A New Device for Rapid Measurement of Touch Sensation in neuropathy

一种快速测量神经病触觉的新装置

• 批准号: 7928750
• 负责人: Donald Simone
• 金额: $ 20.95万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-15 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7928750
• 关键词: Aftercare; Age; Alcohol abuse; Biological Markers; Biopsy; Caliber; Cancer Patient; Carpal Tunnel Syndrome; Chemotherapy-Oncologic Procedure; Cisplatin; Complication; Cutaneous; Detection; Devices; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Disease Progression; Distal; Early Diagnosis; Esthesia; Exhibits; Female; Fiber; Fingers; Functional disorder; Future; HIV Infections; Hand; Height; Individual; Knowledge; Lead; Limb structure; Location; Measurement; Measures; Mechanoreceptors; Methods; Myelinated nerve fiber; Nerve; Nerve Degeneration; Nerve Fibers; Neuropathy; Paclitaxel; Pain; Patients; Peripheral; Peripheral Nerves; Peripheral Nervous System Diseases; Process; Psychophysiology; Recovery; Sensory; Series; Sex Functioning; Skin; Staging; Stroke; Structure; Surface; Tactile; Temperature; Testing; Therapeutic Agents; Therapeutic Intervention; Time; Toes; Touch sensation; Unmyelinated Nerve Fibers; Vincristine; afferent nerve; base; chemotherapy; chemotherapy induced neuropathy; dosage; early onset; indexing; male; nerve supply; neuromechanism; novel; novel strategies; prevent; public health relevance; sensory neuropathy; time use; tool; treatment effect

DESCRIPTION (provided by applicant): Peripheral neuropathy is a disabling complication of many conditions including diabetes, alcohol abuse, HIV infection, carpal tunnel syndrome, and chemotherapy for cancer. It is important to detect neuropathy early in the disease process, when potential for recovery is greatest and to initiate therapy to prevent or slow nerve degeneration. In neuropathy, sensory dysfunction almost always begins in the distal extremities (fingers or toes) where the sensation of touch is diminished or lost. Although quantitative sensory testing methods have been devised to assess cutaneous tactile and temperatures sensations objectively, there is no inexpensive, easy to use, and time efficient test to serve as a biomarker for early-stage peripheral neuropathy. The purpose of this proposal is to explore the utility of a novel approach to assess tactile sensation on the fingers in patients with peripheral neuropathy. We developed a new, objective, and sensitive device to detect impaired touch sensation early in nerve disease. In this test, referred to as the "Bumps" test, the subject searches for small objects (bumps) of varying heights that are randomly placed on a flat surface. This approach will be tested in patients taking chemotherapy for cancer because many patients develop chemotherapy-induced neuropathy and, unlike most neuropathies, baseline measures can be obtained before treatment. In addition, cutaneous innervation will be assessed by skin biopsy and immunostaining of peripheral nerve to determine the relationship between a decrease in tactile sensitivity and innervation by myelinated and unmyelinated nerve fibers in the finger pad. The first specific aim will determine bump detection thresholds (bump height) as a function of sex and age in healthy subjects. We will also determine changes in bump detection in patients undergoing chemotherapy. It is hypothesized that bump detection threshold will increase over time in patients receiving chemotherapy. In the second aim, biopsies will be obtained from the same finger pad used in the psychophysical test in patients at various times during chemotherapy and when bump thresholds increase. It is hypothesized that increased bump detection thresholds will correlate with a decrease in the number of Meissner corpuscles and their myelinated nerve fibers early in disease. Identifying patients with early onset neuropathy may lead to altered dosage or a change of therapeutic agent before the neuropathy becomes painful and intolerable, which often leads to the cessation of therapy. The Bumps test is an inexpensive, portable, and time efficient device for early detection of peripheral neuropathy. In the future, the Bumps test can be used in other disease states. PUBLIC HEALTH RELEVANCE: Peripheral neuropathy is a disabling complication of many conditions including diabetes, alcohol abuse, HIV infection, carpal tunnel syndrome, and chemotherapy for cancer. In neuropathy, sensory dysfunction almost always begins in the distal extremities (fingers or toes) where the sensation of touch is diminished or lost. It is important to detect neuropathy early in the disease process, when potential for recovery is greatest and to initiate therapy to prevent or slow nerve degeneration. We devised a new, objective, and sensitive device to detect impaired touch sensation on the finger pads early in nerve disease. In this test, referred to as the "Bumps" test, the subject searches for small objects (bumps) of varying heights that are randomly placed on a flat surface. This approach will be tested in patients taking chemotherapy for cancer because many patients develop chemotherapy- induced neuropathy and, unlike most neuropathies, baseline measures can be obtained before treatment. A skin biopsy will be obtained so we that can we can compare changes in touch sensitivity to the amount of nerve fibers in the skin. We hypothesize that a decrease in the ability to feel the bumps will correlate with a decrease in innervation of the skin. Identifying patients with early onset neuropathy may lead to altered dosage or a change of therapeutic agent before the neuropathy becomes painful and intolerable, which often leads to the cessation of therapy. If successful, the Bumps test will be an inexpensive, portable, and time efficient device for early detection of peripheral neuropathy. In the future, the Bumps test can be used to diagnose neuropathy in other disease states, such as diabetes, to track disease progression over time, and to assess therapeutic interventions.

