Monday, April 21st, 2014
Diabetic Peripheral Neuropathy (DPN) causes chronic pain (painful diabetic neuropathy) and sensory loss that increases the risk of foot ulcers. DPN has traditionally been viewed as a disease of the peripheral nerves. However, several recent studies hinted at additional involvement of the central nervous system (CNS). Now a novel study using Magnetic Resonance Imaging (MRI) by Dinesh Selvarajah and colleagues published in Diabetes Care (http://www.ncbi.nlm.nih.gov/pubmed/24658391) demonstrates that patients with DPN have structural changes in the brain. Specifically, the study found peripheral gray matter volume loss in regions of the brain associated with sensory and pain perception. These findings may have far reaching implications for treating DPN. If DPN leads to changes in the CNS, then early detection and prevention are critical to mitigate the risk of permanent and severe symptoms. On the other hand, the brain has an amazing capacity to compensate for the focal loss of neurons (i.e., gray matter), which is called plasticity. Pharmacological and neurophysiological techniques that enhance plasticity, which include transcutaneous electrical nerve stimulation, may therefore represent novel therapeutic approaches.