Painless diabetic motor neuropathy

A variant of diabetic lumbosacral radiculoplexus Neuropathy?

Mercedes Garces-Sanchez, Ruple S. Laughlin, Peter J Dyck, Janean K. Engelstad, Jane E. Norell, P. James B Dyck

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: Occasionally, diabetic patients develop painless, lower-limb, motor predominant neuropathy. Whether this is a variant of diabetic lumbosacral radiculoplexus neuropathy (DLRPN) (a painful disorder from ischemic injury and microvasculitis), a variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or another disorder is unsettled. Here, we characterize the clinical and pathological features of painless diabetic motor predominant neuropathy. Methods: We identified patients with this syndrome who underwent nerve biopsy. We compared pathological features to 33 DLRPN and 25 CIDP biopsies. Results: 23 patients were identified (22 had type 2 diabetes mellitus); 12 men; median age 62.2 years (range 36-78); median weight loss 30 pounds (range 0-100). Overall, the clinical features were similar to DLRPN except painless patients had more symmetrical and upper limb involvement, with slower progression and more severe impairment. Physiological testing demonstrated pan-modality sensory loss, autonomic abnormalities and axonal polyradiculoneuropathies. Nerve biopsies were similar to DLPRN showing ischemic injury (multifocal fiber loss [11/23], perineural thickening [18/23], injury neuroma [11/23], neovascularization [17/23]) and evidence of altered immunity and microvasculitis (epineurial perivascular inflammation [23/23], prior bleeding [11/23], vessel wall inflammation [15/23], and microvasculitis [3/23]). In contrast, CIDP biopsies did not show ischemic injury or microvasculitis but revealed demyelination and onion-bulbs. Interpretation: 1) Painless diabetic motor neuropathy is painless DLRPN and not CIDP and is caused by ischemic injury and microvasculitis. 2) The clinical features of painless DLRPN are different from typical DLPRN being more insidious and symmetrical with slower evolution. 3) The slower evolution may explain the lack of pain.

Original languageEnglish (US)
Pages (from-to)1043-1054
Number of pages12
JournalAnnals of Neurology
Volume69
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Diabetic Neuropathies
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Wounds and Injuries
Biopsy
Polyradiculoneuropathy
Inflammation
Neuroma
Onions
Demyelinating Diseases
Upper Extremity
Type 2 Diabetes Mellitus
Weight Loss
Lower Extremity
Immunity
Hemorrhage
Pain

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Painless diabetic motor neuropathy : A variant of diabetic lumbosacral radiculoplexus Neuropathy? / Garces-Sanchez, Mercedes; Laughlin, Ruple S.; Dyck, Peter J; Engelstad, Janean K.; Norell, Jane E.; Dyck, P. James B.

In: Annals of Neurology, Vol. 69, No. 6, 06.2011, p. 1043-1054.

Research output: Contribution to journalArticle

Garces-Sanchez, Mercedes ; Laughlin, Ruple S. ; Dyck, Peter J ; Engelstad, Janean K. ; Norell, Jane E. ; Dyck, P. James B. / Painless diabetic motor neuropathy : A variant of diabetic lumbosacral radiculoplexus Neuropathy?. In: Annals of Neurology. 2011 ; Vol. 69, No. 6. pp. 1043-1054.
@article{1cb6321285af44b8bbd928caa886ad0e,
title = "Painless diabetic motor neuropathy: A variant of diabetic lumbosacral radiculoplexus Neuropathy?",
abstract = "Objective: Occasionally, diabetic patients develop painless, lower-limb, motor predominant neuropathy. Whether this is a variant of diabetic lumbosacral radiculoplexus neuropathy (DLRPN) (a painful disorder from ischemic injury and microvasculitis), a variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or another disorder is unsettled. Here, we characterize the clinical and pathological features of painless diabetic motor predominant neuropathy. Methods: We identified patients with this syndrome who underwent nerve biopsy. We compared pathological features to 33 DLRPN and 25 CIDP biopsies. Results: 23 patients were identified (22 had type 2 diabetes mellitus); 12 men; median age 62.2 years (range 36-78); median weight loss 30 pounds (range 0-100). Overall, the clinical features were similar to DLRPN except painless patients had more symmetrical and upper limb involvement, with slower progression and more severe impairment. Physiological testing demonstrated pan-modality sensory loss, autonomic abnormalities and axonal polyradiculoneuropathies. Nerve biopsies were similar to DLPRN showing ischemic injury (multifocal fiber loss [11/23], perineural thickening [18/23], injury neuroma [11/23], neovascularization [17/23]) and evidence of altered immunity and microvasculitis (epineurial perivascular inflammation [23/23], prior bleeding [11/23], vessel wall inflammation [15/23], and microvasculitis [3/23]). In contrast, CIDP biopsies did not show ischemic injury or microvasculitis but revealed demyelination and onion-bulbs. Interpretation: 1) Painless diabetic motor neuropathy is painless DLRPN and not CIDP and is caused by ischemic injury and microvasculitis. 2) The clinical features of painless DLRPN are different from typical DLPRN being more insidious and symmetrical with slower evolution. 3) The slower evolution may explain the lack of pain.",
author = "Mercedes Garces-Sanchez and Laughlin, {Ruple S.} and Dyck, {Peter J} and Engelstad, {Janean K.} and Norell, {Jane E.} and Dyck, {P. James B}",
year = "2011",
month = "6",
doi = "10.1002/ana.22334",
language = "English (US)",
volume = "69",
pages = "1043--1054",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Painless diabetic motor neuropathy

