الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus represents a syndrome of complex metabolic diseases (insulin deficiency and insulin resistance) and has variable accompanying physiological and metabolic disorders.
These findings indicate that the “diabetes epidemic” will continue even if levels of obesity remain constant.
The prevalence of diabetic neuropathy also increases with the time. and severe diabetic polyneuropathy can develop in young adults within a few months after the onset if the diabetes is poorly controlled.
The high and rising prevalence of diabetes, its impact on mortality and morbidity, It is important to identify subclinical neuropathy before the clinical findings appear; the patients may respond better to an early treatment if the condition is diagnosed early enough .
In a number of peripheral nerve diseases, including diabetic neuropathy, sensory findings are clearer than motor findings, and thus, attempts have been made to develop methods that will provide information on the excitability of sensory nerve fibers.
Unfortunately, conventional Nerve Conduction Studies (NCS) do not assess optimally the overall conduction .The Conduction Velocity (CV) of a normal axon is proportional to its diameter, and conventional NCS record the fastest-conducting sensory and motor fibers. However, many pathological processes do not affect nerves uniformly, and nerve CV may lie within the normal range until fast conducting fibers are affected .
The distal nerve conduction studies of long nerves in the leg can establish an early diagnosis of polyneuropathy.The most distal sensory fibers in the lower extremities are generally first affected in patients with peripheral neuropathy.
As a part of the dying-back phenomenon, sensory nerves in the feet are usually affected in the early stages of polyneuropathy .medial plantar nerve which is estimated as the most distal sensory nerve of the feet may be affected in the early stages of polyneuropathy
On the other hand, changes in neural excitability may also occur in the refractory period. Accordingly, an increased refractory period was reported in diabetic patients so Double shock stimulation (Relative refractory period ) RRP is new sensitive method and conclusive.
The aim of the study is the early detection and diagnosis of diabetic neuropathy in subclinical phase for the possibility of early prevention of progression and thus minimization of burden at all level.
The study was conducted at the Neurophsiological unit department of Neuropsychiatry at Sohag University Hospital.from October 2014 till November 2015. Those patient were classified into 3 groups; 21diabetic asymptomatic patients had no findings regarded clinically and routine NCS for diabetic neuropathy, and 25diabetic symptomatic patients had clinical symptoms and normal routine NCS for diabetic neuropathy.20 Healthy subjects matched to the patients groups according to age and sex will be recruited and taken as control group all are under age of 60. Diabetic patients were diagnosed according to diagnostic criteria( American diabetic association guideline 2014)
Conventional nerve conduction study ,double shock stimulation ,laboratory investigation and HB A1C. Neuropathy scales are done as NIS LL and LANSS.
The study results in the following:-
1-there was a significant increase in mean value of HBA1c in symptomatic compared to asymptomatic .
2- there was insignificant increase in mean value of lipogram parameter (triglesrides and cholesterol), BMI in symptomatic compared to asymptomatic.
3- there was a significant increase in mean value of conventional NCS mainly sensory components in symptomatic compared to asymptomatic, although it is insignificant in asymptomatic compared to control.
4- there was a significant increase in mean value of medial planter NCS mainly amplitude component in asymptomatic compared to symptomatic who showed affection at amplitude,CV and DL.
5- there was a significant increase in mean value of RRP study in asymptomatic .
6-NAPs ratio in asymptomatic is <1 then become >=1 ,1n symptomatic it is<1 then >=1 then <1again .
7- there was a significant increase in mean value of neuropathy scale LANSS symptomatic compared to asymptomatic.
8- there was a significant increase in mean value of neuropathy scale NIS LL symptomatic compared to asymptomatic.
9-significant increase in diabetic poly neuropathy and duration of illness.