Details
Category: Volume 09 Issue 10 October 2021
Hits: 720

Title: To Study the Effect of Vitamin C Supplementation on Brainstem Auditory Evoked Response in Diabetic Patients with Neuropathy

Authors: Dr Shashikant Singh, Dr Shashi Sekhar Singh, Dr U.N Gupta, Dr P.K. Maheswari

 DOI: https://dx.doi.org/10.18535/jmscr/v9i10.15

Abstract

Introduction

Neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes patients. It is estimated that the prevalence of neuropathy in diabetes patients is approximately 25%.1 In diabetic neuropathy patients other part of neurological system is also affected such as autonomous system, sensory and motor pathways. Auditory Brainstem Response (ABR) audiometry.

First described by Jewett and Williston in 1971. There are seven waves traditionally designated with roman numerals from I to VII. Wave I and II represent activity in cochlear nerve, wave III in cochlear nucleus, wave IV in superior olivary complex, wave V which is biggest and most consistent represent activity in nuclei of lateral lemniscus while wave VI and VII in the inferior colliculus.2 Interpretation of the BAEPs usually involves measuring the absolute latency of the three most prominent vertex positive peaks I, III, and V, along with analysis of their relative inter-peak latencies (IPLs), which may provide some anatomical localisation of lesions. Conduction through the eighth nerve and the caudal brainstem is represented by the I to III IPL, while the III to V IPL probably represents transmission through the rostral brainstem and midbrain. Neuropathy is the most frequent late complication of DM. So far most of the clinical and diagnostic studies on diabetic neuropathy have concerned only peripheral and autonomic nerve but recently with the refinement of evoked potential techniques detailed exploration of sensory pathway in central nervous system has been possible7. Brainstem auditory evoked potentials have obtained widespread clinical application in assessing neurologic and audiologic problems. ABR audiometry is considered an effective screening tool in the evaluation of suspected retrocochlear pathology. In general, ABR exhibits a sensitivity of over 90% and a specificity of approximately 70-90%8 (Schmidt.et al., 2001).

