Neurology (clinical), Radiology, Nuclear Medicine and imaging, Rheumatology, Medicine
4
Scopus Publications
Scopus Publications
Nerve ultrasound in painful diabetic neuropathy: a pilot study of sural and tibial nerves Ahmed Sami Alkotami, Saly Hasan Elkholy, Ahmed Mohamed Elshamy, Wael Ahmed Fadel, Ehab Ahmed Shawky Elseidy, et al. Egyptian Journal of Neurology Psychiatry and Neurosurgery, 2026 Background This case–control study investigated the role of nerve ultrasound measurement of the sural and tibial nerve cross-sectional area (CSA) in assessing painful diabetic neuropathy (PDN). It included 30 patients with PDN—15 with small fiber neuropathy (SFN) and 15 with mixed fiber neuropathy (MFN)—along with 15 healthy controls. Participants underwent standard nerve conduction studies including tibial and sural nerves, and nerve ultrasound of both nerves. Results Tibial nerve CSA was significantly higher in patients with MFN only compared to the control group. However, sural nerve CSA was significantly higher in both subgroups of PDN compared to the control group. Larger tibial and sural nerve CSA significantly correlated with lower tibial CMAP and CV, and sural SNAP, respectively, and both significantly correlated with lower IENFD in all subjects, but not in SFN patient group. The sural nerve CSA exceeding 2 mm 2 yielded a sensitivity of 60% and a specificity of 80% to diagnose SFN. Conclusions Sural nerve CSA may be enlarged in patients with PDN, even in its early stages of small fiber affection, while tibial nerve CSA enlargement may correlate with the more advanced MFN parameters.
Diabetic small fiber neuropathy: clinical and electrophysiological study Ahmed S. Alkotami, Saly H. Elkholy, Ahmed M. Elshamy, Ehab A. Elseidy, Wael A. Fadel Egyptian Journal of Neurology Psychiatry and Neurosurgery, 2024 Background Diabetic neuropathy is diagnosed late due to lack of easy and readily available biomarkers; early identification can prompt proper interventions before the irreversible large fiber damage. The aim of this study is to assess small fiber dysfunction using cutaneous silent period (CSP) and sympathetic skin response (SSR) tests in patients with diabetic small fiber neuropathy (SFN) and compare results with clinical, neuropathy severity and quality of life measures. A total of 45 subjects were classified into: Group I: diabetic patients with pure SFN, group II: diabetic patients with mixed fiber neuropathy, and group III: healthy subjects. All underwent evaluation by anthropometric, clinical and quality of life measures, electrophysiological evaluation by CSP and SSR and distal leg skin biopsy. Results Age and gender distribution did not significantly differ between the studied groups. Both patients’ groups showed comparable poor quality of life in relation to healthy subjects. CSP onset latencies and SSR amplitudes significantly correlated with studied clinical and severity measures, but neither correlate with each other in diabetic pure SFN patients. Both CSP and SSR measures were specific in diagnosing diabetic pure SFN, but mostly with poor sensitivity. Combining sensitivities of different CSP and SSR measures improved the overall sensitivity to early screen for SFN in diabetic patients. Conclusions Both CSP and SSR may have the potential to early detect diabetic pure SFN. Suspected diabetic patients with SFN should be separately screened for both somatosensory and sudomotor/autonomic affection.
