT) test, which stimulates peripheral sensory nerve fibers by three different frequencies (2, 000, 250, and 5 Hz), we investigated the relationship between hyperesthesia and glucose metabolic impairment in a community. Our results suggested that hyperesthesia may emerge coupled with developing diabetes, supporting the precedent hypothesis. |
Internal Medicine, 2002 Volume 41 Issue 12 Pages 1124-1129 |
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| David L. Wenzler MD, Frank N. Burks MD, Maureen Cooney RN et al. |
Proof of Concept Trial on Changes in Current Perception Threshold After Sacral Neuromodulation |
With a measurable change in CPT values for Aδ-fibers and Aβ-fibers, these findings suggest that SNM modulates large myelinated afferent fibers in the bladder. Notably, little or no changes were found in the C-fiber CPT measurements. More research is needed with a larger sample size to determine the significance of these findings. |
Nuromodulation Technology at the neural interface, Volume18, Issue3
April 2015
Pages 228-232 |
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| Kenshi Imoto, Tsuneo Takebayashi, Kunihito Kanaya et al. |
Quantitative analysis of sensory functions after lumbar discectomy using current perception threshold testing |
CPT measured by a Neurometer is very useful in assessing lower-extremity sensory functions before and after surgery for lumbar disc herniation. |
European Spine Journal, Volume 16, pages 971–975, (2007) |
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| Chen JM, Chen QF, Wang ZY et al. |
Quantitative and Fiber-Selective Evaluation for Central Poststroke Pain. |
In conclusion, the abnormal fiber types, sensory dysfunction territory, and clinical signs of central poststroke pain in thalamic stroke differ from those in internal capsule stroke. Implementation of the portable and convenient CPT protocol may help clarify the locations of different stroke lesions in various clinical settings. |
Neural Plasticity, 06 Jun 2022, 2022:1507291 |
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| An Y, Li Y, Chang W et al. |
Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea. |
The CPT test could be a useful tool for the quantitative and selective assessment of the sensory nerve function in patients with obstructive sleep apnea. Additional research is required to evaluate the different types of sensory nerve dysfunctions among such patients. |
Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 01 Sep 2019, 15(9):1347-1353 |
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| Hexiang Yin, Mingsheng Liu, Yicheng Zhu et al. |
Reference Values and Influencing Factors Analysis for Current Perception Threshold Testing Based on Study of 166 Healthy Chinese |
As a neurophysiological tool for quantitative assessment of sensory nerve functions, CPT can selectively test different subtypes of sensory nerve fibers in a quick and non-invasive way. The impact of the different factors on the CPT tests will be revealed as follows. Gender differences were shown at 2000 Hz CPT on the back of the hand and the hallux (p < 0.01), and male subjects had a higher CPT. Age had a positive correlation with 250 Hz CPT on the index finger (p < 0.05, r = 1.5), 2000 Hz CPT on the back of the hand (p < 0.001, r = 1.2) and the index finger (p < 0.05, r = 2.5). Manual workers had higher 250Hz CPT on the hallux than mental workers (p < 0.01). Reference values for different subject characteristics based on the influencing factor analysis were established. |
Front Neurosci. 2018; 12: 14.
