Non-diabetic lumbosacral radiculoplexus neuropathy: Natural history, outcome and comparison with the diabetic variety

P. James B Dyck, Jane E. Norell, Peter J Dyck

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Diabetic lumbosacral radiculoplexus neuropathy (DLSRPN) (other names include diabetic amyotrophy) is well recognized, unlike the non-diabetic lumbosacral radiculoplexus neuropathy (LSRPN), which has received less attention. Our objective was to characterize the natural history and outcome of LSRPN and to assess whether it is similar to the diabetic variety in its symptoms, course, electrophysiological features, quantitative sensory and autonomic findings, and the underlying pathophysiology. We studied 57 patients with LSRPN and 33 patients with DLSRPN. We found that the age of onset, course, kind and distribution of symptoms and impairments, laboratory findings and outcomes are essentially alike. Both disorders are a lumbosacral plexus neuropathy associated with weight loss, often beginning focally or asymmetrically in the thigh or leg but usually progressing to involve the initially unaffected segment and the contralateral side. Both have prolonged morbidity due to pain, paralysis, autonomic involvement and sensory loss. In biopsied distal LSRPN nerves, we found changes similar to those found in DLSRPN - alterations typical of ischaemic injury and of microvasculitis. The long-term outcome was determined in 42 LSRPN patients: two had become diabetic, seven had relapsed and only three had recovered completely, although all had improved. We conclude that: (i) LSRPN is a subacute, asymmetrical, painful and debilitating neuropathy of the lower limbs associated with weight loss, and we think it is under-recognized; (ii) recovery from the long-term impairments of LSRPN is usually delayed and incomplete and only a small minority of patients develop diabetes mellitus; (iii) LSRPN mirrors the diabetic variety in its clinical features, course, pathological findings (ischaemic injury from microvasculitis) and long-term outcome; and (iv) LSRPN should be set apart from chronic inflammatory demyelinating polyradiculoneuropathy and from systemic necrotizing vasculitis. We infer an autoimmune basis for LSRPN and emphasize the need for controlled trials of immune-modulating therapy.

Original languageEnglish (US)
Pages (from-to)1197-1207
Number of pages11
JournalBrain
Volume124
Issue number6
StatePublished - 2001

Fingerprint

Natural History
Diabetic Neuropathies
Weight Loss
Lumbosacral Plexus
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Systemic Vasculitis
Age Distribution
Wounds and Injuries
Thigh
Age of Onset
Paralysis
Names
Lower Extremity
Leg
Diabetes Mellitus
Morbidity
Pain
Therapeutics

Keywords

  • Diabetic amyotrophy
  • Lumbosacral plexopathy
  • Microvasculitis
  • Necrotizing vasculitis
  • Non-diabetic lumbosacral radiculoplexus neuropathy

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Non-diabetic lumbosacral radiculoplexus neuropathy : Natural history, outcome and comparison with the diabetic variety. / Dyck, P. James B; Norell, Jane E.; Dyck, Peter J.

In: Brain, Vol. 124, No. 6, 2001, p. 1197-1207.

Research output: Contribution to journalArticle

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