Proximal diabetic neuropathy

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Proximal diabetic neuropathy
Other namesDiabetic Amyotrophy, Diabetic Lumbar Plexopathy, Bruns-Garland syndrome
Specialty Neurology   OOjs UI icon edit-ltr-progressive.svg

Proximal diabetic neuropathy, also known as diabetic amyotrophy, is a complication of diabetes mellitus that affects the nerves that supply the thighs, hips, buttocks and/or lower legs. Proximal diabetic neuropathy is a type of diabetic neuropathy characterized by muscle wasting, weakness, pain, or changes in sensation/numbness of the leg. It is caused by damage to the nerves of the lumbosacral plexus.

Contents

Proximal diabetic neuropathy is most commonly seen people with type 2 diabetics. [1] It is less common than distal polyneuropathy that often occurs in diabetes.

Signs and symptoms

Signs and symptoms of proximal diabetic neuropathy depend on the nerves affected. The first symptom is usually pain in the buttocks, hips, thighs or legs. This pain often starts suddenly and affects one side of the body, although may spread to both sides. This is often followed by variable weakness in the proximal muscles of the lower limbs such as the thigh and buttocks. The damage to nerves supplying specific muscles may cause muscle twitching (fasciculations) in addition to the weakness. It is sometimes associated with weight loss. [2]

Diabetes most commonly causes damage to the long nerves that supply the feet and lower legs, causing numbness, tingling and pain (diabetic polyneuropathy). Although these symptoms may also be present, the pain and weakness of proximal diabetic neuropathy often onset more quickly and affect nerves closer to the torso.[ citation needed ]

Causes

This condition most commonly affects people with type 2 diabetes, although sometimes presents in those without diabetes (nondiabetic lumbosacral radiculoplexus neuropathy). [3] The population trends suggest that hyperglycemia likely plays a role but may not be the causative factor. [4]

The nerve damage associated with the disease was first thought to be caused by metabolic changes such as endoneurial microvessel disease, in which cells that support the endothelium (pericytes) are damaged due to high blood sugar. Pericytes regulate capillary blood flow and phagocytosis of cellular debris and ischemia of the nerves can occur if pericytes are damaged. A different potential mechanism involves an immune mechanism causing a microvasculitis which could lead to ischemia. [4]

Diagnosis

Patients with diabetes and proximal (hip, thigh) pain and weakness may be suspected of having diabetic amyotrophy. More definitive diagnosis can be made with electrodiagnostic studies including nerve conduction studies (NCS) and electromyography (EMG). [5] Diabetic amyotrophy is often a diagnosis of exclusion in diabetic patients with evidence of lumbosacral plexopathy on NCS and EMG studies for whom no other cause of lumbosacral plexopathy can be determined.

Treatment

Proximal diabetic neuropathy can be prevented through management of diabetes. The incidence of proximal diabetic neuropathy incidence is thought to be correlated to blood glucose control in diabetics, and is likely reversible with improved blood glucose control.[ citation needed ]

Medications can help reduce the pain involved in proximal diabetic neuropathy. Common types of medication used to treat diabetic amyotrophy target the nerve directly such as gabapentin or pregabalin.[ citation needed ]

Prognosis

Proximal diabetic neuropathy is often monophasic and will improve after initial onset. However, the pain and weakness usually do not completely resolve and may lead to impairments in mobility and function. [3]

Related Research Articles

Diabetic neuropathy is various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, is a general term describing damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerves are affected. Neuropathy affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Polyneuropathy</span> Medical condition

Polyneuropathy is damage or disease affecting peripheral nerves in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain. It usually begins in the hands and feet and may progress to the arms and legs and sometimes to other parts of the body where it may affect the autonomic nervous system. It may be acute or chronic. A number of different disorders may cause polyneuropathy, including diabetes and some types of Guillain–Barré syndrome.

