Proximal diabetic neuropathy
Proximal diabetic neuropathy | |
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Other names | Diabetic Amyotrophy, Diabetic Lumbar Plexopathy, Bruns-Garland syndrome |
Specialty | Neurology |
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.
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
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
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]
References
- ^ 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
- PMID 9413291.
- ^ S2CID 25618270.
- ^ a b 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.
- ^ 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.