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Una mujer de 52 años con neuropatía periférica incapacitante: revisión de la polineuropatía diabética
1Harvard Medical School, and Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC-810, Boston, MA 02215, USA. srutkove@bidmc.harvard.edu
JAMA
|September 10, 2009
Resumen
La polineuropatía diabética causa dolor intenso y calambres. Si bien existen nuevos medicamentos, los tratamientos más antiguos y el ácido alfa-lipoico pueden ofrecer un alivio similar para el dolor neuropático.
Área de la Ciencia:
- Neurología Neurología.
- Endocrinología Endocrinología.
- Diabetología Diabetología.
Sus antecedentes:
- La polineuropatía diabética es una complicación común de la diabetes mellitus.
- Conduce a una morbilidad significativa, incluyendo dolor neuropático y calambres.
- Los tratamientos actuales a menudo proporcionan solo un alivio sintomático.
Objetivo del estudio:
- Revisar el diagnóstico y el diagnóstico diferencial de la polineuropatía diabética.
- Para discutir las opciones actuales de tratamiento sintomático para el dolor neuropático asociado con la diabetes.
- Evaluar la eficacia y la rentabilidad de varias intervenciones farmacológicas.
Principales métodos:
- Revisión de la literatura de los criterios de diagnóstico para la polineuropatía diabética.
- Análisis de las estrategias de tratamiento, incluyendo el manejo del dolor sintomático.
- Evaluación comparativa de medicamentos y suplementos más antiguos frente a los más nuevos para la eficacia y el costo.
Principales resultados:
- El diagnóstico de la polineuropatía diabética requiere una cuidadosa consideración de los diagnósticos diferenciales.
- El tratamiento sintomático es el pilar para el manejo del dolor y los calambres neuropáticos.
- Los agentes más nuevos como la pregabalina y la duloxetina pueden no ofrecer una eficacia superior a los tratamientos más antiguos y son más caros.
- El ácido alfa-lipoico demuestra una eficacia potencial en el alivio del dolor neuropático.
Conclusiones:
- El manejo de la polineuropatía diabética se centra en el alivio sintomático y potencialmente en ralentizar la progresión a través del control metabólico.
- Se deben dar prioridad a las opciones de tratamiento rentables, con el ácido alfa-lipoico como una consideración terapéutica viable.
- Se justifica una mayor investigación sobre tratamientos nuevos y establecidos para la polineuropatía diabética.
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