References

  1. Axelsson Garry, Johmpson Father, fagerberger et al;   Diabetic Neuropathy: Etiology and Pathogenesis; Med , 1999;22:28–34.
  2. Bayazit Y, Yilmaz M, Kepekçi Y, Mumbuç S, Kanlikama M et al. Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus. J Neurol Sci. 2000;181(l-2):29–32. 
  3. Bayazit Y, Yilmaz M, Kepekçi Y, Mumbuç S, Kanlikama M et al. Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus. J Neurol Sci. 2000;181(l-2):29–32
  4. Block G, Henson DE, Levine M. Vitamin C; a new look. Ann Intern Med 1991;114:909-10
  5. Chatterjee IB, Banerjee A. Estimation of dehyroascorbic acid in blood of diabetic patients. Anal Biochem 1979;98:368-74.
  6. Chen MS, Hutchinson ML, Pecoraro RE, Lee WY, Labbe RF Hyperglycemia induced intracellular depletion of ascorbic acid in human mononuclear leukocytes. Diabetes 1983;32:1078-81.
  7. Comi G.et al. Studies on central nervous system function in diabetes mellitus. J Indian Med Assoc. 2001;84:86–9.
  8. Das T, Kundu S, Mazumdar AK, Mukhopadhyay SC. Studies on central nervous system function in diabetes mellitus. J Indian Med Assoc. 2001;84:86–9.
  9. Durmus C, Yetiser S, Durmus O. Auditory brainstem evoked responses in insulin dependent (ID) and non insulin dependent (NID) diabetic subjects with normal hearing. Int J Audiol. 2004;43:29–33.
  10. Dyck PJ, Karnes JL, Daube J, O'Brien P, Service FJ (1985) Clinical and neuropathologic criteria for the diagnosis and staging of diabetic polyneuropathy. Brain 108: 861–880
  11. Dyck PJ, Karnes JL, Daube J, O'Brien P, Service FJ (1985) Clinical and neuropathologic criteria for the diagnosis and staging of diabetic polyneuropathy. Brain 108: 861–880
  12. Fidele D, Martin A, Cardone C, et al. Impaired auditory Brain Stem Evoked response in diabetes mellitus. Diabetes. 1999;33:1805–1089.
  13. Frei B, England L, Ames BN. Ascorbate is an outstanding antioxidant in human blood plasma. Proc Natl Acad Sci USA 1989;86:6377-81
  14. Harrison’s principles of internal medicine 19e,ch. 459;1104-5
  15. Imam M, Shehata OH. Subclinical central neuropathy in type 2 diabetes mellitus. Bull Alex Fac Med.2009;45:65–73.
  16. Jennings PE, Chirico S, Jones AF, Lunec J, Barnett AH, Vitamin C metabolites and microangiopathy in diabetes mellitus. Diabetes Res 1987;6:151-4
  17. Makasshima, Cristiane H Sales, L de Fatima, Campos Pedrosa et al: Pathogenesis of Diabetic Neuropathy 1998;25:554–562.
  18. Maser RE, Steenkiste AR, Dorman JS et al. (1989) Epidemiological correlates of diabetic neuropathy: report from Pittsburgh epidemiology of diabetes complications study. Diabetes 38: 1456–1461
  19. Maser RE, Steenkiste AR, Dorman JS et al. (1989) Epidemiological correlates of diabetic neuropathy: report from Pittsburgh epidemiology of diabetes complications study. Diabetes 38: 1456–1461
  20. Pirart J (1979) Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care 1: 168–188
  21. Rajendran S, Anandhalakshmi, Mythili B, Vishwanathan R. Evaluation of the incidence of sensorineural hearing loss in patients with type 2 diabetes mellitus. Int J Biol Med Res. 2011;2:982–7.
  22. Retsky KL, Freeman MW, Frei B. Ascorbic acid oxidation product (s) protect human low density lipoprotein against atherogenic modification: anti-rather than prooxidant activity of vitamin C in the presence of transition metal ions. J Biol Chem 1993;268:1304-9.
  23. Sharma R, Gupta SC, Tyagi I et al. Brain Stem Evoked Responses in patients with Diabetes Mellitus. Indian J of Otolaryngology and Head and Neck Surgery 2000;52(3); 221- 229
  24. Siddiqui SS, SA Hasan , Mohd. Aslam et al; Diabetes Mellitus and Neuropathy; J Neurology 2010, 23:45-57.
  25. Sinclair AJ, Lunec J, Girling AJ, Barnett A. Modulators of free radical activity in diabetes mellitus: role of ascorbic acid. Free Radic Aging 1982;342-52.
  26. Som S, Basu S, Mukherjee D, et al. Ascorbic acid metabolism in diabetes mellitus. Metabolism 1981;30-572-7.
  27. SwakshyarSP,Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM et al. The prevalence by staged severity of various types of diabetic neuropathy, in a population-based cohort: The Rochester Diabetic Neuropathy Study. Neurology 2010;43:17-24.
  28. The DCCT Research Group (1988) Factors in the development of diabetic neuropathy. Diabetes 37: 476–481
  29. The DCCT Research Group (1988) Factors in the development of diabetic neuropathy. Diabetes 37: 476–481
  30. Toth et al, Brainstem auditory evoked potential examinations in diabetic patients, Scandinavian Audiology 2001; 30;156-159.
  31. Virtanierni J, Laakso M, Nuutinen J, Karjalainens. Scott Brown's Otolaryngology. 6. Vol. 3. London: Butterworths; 1997. Quoted by Booth JB; p. 95.
  32. Young et al. Central and peripheral conduction abnormalities in diabetes meliitus. Egypt J Neurol Psychiatry Neurosurg. 2005;42:209–21

Corresponding Author

Dr Shashikant Singh