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To explore the role of diabetic autonomic neuropathy (DAN<\/jats:styled-content>) in patients with long\u2010standing DM<\/jats:styled-content>, we investigated psychophysical responses and neuronal activity recorded as evoked brain potentials and dipolar source modelling.<\/jats:p><\/jats:sec>Methods<\/jats:title>Fifteen healthy volunteers and 14 type\u20101 DM<\/jats:styled-content> patients with DAN<\/jats:styled-content> were assessed with a symptom score index characterizing upper GI<\/jats:styled-content> abnormalities. Multichannel (62) electroencephalography was recorded during painful electrical stimulation of the lower oesophagus. Brain activity to painful stimulations was modelled using Brain Electrical Source Analysis (besa<\/jats:sc>).<\/jats:p><\/jats:sec>Results<\/jats:title>Diabetic patients had higher stimulus intensities to evoke painful sensation (p<\/jats:styled-content><\/jats:italic>\u2009\u2264\u20090.001), longer latencies of N<\/jats:styled-content>2 and P<\/jats:styled-content>2 components (both p<\/jats:styled-content><\/jats:italic>\u2009\u2264\u20090.001), and lower amplitudes of P1\u2010N2<\/jats:styled-content> and N2\u2010P2<\/jats:styled-content> complexes (p<\/jats:styled-content><\/jats:italic>\u2009\u2264\u20090.001; p<\/jats:styled-content><\/jats:italic>\u2009=\u20090.02). Inverse modelling of brain sources showed deeper bilateral insular dipolar source localization (p<\/jats:styled-content><\/jats:italic>\u2009=\u20090.002). Symptom score index was negatively correlated with the depth of insular activity (p<\/jats:styled-content><\/jats:italic>\u2009=\u20090.004) and positively correlated with insular dipole strength (p<\/jats:styled-content><\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>DM<\/jats:styled-content> patients show peripheral and central neuroplastic changes. Moreover, the role of abnormal insular processing may explain the appearance and persistence of GI<\/jats:styled-content> symptoms related to DAN<\/jats:styled-content>. This enhanced understanding of DAN<\/jats:styled-content> may have future clinical and therapeutical implications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/j.1532-2149.2012.00254.x","type":"journal-article","created":{"date-parts":[[2012,12,13]],"date-time":"2012-12-13T17:40:42Z","timestamp":1355420442000},"page":"820-831","source":"Crossref","is-referenced-by-count":27,"title":["Peripheral and central nervous contribution to gastrointestinal symptoms in diabetic patients with autonomic neuropathy"],"prefix":"10.1002","volume":"17","author":[{"given":"C.","family":"Brock","sequence":"first","affiliation":[{"name":"Mech\u2010Sense Department of Gastroenterology & Hepatology Aalborg Hospital Aarhus University Hospital Aalborg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Graversen","sequence":"additional","affiliation":[{"name":"Mech\u2010Sense Department of Gastroenterology & Hepatology Aalborg Hospital Aarhus University Hospital Aalborg 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