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Diabetic Lumbosacral Polyradiculoneuropathies.

Anthony A. Amato¹, Richard J. Barohn

¹Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

Current Treatment Options in Neurology

|February 17, 2001

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Diabetic polyradiculoneuropathy may present as two distinct forms: painful, asymmetric, or painless, symmetric. Treatment options like immunotherapy show promise for some patients, but spontaneous improvement is also common.

Area of Science:

Neurology
Endocrinology
Immunology

Background:

Diabetic polyradiculoneuropathy presents diagnostic and therapeutic challenges.
Two distinct clinical forms are proposed: asymmetric, painful (diabetic amyotrophy) and symmetric, painless.

Purpose of the Study:

To differentiate and characterize the two proposed forms of diabetic polyradiculoneuropathy.
To review current understanding of their pathogenic basis and treatment.

Main Methods:

Clinical observation and literature review.
Analysis of potential autoimmune and metabolic etiologies.
Evaluation of immunotherapy responses (corticosteroids, IVIg, plasma exchange).

Main Results:

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Asymmetric, painful form (diabetic amyotrophy) may have an autoimmune basis with spontaneous improvement; immunotherapy can help pain.

Symmetric, painless form may represent diabetic-associated CIDP, potentially responding to immunotherapy, but some cases are unresponsive.

Distinguishing responsive from unresponsive cases is clinically challenging; plasma exchange trial can be diagnostic.

Conclusions:

Diabetic polyradiculoneuropathy likely comprises distinct entities requiring tailored management.
Immunotherapy may benefit specific subgroups, but careful patient selection and monitoring are crucial.
Further research is needed to clarify pathogenesis and optimize treatment strategies.