T2 - A variant of diabetic lumbosacral radiculoplexus Neuropathy?

AU - Garces-Sanchez, Mercedes

AU - Laughlin, Ruple S.

AU - Dyck, Peter J

AU - Engelstad, Janean K.

AU - Norell, Jane E.

AU - Dyck, P. James B

PY - 2011/6

Y1 - 2011/6

N2 - Objective: Occasionally, diabetic patients develop painless, lower-limb, motor predominant neuropathy. Whether this is a variant of diabetic lumbosacral radiculoplexus neuropathy (DLRPN) (a painful disorder from ischemic injury and microvasculitis), a variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or another disorder is unsettled. Here, we characterize the clinical and pathological features of painless diabetic motor predominant neuropathy. Methods: We identified patients with this syndrome who underwent nerve biopsy. We compared pathological features to 33 DLRPN and 25 CIDP biopsies. Results: 23 patients were identified (22 had type 2 diabetes mellitus); 12 men; median age 62.2 years (range 36-78); median weight loss 30 pounds (range 0-100). Overall, the clinical features were similar to DLRPN except painless patients had more symmetrical and upper limb involvement, with slower progression and more severe impairment. Physiological testing demonstrated pan-modality sensory loss, autonomic abnormalities and axonal polyradiculoneuropathies. Nerve biopsies were similar to DLPRN showing ischemic injury (multifocal fiber loss [11/23], perineural thickening [18/23], injury neuroma [11/23], neovascularization [17/23]) and evidence of altered immunity and microvasculitis (epineurial perivascular inflammation [23/23], prior bleeding [11/23], vessel wall inflammation [15/23], and microvasculitis [3/23]). In contrast, CIDP biopsies did not show ischemic injury or microvasculitis but revealed demyelination and onion-bulbs. Interpretation: 1) Painless diabetic motor neuropathy is painless DLRPN and not CIDP and is caused by ischemic injury and microvasculitis. 2) The clinical features of painless DLRPN are different from typical DLPRN being more insidious and symmetrical with slower evolution. 3) The slower evolution may explain the lack of pain.

AB - Objective: Occasionally, diabetic patients develop painless, lower-limb, motor predominant neuropathy. Whether this is a variant of diabetic lumbosacral radiculoplexus neuropathy (DLRPN) (a painful disorder from ischemic injury and microvasculitis), a variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or another disorder is unsettled. Here, we characterize the clinical and pathological features of painless diabetic motor predominant neuropathy. Methods: We identified patients with this syndrome who underwent nerve biopsy. We compared pathological features to 33 DLRPN and 25 CIDP biopsies. Results: 23 patients were identified (22 had type 2 diabetes mellitus); 12 men; median age 62.2 years (range 36-78); median weight loss 30 pounds (range 0-100). Overall, the clinical features were similar to DLRPN except painless patients had more symmetrical and upper limb involvement, with slower progression and more severe impairment. Physiological testing demonstrated pan-modality sensory loss, autonomic abnormalities and axonal polyradiculoneuropathies. Nerve biopsies were similar to DLPRN showing ischemic injury (multifocal fiber loss [11/23], perineural thickening [18/23], injury neuroma [11/23], neovascularization [17/23]) and evidence of altered immunity and microvasculitis (epineurial perivascular inflammation [23/23], prior bleeding [11/23], vessel wall inflammation [15/23], and microvasculitis [3/23]). In contrast, CIDP biopsies did not show ischemic injury or microvasculitis but revealed demyelination and onion-bulbs. Interpretation: 1) Painless diabetic motor neuropathy is painless DLRPN and not CIDP and is caused by ischemic injury and microvasculitis. 2) The clinical features of painless DLRPN are different from typical DLPRN being more insidious and symmetrical with slower evolution. 3) The slower evolution may explain the lack of pain.

UR - http://www.scopus.com/inward/record.url?scp=79959378301&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959378301&partnerID=8YFLogxK

U2 - 10.1002/ana.22334

DO - 10.1002/ana.22334

M3 - Article

VL - 69

SP - 1043

EP - 1054

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 6

ER -