Can we reverse neuropathy?

Can we reverse neuropathy? Probably one of the million dollar questions in diabetic foot research that has been haunting clinicians and researchers for years. Loss of protective sensation is the primary risk factor for diabetic foot ulcers, and no treatment is available to reverse this loss. Electrical stimulation has received some attention in the periphery of clinical research, as a potential option to actually target the neuropathy, rather than its consequences. A new paper from Bijan Najafi and colleagues shoves this a to center stage. Is this the first step towards a major breakthrough?

In a randomized controlled trial, they recruited 28 participants. All were provided with a device that provides electrical plantar stimulation, but the device was only functioning in some of them. A strong point of the trial was that participants couldn’t feel the stimulation (because of their neuropathy), and researchers couldn’t see it, which makes it a double-blind trial. Participants were asked to put on the system for one hour every day. Ideally before going to bed, to save them from the burden of having to walk with the system.

All outcomes of the research at six weeks show rather positive results, suggesting great potential for electrical stimulation. Most striking was the change in vibration perception threshold: from 41V to 30V in the active group. However, the changes in the comparison group weren’t presented. It would also be really interesting to see whether this improvement in vibration perception remained in the two weeks following the trial.

Some further methodological comments can be made, as not all of the strict criteria for randomized controlled trials were followed. However, if we look at these results as a first pilot trial, it provides promising findings for a method to reverse neuropathy. More research is needed before you can use this in your clinical practice, but it looks like we will hear more from this group in the coming years. To start with, at the DFA conference in September, where the lead author of this paper (Bijan Najafi) will provide one of the keynote lectures.