Diabetic Neuropathy

ABSTRACT

Diabetic neuropathy is not a single entity but manifests as several different clinical syndromes. It is likely that different pathophysiological mechanisms contribute to the development of the neuropathy, including metabolic alterations, microvascular changes, and inflammatory changes. A summary of the underlying pathophysiological mechanisms and clinical aspects of different diabetic neuropathies are outlined in this article.

KEYWORDS

Diabetic neuropathy - painful neuropathy - amyotrophy - multifocal neuropathy

REFERENCES

• 1 Thomas P K, Tomlinson D R. Diabetic and hypoglycemic neuropathy. In: Dyck PJ, Thomas PK Peripheral Neuropathy. Philadelphia; WB Saunders 1993: 1219-1250
• 2 Oates P J. Polyol pathway and diabetic peripheral neuropathy.  Int Rev Neurobiol. 2002;  50 325-392
• 3 Cameron N E, Eaton S E, Cotter M A, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy.  Diabetologia. 2001;  44 1973-1988
• 4 Thornalley P J. Glycation in diabetic neuropathy: characteristics, consequences, causes, and therapeutic options.  Int Rev Neurobiol. 2002;  50 37-57
• 5 Kelkar P, Masood M, Parry G J. Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy).  Neurology. 2000;  55 83-88
• 6 Dyck P J, Windebank A J. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment.  Muscle Nerve. 2002;  25 477-491
• 7 Kelkar P, Parry G J. Mononeuritis multiplex in diabetes mellitus: evidence for underlying immune pathogenesis.  J Neurol Neurosurg Psychiatry. 2003;  74 803-806
• 8 Said G, Lacroix C, Lozeron P, Ropert A, Plante V, Adams D. Inflammatory vasculopathy in multifocal diabetic neuropathy.  Brain. 2003;  126 376-385
• 9 Graham A R, Johnson P C. Direct immunofluorescence findings in peripheral nerve from patients with diabetic neuropathy.  Ann Neurol. 1985;  17 450-454
• 10 Krendel D A, Zacharias A, Younger D S. Autoimmune diabetic neuropathy.  Neurol Clin. 1997;  15 959-971
• 11 Pittenger G, Vinik A. Nerve growth factor and diabetic neuropathy.  Exp Diabesity Res. 2003;  4 271-285
• 12 Hall K E, Liu J, Sima A A, Wiley J W. Impaired inhibitory G-protein function contributes to increased calcium currents in rats with diabetic neuropathy.  J Neurophysiol. 2001;  86 760-770
• 13 Craner M J, Klein J P, Renganathan M, Black J A, Waxman S G. Changes of sodium channel expression in experimental painful diabetic neuropathy.  Ann Neurol. 2002;  52 786-792
• 14 Jamal G A. The use of gamma linolenic acid in the prevention and treatment of diabetic neuropathy.  Diabet Med. 1994;  11 145-149
• 15 Cameron N E, Cotter M A, Horrobin D H, Tritschler H J. Effects of alpha-lipoic acid on neurovascular function in diabetic rats: interaction with essential fatty acids.  Diabetologia. 1998;  41 390-399
• 16 Dyck P J, Kratz K M, Karnes J L et al.. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study.  Neurology. 1993;  43 817-824
• 17 Pagnanelli D M, Barrer S J. Outcome of carpal tunnel release surgery in patients with diabetes.  Neurosurg Focus. 1997;  3 e9
• 18 Mondelli M, Padua L, Reale F, Signorini A M, Romano C. Outcome of surgical release among diabetics with carpal tunnel syndrome.  Arch Phys Med Rehabil. 2004;  85 7-13
• 19 LeRoux P D, Ensign T D, Burchiel K J. Surgical decompression without transposition for ulnar neuropathy: factors determining outcome.  Neurosurgery. 1990;  27 709-714
• 20 Dyck P J, Norell J E, Dyck P J. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy.  Neurology. 1999;  53 2113-2121
• 21 Llewelyn J G, Thomas P K, King R H. Epineurial microvasculitis in proximal diabetic neuropathy.  J Neurol. 1998;  245 159-165
• 22 Kilfoyle D, Kelkar P, Parry G J. Pulsed methylprednisolone is a safe and effective treatment for diabetic amyotrophy.  J Clin Neuromusc Dis. 2003;  4 168-170
• 23 Kelkar P, Hammer-White S. Impaired glucose tolerance in non-diabetic lumbosacral radiculoplexus neuropathy.  Muscle Nerve. 2005;  31 273-274
• 24 Miyasaki H, Hasegawa O, Mori I, Matsumoto S, Arita T. [Incidence of diabetic neuropathy which fulfills electrophysiologic criteria of CIDP].  No To Shinkei. 1999;  51 415-418
• 25 Sharma K R, Cross J, Farronay O, Ayyar D R, Shebert R T, Bradley W G. Demyelinating neuropathy in diabetes mellitus.  Arch Neurol. 2002;  59 758-765
• 26 Wilson J R, Stittsworth Jr J D, Kadir A, Fisher M A. Conduction velocity versus amplitude analysis: evidence for demyelination in diabetic neuropathy.  Muscle Nerve. 1998;  21 1228-1230