الفهرس 
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Abstract
In the present study, the aim was to study the role of hyperbaric oxygen therapy in management of patients with diabetic peripheral neuropathy (DPN) as an adjunctive modality of treatment.
The study was conducted on 60 diabetic patients who had diabetes mellitus for more than 5 years. They were divided into two groups. 30 subjects were recruited from the Naval Hyperbaric Medical Institute and its outpatient clinics (group I). The other 30 subjects were recruited from the Diabetic foot Care unit, Department of diabetes and metabolism, Alexandria University (group II). They had either type I or type II DM, screened using Diabetic Neuropathy Symptom Score (DNS score), categorized into mild or moderate DPN according to Toronto clinical neuropathy scoring system, maintained on stable medical treatment for ≥6 weeks and in stable condition (HbA1c ≤ 10%).
Patients with the following criteria were excluded: those having PN for other causes (collagenic, uremic, toxic, paraneoplastic, alcoholic…etc), patients with other central neurological deficit, patients with severe degree of DPN categorized by TCSS, Presence of Deep Vein Thrombosis, patients suffering from Claustrophophia, patients having cardiac disease with ejection fraction less than 50%, Patients with uncontrolled epileptic seizures, presence of Pneumothorax, chronic obstructive pulmonary diseases (COPD), Uncontrolled Bronchial asthma or interstitial lung fibrosis.
group I consisted of 30 subjects, (M: F=20:10), with ages (37-71 years), diagnosed with diabetic peripheral neuropathy and planned for receiving HBOT sessions. While the group II consisted of 30 consecutive diabetic patients (M: F =17:13), with age of (37-70 years) and planned for being maintained on standardized medical treatment for 6 weeks.
Ethical approval and written informed consent were taken from all patients. Complete history taking and detailed history of diabetes of all studied patients were done. Screening for the presence of diabetic periphral neuropathy was done using Diabetic neuropathy symptom score questionnaire (DNS score). Complete neurological examination, with special consideration to peripheral nerve examination was done. Clinical assessment of degree of DPN using Toronto CSS was done which addresses the following parameters:
• Symptom score: presence of (pain, numbness, tingling, weakness, ataxia, upper limb symptoms)
• Reflex score assessing both knee reflex and ankle reflex.
• Sensory test score: addressing pin prick, temperature, light tough, vibration sense, position sense)
Laboratory tests including complete blood count, Glycosylated Hemoglobin, Erythrocyte sedimentation rate, liver enzymes, renal function tests, fasting blood glucose and thyroid functions were done. Nerve conduction study of the lower limbs was done for all patients in both groups. Sural, posterior tibial and common peroneal nerves were studied using Nihon Kohden apparatus. Studies included the following parameters: conduction velocity (NCV), distal latency (DL), amplitude, Hoffman’s reflex (H-reflex) and F-wave. Hyperbaric oxygen therapy sessions were done -only- for group I, five days per week for 6 weeks. Each session was 90 minute durations, performed in Multiplace hyperbaric chamber (ETC Hypermed Model 626, 2005, USA). All the above data was obtained before the patients start the study (as initial assessment) and 6 weeks after engagement in the study plan for each group.
As regard results, there was clinical improvement in diabetic patients after performing 30 consecutives HBOT sessions, in the form of decrease in Toronto CSS values represented as improved symptom score with alleviation of pain, numbness and tingling, re-appearance of diminished knee and ankle reflexes, regaining of awareness of joint position sensation, lowering of the level of stocking hypothesia due to periphral neuropathy after HBOT sessions.
Regarding nerve conduction study results, there was significant increase of nerve conduction velocity and amplitude after receiving 30 consecutives HBOT sessions that might reflect a process of remylination and axonal regeneration. Distal latency of motor conduction has been decreased; parameters of Hoffman’s reflex and F-wave latency have been decreased in patients with DPN who received HBOT sessions reflecting better neural conduction.