Published online 2018 Jan 26 |
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| Tsui, 2013 |
Reproducibility of current perception threshold with the Neurometer(®) vs the Stimpod NMS450 peripheral nerve stimulator in healthy volunteers: an observational study |
Overall, the Stimpod device displayed good to excellent reproducibility in measuring CPT in healthy volunteers. The Neurometer displayed poor reproducibility at low frequency (5 Hz). These results suggest that peripheral nerve stimulators may be potential devices for measuring CPT to assess nerve blocks. |
Can J Anesth., 013 Aug;60(8):753-60 |
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| Hae-Young Lopilly Park; Juyoung Shin; Jae Hyung Lee et al. |
Retinal Nerve Fiber Layer Loss in Patients With Type 2 Diabetes and Diabetic Neuropathy |
Peripheral neuropathy was evaluated by measuring the current perception threshold (CPT) using a Neurometer. (...) Evaluation of peripheral neuropathy using the CPT grade revealed significantly higher neuropathy grades in the group with inferior Retinal nerve fiber layer (RNFL) defects than in the group with superior RNFL defects (Table 1) |
Diabetes Care 2016;39(5):e69–e70 |
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| Kohei Koga, Hidemasa Furue, Md Harunor Rashid |
Selective activation of primary afferent fibers evaluated by sine-wave electrical stimulation |
Thus, the transcutaneous sine-wave stimulation can be applied to evaluate functional changes of sensory transmission by comparing thresholds with the three stimulus frequencies |
Mol Pain. 2005; 1: 13. |
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| JJ Katims et al. |
Sensory Perception in Uremic Patients |
The CPT examination provides a sensitive and easy to administer test of PNS sensory function for the purpose of assessing the adequacy of dialysis in chronic hemodialysis patients; the CENS examination also may prove useful in this regard. |
ASAIO Transactions, 1991 Jul-Sep;37(3):M370-2. |
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| Hung Youl Seok, So Young Do, Gholam K. Motamedi et al. |
Symptom-related changes in current perception threshold of restless legs syndrome |
The significantly lower CPT values for all three frequencies in symptom+ patients suggest that central sensory processing disturbance of sensory nerve fibres’ input may be involved in the development of symptoms in restless legs syndrome patients |
Journal of Sleep Research, Volume 29, Issue 3, June 2020, e12890 |
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| AAEM Technology Review |
Technology review: The Neurometer® current perception threshold (CPT) |
Scientific publications and information from promotional literature report the usefulness of this instrument for the detection, screening, diagnosis, and management of diseases of the peripherial nervous system. |
Muscle&Nerve Volume 22, Issue 4, April 1999.
Pages 523-531 |
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| Hung Youl Seok, Mi-Yeon Eun |
TH-275. Dopaminergic treatment does not restore altered central sensory processing in restless legs syndrome |
The CPT was measured in the evening on the bilateral great toes of each subject at frequencies of 5 Hz, 250 Hz, and 2,000 Hz using the Neurometer® CPT/C device (Neurotron Inc., Baltimore, MD, USA). The CPT measurement was repeated after dopamine agonist treatment for at least 2 months. In this study, dopamine agonist treatment reduced symptoms associated with RLS, but it failed to reverse the altered CPT in RLS. These findings suggest that alterations in central sensory processing in RLS may involve multifactorial mechanisms other than dopaminergic system dysfunction. |
Clinical Neurophysiology
Volume 141, Supplement, September 2022, Pages S174-S175 |
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| Yuwen Lee, Mary Robinson, Nathan Wong et al. |
The effect of pentoxifylline on current perception thresholds in patients with diabetic sensory neuropathy |
Pentoxifylline effectiveness was evaluated by measuring glycated hemoglobin, blood pressure and current perception threshold (CPT). The CPT results showed no statistically significant effect of pentoxifylline on mean nerve sensory perception thresholds in ankle and toe at 5, 250 and 2000 Hz. There were no significant changes in glycated hemoglobin or in systolic and diastolic blood pressure during the trial. Thus, glycated hemoglobin and blood pressure did not explain the lack of pentoxifylline effect on diabetic neuropathy. In conclusion, pentoxifylline appears not to add benefits to the clinical treatment of diabetic sensory neuropathy of the lower extremit |