<span class="mw-page-title-main">Alcoholic polyneuropathy</span> Medical condition

Alcoholic polyneuropathy is a neurological disorder in which peripheral nerves throughout the body malfunction simultaneously. It is defined by axonal degeneration in neurons of both the sensory and motor systems and initially occurs at the distal ends of the longest axons in the body. This nerve damage causes an individual to experience pain and motor weakness, first in the feet and hands and then progressing centrally. Alcoholic polyneuropathy is caused primarily by chronic alcoholism; however, vitamin deficiencies are also known to contribute to its development. This disease typically occurs in chronic alcoholics who have some sort of nutritional deficiency. Treatment may involve nutritional supplementation, pain management, and abstaining from alcohol.

<span class="mw-page-title-main">Nerve conduction study</span> Diagnostic test for nerve function

A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests may be performed by medical specialists such as clinical neurophysiologists, physical therapists, physiatrists, and neurologists who subspecialize in electrodiagnostic medicine. In the United States, neurologists and physiatrists receive training in electrodiagnostic medicine as part of residency training and in some cases acquire additional expertise during a fellowship in clinical neurophysiology, electrodiagnostic medicine, or neuromuscular medicine. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing.

Meralgia paresthetica or meralgia paraesthetica is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the spinal column to the thigh.

<span class="mw-page-title-main">Sacral plexus</span> Nerve plexus

In human anatomy, the sacral plexus is a nerve plexus which provides motor and sensory nerves for the posterior thigh, most of the lower leg and foot, and part of the pelvis. It is part of the lumbosacral plexus and emerges from the lumbar vertebrae and sacral vertebrae (L4-S4). A sacral plexopathy is a disorder affecting the nerves of the sacral plexus, usually caused by trauma, nerve compression, vascular disease, or infection. Symptoms may include pain, loss of motor control, and sensory deficits.

<span class="mw-page-title-main">Nerve conduction velocity</span> Speed at which an electrochemical impulse propagates down a neural pathway

In neuroscience, nerve conduction velocity (CV) is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, which include age, sex, and various medical conditions. Studies allow for better diagnoses of various neuropathies, especially demyelinating diseases as these conditions result in reduced or non-existent conduction velocities. CV is an important aspect of nerve conduction studies.

Polyneuropathy in dogs and cats is a collection of peripheral nerve disorders that often are breed-related in these animals. Polyneuropathy indicates that multiple nerves are involved, unlike mononeuropathy. Polyneuropathy usually involves motor nerve dysfunction, also known as lower motor neuron disease. Symptoms include decreased or absent reflexes and muscle tone, weakness, or paralysis. It often occurs in the rear legs and is bilateral. Most are chronic problems with a slow onset of symptoms, but some occur suddenly.

<span class="mw-page-title-main">Inferior gluteal nerve</span>

The inferior gluteal nerve is the main motor neuron that innervates the gluteus maximus muscle. It is responsible for the movement of the gluteus maximus in activities requiring the hip to extend the thigh, such as climbing stairs. Injury to this nerve is rare but often occurs as a complication of posterior approach to the hip during hip replacement. When damaged, one would develop gluteus maximus lurch, which is a gait abnormality which causes the individual to 'lurch' backwards to compensate lack in hip extension.

<span class="mw-page-title-main">Foot drop</span> Gait abnormality

Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the deep fibular nerve, including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.

<span class="mw-page-title-main">Chronic inflammatory demyelinating polyneuropathy</span> Medical condition

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder is sometimes called chronic relapsing polyneuropathy (CRP) or chronic inflammatory demyelinating polyradiculoneuropathy. CIDP is closely related to Guillain–Barré syndrome and it is considered the chronic counterpart of that acute disease. Its symptoms are also similar to progressive inflammatory neuropathy. It is one of several types of neuropathy.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

Plexopathy is a disorder of the network of nerves in the brachial or lumbosacral plexus. Symptoms include pain, muscle weakness, and sensory deficits (numbness).

