2013. 143 diabetic polyneuropathy DPN DPN DPN DPN NCS M M 4 DPN DPN golden standard DPN Key Words : nerve conduction study, staging of diabetic neuropathy, sensory nerve action potential, compound muscle action potential, diagnostic algorithm diabetes mellitus DM DM 2,000 1 DM diabetic polyneuropathy DPN DM DPN DM 3,000 7 2 3 DPN DM 30 40 DPN prickling/tingling sensation painful DPN DPN painless DPN DPN DM DPN Michigan Neuro pathy Diagnostic Instrument 4 Tronto Neuropathy Clinical Score 5 golden standard nerve conduction study NCS DM NCS 1960 6 8 sensory conduction velocity SCV motor
144 conduction velocity MCV F DPN 9 DPN 5 10 20 5 10 sensory nerve action potential SNAP SNAP NCS DPN NCS NCS DPN NCS DPN 10 NCS NCS DPN NCS DPN 11 distal axonal degeneration 41 3 DPN DM CIDP DPN 1 NCS NCS DPN NCS NCS DM 80 2 3 40 12 13 DPN NCS F NCS 14 F NCS 15 NCS NCS 2 NCS NCS DPN SNAP compound motor muscle action potential CMAP DPN DPN DPN
2013. DPN 16 15 20 mv DM 17 DPN CMAP epiphenomenon MCV SCV DPN MCV 5 10 20 18 20 30 cm MCV SCV 2 5 10 19 MCV DM 30 40 Kimura F F 1 m F 19 DPN F MCV F 60 70 14 15 3 NCS DM CMAP CMAP DPN CMAP 12 MCV F CMAP SNAP DPN NCS 145 CMAP DPN MCV F CMAP 2 mv MCV epiphenomenon DPN 1 NCS NCS 10 cm 1 cm SCV 10 SCV EMG onoff 37 1 SCV 19 DPN SCV 30 40 SNAP DM SNAP SNAP SNAP SNAP 2 NCS DPN NCS NCS SNAP near-nerve SNAP
146 NCS 20 Near-nerve / SNAP DPN near-nerve NCS Nagaki 21 DPN nearnerve DPN NCS DPN SNAP SCV 22 SNAP NCS 50 NCS DPN Dyck NCS 5 Σ5 23 24 Σ5 NCS NCS NCS DPN SNAP SNAP over diagnosis under diagnosis 41 3 SNAP SNAP 1 epiphenomenon SNAP SCV MCV F by Chance SNAP F A 25 A EDB DPN CMAP 26 CMAP NCS NCS DPN 2 SNAP 5 μv CMAP
2013. 147 1 NCS 2013 NCS / DPN F 45.8 52.4 ms/1.5 1.8 m and/or MCV 42 m/s and/or A and/or SCV 42 m/s and/or CMAP 2 mv and/or MCV 42 m/s CSAP 5 μv CMAP 2 5 mv CMAP 2 mv NCS 0 NCS NCS NCS NCS SNAP CMAP 5 mv 6 mv 5 mv 5 μv SNAP 5 mv CMAP 2 mv CMAP SNAP 5 μv NCS 1 NCS DPN NCS DPN 10 27 2009 28 2010 NCS DPN 2011 NCS DPN 2011 29 2012 30 1 57 NCS DM 57 NCS 10 57 23 48 NCS 77 1 14 NCS 9 DPN 70 30 40 NCS DPN NCS DM 57 10
148 2 NCS A / A B / CMAP B A B CSAP A A CSAP A / CMAP B A B CMAP / A A NCS 0 1 NCS DPN 2 NCS NCS NCS NCS 2 SNAP 10 29 30 1 SNAP 5 μv SNAP 5 μv NCS SCV F MCV A NCS CMAP NCS 0 SNAP 5 μv CMAP SNAP 5 μv CMAP 2 mv DPN 41 3 2 NCS DPN 2013 DPN 2 SNAP 5 μv SNAP 5 μv CMAP CMAP 5 mv NCS CMAP 5 mv 2 mv NCS CMAP 2 mv NCS CMAP 2 mv SNAP 2 μv SNAP CMAP 2 mv 5 μv SNAP DPN CIDP DPN CMAP 3 SNAP SNAP NCS F CMAP
2013. NCS 50 50 50 50 200 50 200 4 m 2 m 8 m 50 50 5 μv SNAP SNAP 2.5 μv 10 μv 5 μv 10 μv 2.5 μv 8 μv SNAP 4 16 μv 5 μv 90 5 16 μv 2 μv 1 4 μv 1 pp 9 26 2012. 2 Tesfaye S, Boulton AJM, Dyck PJ, et al: Diabetic neuropathies. Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33: 2285 2293, 2010. 3 50: 799 806, 2007. 4 Herman WH, Pop-Busui R, Braffett BH, et al: Use of the 149 Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes. Results from the diabetes control and complication trial/ epidemiology of diabetes interventions and complications. Diabet Med 29: 937 944, 2012. 