Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
AuthorsWorthington, Anne; orcid: 0000-0002-2331-3750; email: email@example.com
Kalteniece, Alise; email: firstname.lastname@example.org
Ferdousi, Maryam; orcid: 0000-0002-7989-8233; email: email@example.com
D’Onofrio, Luca; orcid: 0000-0003-3905-0139; email: firstname.lastname@example.org
Dhage, Shaishav; email: Shaishav.Dhage@christie.nhs.uk
Azmi, Shazli; email: email@example.com
Adamson, Clare; email: firstname.lastname@example.org
Hamdy, Shaheen; email: Shaheen.Hamdy@manchester.ac.uk
Malik, Rayaz A.; orcid: 0000-0002-7188-8903; email: email@example.com
Calcutt, Nigel A.; email: firstname.lastname@example.org
Marshall, Andrew G.; email: email@example.com
MetadataShow full item record
AbstractImpaired rate-dependent depression of the Hoffman reflex (HRDD) is a potential biomarker of impaired spinal inhibition in patients with painful diabetic neuropathy. However, the optimum stimulus-response parameters that identify patients with spinal disinhibition are currently unknown. We systematically compared HRDD, performed using trains of 10 stimuli at five stimulation frequencies (0.3, 0.5, 1, 2 and 3 Hz), in 42 subjects with painful and 62 subjects with painless diabetic neuropathy with comparable neuropathy severity, and 34 healthy controls. HRDD was calculated using individual and mean responses compared to the initial response. At stimulation frequencies of 1, 2 and 3 Hz, HRDD was significantly impaired in patients with painful diabetic neuropathy compared to patients with painless diabetic neuropathy for all parameters and for most parameters when compared to healthy controls. HRDD was significantly enhanced in patients with painless diabetic neuropathy compared to controls for responses towards the end of the 1 Hz stimulation train. Receiver operating characteristic curve analysis in patients with and without pain showed that the area under the curve was greatest for response averages of stimuli 2–4 and 2–5 at 1 Hz, AUC = 0.84 (95%CI 0.76–0.92). Trains of 5 stimuli delivered at 1 Hz can segregate patients with painful diabetic neuropathy and spinal disinhibition, whereas longer stimulus trains are required to segregate patients with painless diabetic neuropathy and enhanced spinal inhibition.
CitationDiagnostics, volume 11, issue 7, page e1247
DescriptionFrom MDPI via Jisc Publications Router
History: accepted 2021-07-07, pub-electronic 2021-07-12
Publication status: Published
Funder: American Diabetes Association; Grant(s): 1-17ICTS-062
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