<span class="mw-page-title-main">Nerve compression syndrome</span> Human disease

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

Multifocal motor neuropathy (MMN) is a progressively worsening condition where muscles in the extremities gradually weaken. The disorder, a pure motor neuropathy syndrome, is sometimes mistaken for amyotrophic lateral sclerosis (ALS) because of the similarity in the clinical picture, especially if muscle fasciculations are present. MMN is thought to be autoimmune. It was first described in the mid-1980s.

Cancer pain can be caused by pressure on, or chemical stimulation of, specialised pain-signalling nerve endings called nociceptors, or by damage or illness affecting nerve fibers themselves.

Electrodiagnosis (EDX) is a method of medical diagnosis that obtains information about diseases by passively recording the electrical activity of body parts or by measuring their response to external electrical stimuli. The most widely used methods of recording spontaneous electrical activity are various forms of electrodiagnostic testing (electrography) such as electrocardiography (ECG), electroencephalography (EEG), and electromyography (EMG). Electrodiagnostic medicine is a medical subspecialty of neurology, clinical neurophysiology, cardiology, and physical medicine and rehabilitation. Electrodiagnostic physicians apply electrophysiologic techniques, including needle electromyography and nerve conduction studies to diagnose, evaluate, and treat people with impairments of the neurologic, neuromuscular, and/or muscular systems. The provision of a quality electrodiagnostic medical evaluation requires extensive scientific knowledge that includes anatomy and physiology of the peripheral nerves and muscles, the physics and biology of the electrical signals generated by muscle and nerve, the instrumentation used to process these signals, and techniques for clinical evaluation of diseases of the peripheral nerves and sensory pathways.

<span class="mw-page-title-main">Radiation-induced lumbar plexopathy</span> Type of nerve damage

Radiation-induced lumbar plexopathy (RILP) or radiation-induced lumbosacral plexopathy (RILSP) is nerve damage in the pelvis and lower spine area caused by therapeutic radiation treatments. RILP is a rare side effect of external beam radiation therapy and both interstitial and intracavity brachytherapy radiation implants.

Femoral nerve dysfunction, also known as femoral neuropathy, is a rare type of peripheral nervous system disorder that arises from damage to nerves, specifically the femoral nerve. Given the location of the femoral nerve, indications of dysfunction are centered around the lack of mobility and sensation in lower parts of the legs. The causes of such neuropathy can stem from both direct and indirect injuries, pressures and diseases. Physical examinations are usually first carried out, depending on the high severity of the injury. In the cases of patients with hemorrhage, imaging techniques are used before any physical examination. Another diagnostic method, electrodiagnostic studies, are recognized as the gold standard that is used to confirm the injury of the femoral nerve. After diagnosis, different treatment methods are provided to the patients depending upon their symptoms in order to effectively target the underlying causes. Currently, femoral neuropathy is highly underdiagnosed and its precedent medical history is not well documented worldwide.

References

  1. National Diabetes Information Clearinghouse (NDIC). (2009, February). Diabetic neuropathies: the nerve damage of diabetes. Retrieved March 20, 2012, from http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/#proximalneuropathy
  2. Pascoe, M. K.; Low, P. A.; Windebank, A. J.; Litchy, W. J. (1997). "Subacute diabetic proximal neuropathy". Mayo Clinic Proceedings. 72 (12): 1123–1132. doi:10.4065/72.12.1123. ISSN   0025-6196. PMID   9413291.
  3. 1 2 Dyck, P. James B.; Windebank, Anthony J. (2002). "Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment". Muscle & Nerve. 25 (4): 477–491. doi:10.1002/mus.10080. ISSN   0148-639X. PMID   11932965. S2CID   25618270.
  4. 1 2 Dyck P. J., Winderbank, A. J. (2002). Diabetic and non diabetic lumbosacral radiculoplexus neuropathies. New insights into pathophysiology and treatment. Muscle Nerve, 25, 477–491.
  5. Diabetic Amytrophy. 2014. American Association of Neuromuscular & Electrodiagnostic Medicine. "Diabetic Amyotrophy | American Association of Neuromuscular & Electrodiagnostic Medicine". Archived from the original on 2014-05-22. Retrieved 2014-05-21.