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Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy

Impaired 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 systematic...

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Autores principales: Worthington, Anne, Kalteniece, Alise, Ferdousi, Maryam, D’Onofrio, Luca, Dhage, Shaishav, Azmi, Shazli, Adamson, Clare, Hamdy, Shaheen, Malik, Rayaz A., Calcutt, Nigel A., Marshall, Andrew G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306975/
https://www.ncbi.nlm.nih.gov/pubmed/34359330
http://dx.doi.org/10.3390/diagnostics11071247
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author Worthington, Anne
Kalteniece, Alise
Ferdousi, Maryam
D’Onofrio, Luca
Dhage, Shaishav
Azmi, Shazli
Adamson, Clare
Hamdy, Shaheen
Malik, Rayaz A.
Calcutt, Nigel A.
Marshall, Andrew G.
author_facet Worthington, Anne
Kalteniece, Alise
Ferdousi, Maryam
D’Onofrio, Luca
Dhage, Shaishav
Azmi, Shazli
Adamson, Clare
Hamdy, Shaheen
Malik, Rayaz A.
Calcutt, Nigel A.
Marshall, Andrew G.
author_sort Worthington, Anne
collection PubMed
description Impaired 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.
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spelling pubmed-83069752021-07-25 Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy Worthington, Anne Kalteniece, Alise Ferdousi, Maryam D’Onofrio, Luca Dhage, Shaishav Azmi, Shazli Adamson, Clare Hamdy, Shaheen Malik, Rayaz A. Calcutt, Nigel A. Marshall, Andrew G. Diagnostics (Basel) Article Impaired 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. MDPI 2021-07-12 /pmc/articles/PMC8306975/ /pubmed/34359330 http://dx.doi.org/10.3390/diagnostics11071247 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Worthington, Anne
Kalteniece, Alise
Ferdousi, Maryam
D’Onofrio, Luca
Dhage, Shaishav
Azmi, Shazli
Adamson, Clare
Hamdy, Shaheen
Malik, Rayaz A.
Calcutt, Nigel A.
Marshall, Andrew G.
Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
title Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
title_full Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
title_fullStr Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
title_full_unstemmed Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
title_short Optimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
title_sort optimal utility of h-reflex rdd as a biomarker of spinal disinhibition in painful and painless diabetic neuropathy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306975/
https://www.ncbi.nlm.nih.gov/pubmed/34359330
http://dx.doi.org/10.3390/diagnostics11071247
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