Acta Neurol Scand 1999: 99: 381-386 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA 7"; Prìnted in UK. Ali rìghts reserved Copyright © Munksgaard 1999 ACTA NEUROLOGICA SCANDINAVICA ISSN 0001-6314 zyxwvutsrqponm Impaired ascendant centrai pathways conduction in impotent diabetic subjects Sartucci F, Piaggesi A , Logi F, Bonfiglio L , Bongioanni P, Pellegrinetti A , Baccetti F, Navalesi R, Murri L. Impaired ascendant centrai pathways conduction in impotent diabetic subjects. Acta Neurol Scand 1999: 99: 381-386. © Munksgaard 1999. ; zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQP Objectives - Diabetic impotence is generally due to peripheral neuropathy, but a centrai pathway impairment has also been suggested. We evaluated somatosensory transmission in a group of impotent diabetic men to assess the role of centrai nervous system (CNS) involvement. Materials and methods - Somatosensory evoked potentials (SEPs) of pudendal (pdn) and posterior tibial (ptn) nerves were recorded in 74 patients. Type and duration of diabetes, severity of sexual dysfunction, medium term metabolic control, occurrence of micro- angiopathic chronic complications and autonomie neuropathy were evaluated. Results - Our data show an impairment of centrai conduction times in pdn (25.7%) and ptn (39.2%) greater than peripheral nervous impairment (pdn 12.2%, ptn 8.1%), in impotent diabetic patients without any further major complication. Central nervous conduction delay resulted to be correlated with poor glycemic control. Significant evident autonomie dysfunction was found only in a minority of cases. Conclusion - Our data might suggest that altered conduction along CNS and somatic peripheral neuropathy might develop independently. We confimi the hypothesis of a "centrai diabetic neuropathy" and suggest that centrai sensory pathways involvement, not related to peripheral impairment, could play a role in the pathogenesis of erectile dysfunction in diabetic patients. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA F. Sartucci\. Piaggesi^ F. Logi\ L. 3onfiglio\. Bongioanni\ A. i'ellegrinettP, F. Baccetti^ R. Navalesi^ L. Murri^ 'Department of Neurosciences, Institute of Neurology, and 'Chair of IVIetabplic Diseases, University of Pisa, Pisa, Italy : ^ :,• :• : y:':! • ^• • Key words: diabetes mellitus; impotence; SEPs; centrai neuropathy; autonomie function Dr F. Sartucci, Dept of Neurosciences^ Institute of Neurology, University of .Pisa, Via Roma 67, 1-56126 Pisa, Italy , Accepted for publication January 26, 1999 Human penile erection is mediated by somatic and autonomie nerves, via spinai and cerebral pathways and centres. The pudendal nerve supplies the somatic innervation to the extemal genitalia and perineum and motor innervation to the pelvic floor muscles; the autonomie innervation consists of hypogastrie and pelvic nerves which conduct both sensory and motor impulses (1). The neural integrity of these centrai and peripheral afferent- efferent nerves and the cerebrospinal pathways represent an essential requisite in the sexual responsiveness (2, 3). Pudendal nerve (pdn) somatosensory evoked potentials (SEPs) provide an objectjve means of testing the afferent pathways from penile dorsal nerve to the sensory cortex and allow the investiga- tion of impotence dysfunction (4—6). Diabetes mellitus (DM) is an important cause of sexual impairment in the male population; in diabetic patients erectile impotence is three times more frequent than in non-diabetic subjects (15% between 20 and 40 years; 40-60% between 50 and 70 years (7, 8)). The pathophysiology of diabetic male impotence has not been elearly elueidated yet; in most cases an organic cause is assumed. Some authors associate diabetic impotence with peripheral neuropathy (4, 6, 9), while others underline the role of vascular factors (10, 11). Both hypotheses converge in the assumption that diabetic metabolic disorders cause angiopathy which in turn causes ischemie neuro- pathy (12, 13). Furthermore, troubles of the hypothalamie-pituitary-gonadal axis (14) and dys- regulation of the centrai autonomie nervous system bave been reported as possible causes of impotence (15). Even if diabetic impotence is generally presumed to be secondary to peripheral nerves impairment, a 381