描述(申请人提供)：周围神经病变是一种致残性并发症，包括糖尿病、酗酒、艾滋病毒感染、腕管综合征和癌症化疗。重要的是在疾病过程中及早发现神经病变，当恢复潜力最大时，并开始治疗以防止或减缓神经退化。在神经病中，感觉功能障碍几乎总是始于远端肢体(手指或脚趾)，那里的触觉减弱或丧失。虽然已经设计了定量的感觉测试方法来客观地评估皮肤的触觉和温度感觉，但还没有便宜、易用和省时的测试来作为早期周围神经病的生物标志物。这项建议的目的是探索一种新的方法来评估周围神经病患者手指上的触觉感觉。我们开发了一种新的、客观和灵敏的设备来检测神经疾病早期的触摸感觉受损。在这项被称为“凹凸”测试的测试中，受试者搜索随机放置在平面上的不同高度的小物体(凸起)。这种方法将在接受癌症化疗的患者中进行测试，因为许多患者会患上化疗引起的神经病变，而且与大多数神经疾病不同的是，可以在治疗前获得基线测量。此外，皮肤神经支配将通过皮肤活检和周围神经免疫染色来评估，以确定触觉敏感度下降与指垫中有髓和无髓神经纤维的神经支配之间的关系。第一个具体目标将确定健康受试者的凸起检测阈值(凸起高度)作为性别和年龄的函数。我们还将确定接受化疗的患者的肿块检测的变化。假设在接受化疗的患者中，肿块检测阈值会随着时间的推移而增加。在第二个目标中，在化疗期间的不同时间和肿胀阈值增加时，将从患者的心理物理测试中使用的同一指垫进行活检。据推测，肿块检测阈值的增加将与疾病早期迈斯纳小体及其有髓神经纤维数量的减少相关。在神经病变变得痛苦和无法忍受之前，识别出早期起病的患者可能会导致改变剂量或更换治疗药物，这通常会导致停止治疗。颠簸试验是一种廉价、便携、省时的设备，可用于早期发现周围神经病变。在未来，颠簸测试可以用于其他疾病状态。 公共卫生相关性：周围神经病变是许多疾病的致残性并发症，包括糖尿病、酗酒、艾滋病毒感染、腕管综合征和癌症化疗。在神经病中，感觉功能障碍几乎总是始于远端肢体(手指或脚趾)，那里的触觉减弱或丧失。重要的是在疾病过程中及早发现神经病变，当恢复潜力最大时，并开始治疗以防止或减缓神经退化。我们设计了一种新的、客观和灵敏的设备来检测神经疾病早期指垫上的触觉受损。在这项被称为“凹凸”测试的测试中，受试者搜索随机放置在平面上的不同高度的小物体(凸起)。这种方法将在接受癌症化疗的患者中进行测试，因为许多患者会患上化疗引起的神经病变，而且与大多数神经疾病不同的是，可以在治疗前获得基线测量。我们将进行皮肤活检，以便我们可以将触摸敏感度的变化与皮肤中神经纤维的数量进行比较。我们假设，感觉肿块的能力的下降将与皮肤神经支配的减少相关。在神经病变变得痛苦和无法忍受之前，识别出早期起病的患者可能会导致改变剂量或更换治疗药物，这通常会导致停止治疗。如果成功，颠簸测试将成为一种廉价、便携和省时的设备，用于早期发现周围神经病变。在未来，颠簸测试可以用于诊断其他疾病状态的神经病变，如糖尿病，跟踪疾病随时间的进展，并评估治疗干预措施。