Subacute diabetic proximal neuropathy

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Abstract

Objective: To evaluate the clinical, electrophysiologic, autonomic, and neuropathologic characteristics and the natural history of subacute diabetic proximal neuropathy and its response to immunotherapy. Material and Methods: For the 12-year period from 1983 to 1995, we conducted a retrospective review of medical records of Mayo Clinic patients with diabetes who had subacute onset and progression of proximal weakness. The responses of treated versus untreated patients were compared statistically. Results: During the designated study period, 44 patients with subacute diabetic proximal neuropathy were encountered. Most patients were middle-aged or elderly, and no sex preponderance was noted. The proximal muscle weakness often was associated with reduced or absent lower extremity reflexes. Associated weight loss was a common finding. Frequently, patients had some evidence of demyelination on nerve conduction studies, but it invariably was accompanied by concomitant axonal degeneration. The cerebrospinal fluid protein concentration was usually increased. Diffuse and substantial autonomic failure was generally present. In most cases, a sural nerve biopsy specimen suggested demyelination, although evidence of an inflammatory infiltrate was less common. Of 12 patients who received treatment (with prednisone, intravenous immune globulin, or plasma exchange), 9 had improvement of their conditions, but 17 of 29 untreated patients (59%) with follow-up also eventually had improvement, albeit at a much slower rate. Improvement was usually incomplete. Conclusion: We suggest that the entity of subacute diabetic proximal neuropathy is an extensive and severe variant of bilateral lumbosacral radiculoplexopathy, with some features suggestive of an immune- mediated cause. It differs from chronic inflammatory demyelinating polyradiculoneuropathy in that most cases have a more restricted distribution and seem to be monophasic and self-limiting. The efficacy of immunotherapy is unproved, but such intervention may be considered in the severe and progressive cases or ones associated with severe neuropathic pain.

Original languageEnglish (US)
Pages (from-to)1123-1132
Number of pages10
JournalMayo Clinic Proceedings
Volume72
Issue number12
StatePublished - 1997

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Diabetic Neuropathies
Demyelinating Diseases
Immunotherapy
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Cerebrospinal Fluid Proteins
Sural Nerve
Plasma Exchange
Intravenous Immunoglobulins
Neural Conduction
Muscle Weakness
Neuralgia
Prednisone
Medical Records
Reflex
Weight Loss
Lower Extremity
Biopsy

ASJC Scopus subject areas

  • Medicine(all)

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Subacute diabetic proximal neuropathy. / Pascoe, Melinda K.; Low, Phillip Anson; Windebank, Anthony John; Litchy, William J.

In: Mayo Clinic Proceedings, Vol. 72, No. 12, 1997, p. 1123-1132.

Research output: Contribution to journalArticle

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