Dynamics of Sensory and Motor Deficiency against the Background of Transcutaneous Electro Neuro Stimulation in the Therapy of Patients with Diabetic Distal Polyneuropathy

Al Zamil M¹*, Minenko IA² and Kulikova NG³

Received: May 31, 2018;   Published: June 11, 2018

DOI: 10.26717/BJSTR.2018.05.001195

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Abstract

Introduction: Transcutaneous electroneurostimulation has been used for a long time in the treatment of neuropathic pain syndrome in type 2 diabetes mellitus. However, the effectiveness of this method in treating other manifestations of the distal polyneuropathy of the lower limbs as a sensory and motor deficiency has been little studied.

Objectives: To study the dynamics of sensory and motor deficiency against the background of the use of high-frequency low-amplitude TENS (HL TENS) and low-frequency high-amplitude TENS (LH TENS) in the treatment of distal polyneuropathy of the lower limbs in patients with type 2 diabetes mellitus.

Materials and Methods: 122 patients with the distal polyneuropathy of the lower limbs were examined. 40 patients underwent standard medical therapy and, in addition to drug therapy, 41 patients underwent HL TENS (100 Hz-100μs - painless sensory response) and 40 patients with LH TENS (1 Hz-200μs-painless motor response). Patients were examined before treatment, immediately after treatment and within 6 months after treatment. Severity of negative sensory symptoms was determined by a 5-point scale with the mean value of temperature, tactile, pain and vibration sensitivity on the two extremities. The paresis of the foot during extension was determined by a 5-point scale. Electromyographic indices of the sural, peroneal and tibial nerves were studied.

Results: TENS enhances the therapeutic effect of standard drug therapy in regression of negative sensory symptoms by 1.3 times and has a prolonged effect that lasts more than 6 months after the end of the course of treatment. In this case, the paresis of the foot against the background of LH TENS regressed with extension by 16.7% and with flexion by 21.1% and did not change significantly against the background of HL TENS and drug therapy. Negative sensory symptoms more regressed against background of LH TENS immediately after treatment by 77% and at the end of the long-term period by 2.2 times compared with HL TENS. The motor deficit regressed against the background of the LH TENS by 16.7% with the extension of the foot and by 21.1% with the flexion of the foot and was preserved without significant dynamics for the entire remote period. Against the background of drug therapy and HL TENS, motor deficiency remained without significant dynamics. The dynamics of electromyographic indicators were not significant. However, in some cases there was an improvement in the M-response rate against the background of the use of LH TENS

Conclusion: TENS is a highly effective method for the treatment of distal polyneuropathy of the lower limbs in combination with drug therapy. Negative sensory symptoms, motor deficiency and EMG disturbances regress more against the background of LH TENS with respect to HL TENS.