Trigeminal small-fibre dysfunction in patients with diabetes mellitus: a study with laser evoked potentials and corneal reflex

Objective: To investigate trigeminal small-fibre function in patients with diabetes mellitus. Methods: In 52 diabetic patients we studied the trigeminal laser evoked potentials after stimulation of the skin bordering the lower lip. In the 21 patients with the severest peripheral nerve damage we also studied the electrically evoked corneal reflex. Both responses are mediated by small myelinated afferents. Results: Laser evoked potentials had a longer mean latency and lower amplitude in diabetic patients than in normal subjects (P<0.005). The abnormality frequency of the laser evoked potentials correlated with the severity of polyneuropathy (P<0.005). In contrast, the corneal reflex was normal. Conclusion: Dysfunction of small afferents of the mandibular nerve is frequent in patients with diabetic polyneuropathy. We speculate that the primary cause could be segmental demyelination.