Journal of Diabetes and its Complications
Volume 11, Issue 5, September–October 1997, Pages 274-278 |
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| Ismail et al. |
The Effect of Wrist Braces on Curent Perception Threshold (CPT) among Female Data Processing Operators in Malaysia |
This study suggests that CPT value showed an increased trend after data entry tasks when no wrist braces used and a reduced trend when wrist braces were used. This study concluded that wearing a wrist brace for a short period of time during repetitive activities has no immediate influence on CPT value among computer operators, however, this study suggests that wrist braces may be beneficial in protecting workers against median nerve compression. |
World Journal of Medical Sciences, 4 (2): 79-84, 2009. |
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| Aird, 2006 |
The Impact of Wrist Extension Provocation on Current Perception Thresholds in Patients with Carpal Tunnel Syndrome: A Pilot Study |
A positional effect on sensibility was noted at 2,000 Hz in subjects with CTS. Further evaluation is required to determine the role and optimal test protocols for provocative-sensory testing in diagnosis and outcome assessment of CTS. For CPT these should focus on using the 2,000 Hz frequency. |
JOURNAL OF HAND THERAPY, 2006 Jul-Sep;19(3):299-305 |
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| Dr. E. A. Masson, A. J. M. Boulton |
The Neurometer: Validation and Comparison with Conventional Tests for Diabetic Neuropathy |
The possible application of the Neurometer to the diagnosis and measurement of diabetic neuropathy was evaluated. The preliminary Neurometry results in comparison to those of conventional nerve testing techniques, including thermal and vibration detection thresholds, are discussed. It appears that the device may be a useful screening instrument which could give a fairly comprehensive idea of the functional integrity of different nerve fibre populations, and a full assessment takes only 10 to 15 min, in contrast to the conventional alternatives. |
Diabetic Medicine, Volume8, IssueS2
Special Issue: Special Issue: Symposium
October 1991
Pages S63-S66 |
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| François Gaudreault, Pierre Drolet, Michel Fallaha et al. |
The Reliability of the Current Perception Threshold in Volunteers and Its Applicability in a Clinical Setting |
CPT proved to be a reliable assessment tool for within-day sensory perception in healthy volunteers. Our study also suggests that CPT can be applied to characterize, in a quantitative manner, the sensory onset of a peripheral nerve block in a clinical setting, thereby supporting its use in future studies comparing different regional anesthetic modalities or approaches. |
Anesth Analg
. 2015 Mar;120(3):678-683. |
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| Dongwook Han, Misook Ha |
The Usefulness of Current Perception Threshold Test in Both Lower Extremities with Diabetic Patient |
Stimulations of 5 Hz, 250 Hz, and 2,000 Hz of frequency were generated with a Neurometer CPT (Neurotron Inc., Baltimore, MD, U.S.A.) and delivered selectively to C fibers, A-delta fibers and A-beta fibers. (...) The perception thresholds varied with diabetes duration and showed that degeneration of A-beta fibers and A-delta fibers that have myelin was more rapid than that of C fibers that are without myelin. Therefore, therapeutic interventions should be applied at the early stage of neuropathy. |
Journal of Physical Therapy Science 2011 Volume 23 Issue 1 Pages 13-15 |
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| David R. Steinberg MD, Richard H. Gelberman MD, Bjorn Rydevik MD, PhD et al. |
The utility of portable nerve conduction testing for patients with carpal tunnel syndrome: A prospective clinical study |
The portable electroneurometer is a convenient, painless, inexpensive device for screening patients with carpal tunnel syndrome. |
The Journal of Hand Surgery
Volume 17, Issue 1, January 1992, Pages 77-81 |
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| Dr D.L. Pitei, P.J. Watkins, M.J. Stevens et al. |
The Value of the Neurometer in Assessing Diabetic Neuropathy by Measurement of the Current Perception Threshold |
The Neurometer is a simple instrument to use in clinical practice. It has a degree of neuroselectivity but like all subjective sensory tests has a large variability. |
Diabetic Medicine, Volume11, Issue9.
