SUBCLINICAL NEUROPATHY IN TYPE-I DIABETIC CHILDREN

Objectives: Small and large, somatic and autonomic nerve fibre functio ns were neurophysiologically evaluated in 33 asymptomatic neurological ly free type 1 diabetic children and 69 age-matched healthy controls. Methods: The evaluation of large and small somatic nerve fibre functio n was performed by conventional nerve conduction studies, thermal spec ific and thermal pain sensitivity tests, as well as autonomic nerve fi bre functions by sympathetic skin response and R-R interval variation assessment. Results: A significant difference was established between the healthy and the diabetic group. Neurophysiologically determined su bclinical neuropathy was found in 87% of type 1 diabetic children. The majority of abnormal recordings were found on the lower limbs. The dy sfunction of the somatic motor large nerve fibre type in the lower lim bs was altered in 57% of patients, somatic sensory large in 39%, somat ic sensory small in 45%, and sympathetic in 45%. The leading abnormal measure was a delayed sympathetic skin response on the foot (42% of di abetic children) followed by a reduced amplitude of sural nerve action potential (36%). The whole spectrum of recordings showed scattered in volvement of nerve functions. There was no selective susceptibility of nerve fibre types exposed to a noxious factor. Conclusion: A complex neurophysiological assessment, including standard nerve conduction stu dies as well as psychophysical examination and autonomic nerve functio n tests, evaluating the function of small and large nerve fibres, is r ecommended for evaluating the subclinical neuropathy in asymptomatic t ype I diabetic children. (C) 1998 Elsevier Science Ireland Ltd. All ri ghts reserved.