Abstract Details

Title A Pilot Trial of Peripheral Nerve Decompression for Painful Diabetic Neuropathy

Topic Peripheral Nerve

Presentation(s) P01 - (-)

Poster/Presentation
Number 125

Objective

Background BACKGROUND: Despite extensive research there is no clear understanding of the pathophysiology of diabetic neuropathy. One approach that has emerged is the concept of decompressing nerves that are commonly entrapped in diabetes. Unfortunately there is no consensus on how entrapped nerves can be identified as nerve conduction studies (NCS) often do not detect abnormalities or may be difficult to reliably obtain. Anecdotally many patients report improved pain and sensibility following decompression surgeries however prospective studies evaluating changes in symptoms, and electrophysiology have been limited.

Design/Methods DESIGN/METHODS: 10 patients with painful diabetic neuropathy who chose to undergo peripheral nerve decompression were enrolled. Patients were given a HR-QOL, PGI, NPS, and BPI questionnaires at screening to evaluate initial pain and severity of their neuropathy. Neurological, Physical Exams, strength, skin biopsies for epidermal nerve fiber density and NCS were performed preoperatively. Peroneal and tibal nerves were assessed by Medtronic's Nerve Integrity Monitor 3.0 intraoperatively before and after decompression. Immediately post operatively, NCS and neurological exams were assessed. Repeat exams were performed at weeks 4 and 12 with repeat skin biopsies and NCS at 12 and 24 weeks.

Results RESULTS: To date there is a clear trend for improvement in NCS even at sites where no compression was demonstrated pre-operatively suggesting compression may be present in some nerves that cannot be demonstrated by routine NCS. Improvements in distal toe strength in patients with toe extensor weakness were noted. Final data for all of the outcome measures will be collected and analyzed before the meeting in April.

Conclusions CONCLUSIONS: Peripheral nerve decompression for painful diabetic neuropathy may have validity in the treatment of symptoms of diabetic neuropathy. A larger controlled multi-center study is indicated.

Authors/Disclosures
Todd D. Levine, MD (Honor Health) PRESENTER	Dr. Levine has received personal compensation for serving as an employee of CND life sciences . Dr. Levine has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Nufactor. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for PNA. Dr. Levine has or had stock in CND Life Sciences.Dr. Levine has or had stock in Corinthian reference lab.
	No disclosure on file
Nicole C. Hank, MCR, MHSM (Imaging Endpoints)	No disclosure on file
Richard B. Lipton, MD, FAAN (Albert Einstein College of Medicine)	Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GlaxoSmithKline. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vedanta. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axon. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Satsuma. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cool Tech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BDSI. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axsome. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clexio. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shiratronics. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Lipton has or had stock in Biohaven.Dr. Lipton has or had stock in Manistee.Dr. Lipton has or had stock in Axon.Dr. Lipton has or had stock in CoolTech. The institution of Dr. Lipton has received research support from Teva. The institution of Dr. Lipton has received research support from Amgen. The institution of Dr. Lipton has received research support from Allergan/Abbvie. The institution of Dr. Lipton has received research support from Gammacore. The institution of Dr. Lipton has received research support from Axsome. The institution of Dr. Lipton has received research support from Charleston Labs. The institution of Dr. Lipton has received research support from Eli Lilly. The institution of Dr. Lipton has received research support from Satsuma. The institution of Dr. Lipton has received research support from NIH . The institution of Dr. Lipton has received research support from Veterans Administration. Dr. Lipton has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
David Hacker	No disclosure on file
David S. Saperstein, MD (Center for Complex Neurology, EDS & POTS)	No disclosure on file

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