November 1994
Pages 872-876 |
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| Zhao Q, Guo W. |
A Meta analysis of characteristics of median nerve and sural nerve injury in patients with diabetic peripheral neuropathy. |
The current perception threshold (CPT) value of median nerve and sural nerve were comparedat2000Hz, 250Hz and 5Hz between patients with DPN and the normal control group. Systematic reviews showed that the sensitivity of themediannerve and sural nerve in DPN patients was generally reduced. Sensory nerve quant |
TMR Integrative Medicine 2018, 2(1): 39-47. |
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| Yamashita, Toshihiko MD*; Kanaya, Kunihito MD*; Sekine, Masatoshi MD et al. |
A Quantitative Analysis of Sensory Function in Lumbar Radiculopathy Using Current Perception Threshold Testing |
Current perception threshold testing showed that the functions of A-beta, A-delta, and C fibers deteriorated in patients with lumbar radiculopathy. This technique may be useful for quantifying sensory nerve dysfunction in patients with radiculopathy. |
Spine 27(14):p 1567-1570, July 15, 2002. |
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| Shin-Ichiro Seno et al. |
Analysis of the effect of fingertip size for sex differences in current perception thresholds with transcutaneous electrical stimulation in healthy subjects |
Sex differences in CPTs were not
completely abolished by adjusting for fingertip length or area. Thus, the evaluation of the CPT in clinical fields is not only an evaluation of the peripheral nerve function but should also be considered with regard to various influences |
preprint |
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| Dughun Choi et al. |
Association between Sleep Quality and Painless Diabetic Peripheral Neuropathy Assessed by Current Perception Threshold in Type 2 Diabetes Mellitus |
since CPT assesses the function of three major types of sensory fibers by using different impulse frequencies, it has been used as a tool of early detection of DPN including its painless type, which is required in current study design [47484950]. We also used CPT subscale tests which were not performed in the previous studies on DPN and poor sleep quality. Additionally, to the best of our knowledge, our study was the first to report the association between painless DPN and sleep quality, using a widely-used objective device and questionnaire. |
Diabetes & Metabolism Journal 2020;45(3):358-367. |
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| Shiro et al. |
Correlation Between Gut Microbiome Composition and Acute Pain Perception in Young Healthy Male Subjects |
During the current perception threshold examination, we used 5, 250, and 2,000 Hz to stimulate C, Aδ, and Aβ fibers. The present study showed that acute pain perception was associated with GM composition in young healthy males |
Pain Medicine2020 december, 22(6) |
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| Shimo et.al |
Decrease in current perception thresholds of A-beta fibers by subthreshold noise stimulation using transcutaneous electrical nerve stimulation |
Our study demonstrated that subthreshold TENS decreases CPT in A-beta fibers, thereby potentially improving the tactile and proprioception sensation as well as stochastic resonance with white noise. |
NeuroReport, 023 Mar 22;34(5):287-289. |
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| Oyamaguchi et al. |
Evaluation of the effects of manual acupuncture and electroacupuncture at LI4 and LI11 on perception thresholds: a prospective crossover trial |
The objective of the study was to investigate and compare the effects of manual acupuncture (MA) and electroacupuncture (EA) on current perception thresholds (CPTs) using quantitative methods. Both MA and EA increased the sensory thresholds of Aβ, Aδ, and C-fibers in the mental region for ⩾30 min after needle removal. Additional of electrical stimulation may not confer additional benefits over needling alone. |
Acupuncture in Medicine, 2023 Aug;41(4):206-214. |
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| Schimo et al. |
Inhibition of current perception thresholds inA‑delta and C fbers through somatosensory stimulation of the body surface |
Applying noxious stimulation to the body surface increased pain thresholds of both the Aδ
and C fbers, whereas changes in tactile thresholds were not signifcant. Inhibition of sensory information by
nociceptive inputs may selectively suppress nociceptive stimuli. |
Scientific Reports 12(1), 2022 |
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| Matsutomo et a. |
Assessment of Peripheral Neuropathy Using Measurement of the Current Perception Threshold with the Neurometer® in Patients with Type 2 Diabetes Mellitus |
Significantly higher CPT values were obtained in patients with proliferative diabetic retinopathy and macroalbuminuria. These data suggest that CPT is useful in detecting abnormalities of myelinated as opposed to unmyelinated nerve fibres in patients with type 2 diabetes. |
Sage Journals, July, 2005 |
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