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An Evidence-Informed Assessment and Treatment of Vibration Perception in Diabetic Peripheral Neuropathy

Kumar Senthil P. , Kumar Senthil P. , Adhikari Prabha , Jeganathan P.S. , Misri Z.K. , D’Souza Sydney C.

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International Journal of Neurology and Neurosurgery 6(2):p 45-53, July - December 2014. | DOI:

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Abstract

Background: Assessment of vibration sensation is essential for diagnosing large-fiber dysfunction in peripheral neuropathies and is considered as a gold standard for diagnosis of diabetic peripheral neuropathy (DPN), since it can efficiently predict the natural history and progression of the disorder. Purpose: To explore the existing evidence for vibration perception in DPN in terms of evidence from published assessment and treatment studies. Methods: A systematic review of PubMed using the search terms– ‘vibration and diabetic neuropathy’ was done to identify articles from 2008 to 2012. The obtained articles were categorized under assessment and treatment studies depending upon their scientific objective. The data were extracted and descriptively synthesized. Results: Tuning fork (sensation) and biothesiometry (sensory threshold) was used for diagnosis of vibration sensation. Vibration perception threshold (VPT) had good measurement properties that merit its clinical use in bedside screening as well as population-based estimation of prevalence of DPN. Medical management (hypoglycemic drugs, neurotropic drugs, vasoactive drugs, herbal medicine and acupuncture), electrical and mechanical treatments were shown to influence VPT. VPT had good predictive ability to identify large-fiber dysfunction and impending risk for other comorbidities/ complications of DPN such as foot ulcers and amputations. Conclusion: Vibration perception was used as a diagnostic, therapeutic and prognostic tool in DPN.

Keywords: Diabetic peripheral neuropathy; Neurological examination; Sensory evaluation; Large-fiber dysfunction.

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