Treatment-Induced Diabetic Neuropathy: A Reversible Painful Autonomic Neuropathy

被引:130
|
作者
Gibbons, Christopher H. [1 ]
Freeman, Roy [1 ]
机构
[1] Harvard Univ, Beth Israel Deaconess Med Ctr, Auton & Peripheral Nerve Lab, Dept Neurol,Med Sch, Boston, MA 02215 USA
关键词
GLYCEMIC CONTROL; SKIN BIOPSY; PROINFLAMMATORY CYTOKINES; HYPOGLYCEMIC NEUROPATHY; SENSORY NEUROPATHY; POLYNEUROPATHY; RETINOPATHY; NERVE; INSULIN; MECHANISMS;
D O I
10.1002/ana.21952
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To describe the natural history, clinical, neurophysiological, and histological features, and outcomes of diabetic patients presenting with acute painful neuropathy associated with glycemic control, also referred to as insulin neuritis. Methods: Sixteen subjects presenting with acute painful neuropathy had neurological and retinal examinations, laboratory studies, autonomic testing, and pain assessments over 18 months. Eight subjects had skin biopsies for evaluation of intraepidermal nerve fiber density. Results: All subjects developed severe pain within 8 weeks of intensive glucose control. There was a high prevalence of autonomic cardiovascular, gastrointestinal, genitourinary, and sudomotor symptoms in all subjects. Orthostatic hypotension and parasympathetic dysfunction were seen in 69% of subjects. Retinopathy worsened in all subjects. Reduced intraepidermal nerve fiber density (IENFD) was seen in all tested subjects. After 18 months of glycemic control, there were substantial improvements in pain, autonomic symptoms, autonomic test results, and IENFD. Greater improvements were seen after 18 months in type 1 versus type 2 diabetic subjects in autonomic symptoms (cardiovascular p < 0.01; gastrointestinal p < 0.01; genitourinary p < 0.01) and autonomic function tests (p < 0.01, sympathetic and parasympathetic function tests). Interpretation: Treatment-induced neuropathy is characterized by acute, severe pain, peripheral nerve degeneration, and autonomic dysfunction after intensive glycemic control. The neuropathy occurred in parallel with worsening diabetic retinopathy, suggesting a common underlying pathophysiological mechanism. Clinical features and objective measures of small myelinated and unmyelinated nerve fibers can improve in these diabetic patients despite a prolonged history of poor glucose control, with greater improvement seen in patients with type 1 diabetes. ANN NEUROL 2010;67:534-541
引用
收藏
页码:534 / 541
页数:8
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