5 Bril V, Tomioka S, Buchanan RA, et al: Reliability and validity of the modified Toronto Clinical Neuropathy Score in diabetic sensorimotor polyneuropathy. Diabet Med 26: 240 246, 2009. 6 Gilliatt RW, Willison RG: Peripheral nerve conduction in diabetic neuropathy. J Neurol Neurosurg Psychiatry 25: 11 18, 1962. 7 Noel P: Sensory nerve conduction in the upper limbs at various stages of diabetic neuropathy. J Neurol Neurosurg Psychiatry 36: 786 796, 1973. 8 Behse F, Buchthal F, Carlsen F: Nerve biopsy and conduction studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry 40: 1072 1082, 1977. 9 Hotta N, Kawamori R, Atsumi Y, et al: Stratified analysis for selecting appropriate target patients with diabetic peripheral neuropathy for long-term treatment with an aldose reductase inhibitor, epalrestat. Diabet Med 25: 818 825, 2008. 10 244: 146 150, 2013. 11 Yagihashi S, Mizukami H, Sugimoto K: Mechanism of diabetic neuropathy: Where are we now and where to go? J Diabetes Invest 2: 1 32, 2011. 12 Baba M, Suzuki C, Arai A, et al: Extensor digitorum brevis muscle in diabetic patients. J Peripher Nerv Syst 14 S2 : 10 11, 2009. 13 Severinsen K, Andersen H: Evaluation of atrophy of foot muscles in diabetic neuropathy. A comparative study of nerve conduction studies and ultrasonography. Clin Neurophysiol 118: 2172 2175, 2007. 14 Andersen H, Stalberg E, Falck B: F-wave latency, the most sensitive nerve conduction parameter in patients with diabetes mellitus. Muscle Nerve 20: 1296 1302, 1997. 15 Baba M, Kimura K, Suda T, et al: Three-year inhibition of aldose reductase on development of symptomatic neuropathy in diabetic patients. J Peripher Nerv Syst 11: 175 177, 2006. 16 Lamontagne A, Buchthal F: Electrophysiological studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry 33: 442 452, 1970. 17 Greene DA, Arezzo JC, Brown MB: Effect of aldose reductase inhibition on nerve conduction and morphometry in diabetic neuropathy. Neurology 53: 580 591, 1999. 18 Baba M, Gilliatt RW, Harding A, et al: Effect of diphtheria toxin to Schwann cells in the presence of axonal atrophy. J Neurol Sci 64: 199 211, 1984. 19 Kohara N, Kimura J, Kaji R, et al: F-wave latency serves as the most reproducible measure in nerve conduction studies of diabetic polyneuropathy. Multicenter analysis in healthy subjects and patients with diabetic neuropathy. Diabetologia 42:
150 915 921, 2000. 20 Trojaborg W: The electrophysiologic profile of diabetic neuropathy. Semin Neurol 16: 123 128, 1996. 21 Nagaki J, Kajiwara K, Miyamoto F, et al: Studies on electrophysiological abnormalities of the sural nerve in diabetic patients. In Ward J, Goto Y eds Diabetic Neuropathy Wiley, Chichester, UK, pp 297 308, 1990. 22 Reeves ML, Seigler DE, Ayyar DR, et al: Medial plantar sensory response. Sensitive indicator of peripheral nerve dysfunction in patients with diabetes mellitus. Am J Med 76: 842 846, 1984. 23 Dyck PJ, Overland CJ, Low PA, et al: Signs and symptoms vs nerve conduction to diagnose diabetic sensorimotor polyneuropathy. Muscle Nerve 42: 157 164, 2010. 24 22: 72 77, 2011. 41 3 25 A 19: 250 252, 2008. 26 45: 234 238, 2003. 27 25: 1083 1088, 2003. 28 19 21 p 22, 2010 29 2012 pp 296 300, 2012. 30 40: 419, 2012.