Chair: Magdalena Kocot-Kępska, Poland
Speaker: Solomon Tesfaye, United Kingdom
Diabetic Neuropathy: Perception Beyond the Seam of the Periphery
Diabetic peripheral neuropathy (DPN) is a common, debilitating and distressing complication of diabetes. Most patients develop painless, insensate distal nerve damage which increases the risk of foot ulceration and subsequent amputation. Amputation is not only devastating in its impact on the person with diabetes and their family, leading to loss of independence and livelihood; it is also very expensive in material terms and results in only 50% surviving for two years. Around a quarter of all diabetic patients also develop a chronic painful condition mainly affecting the legs which can result in considerable disability and suffering. Many such patients with painful DPN have depression, anxiety, fear and stress, and do not sleep well. There is thus an urgent need to detect DPN early by using objective, validated point-of-care devices as clinical exam or the use of the 10 gram monofilament is not reliable. Early detection will lead to an earlier intervention to reduce risk factors for the development of DPN. There has also been emerging evidence that DPN may not be as its name suggest, and may involve the central nervous system. We have reported the involvement of the spinal cord in DPN on MRI. More recently we have reported the involvement of the brain in DPN by demonstrating: 1) thalamic neuronal/mitochondrial dysfunction using MR Spectroscopy, 2) increased thalamic vascularity in painful DPN during spontaneous pain on perfusion imaging, and 3) cortical reorganisation of somatosensory pain processing based on pain phenotype on functional MRI. If we are able to develop non-invasive, objective biomarkers of painful DPN this would be a great advance as it would serve as a target for the development of new drugs for this distressing condition.