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Fifteen patients had evidence of axonal neuropathy by electrophysiologic studies(group A).All 15 patients had non-insulin-dependent diabetes mellitus,10 patients had weight loss,and 13 patients had prominent involvement of thighs and/or thoracic bands consistent with diabetic amyotrophy or mononeuropathy multiplex.Small vessel disease was seen in all 10 patients who underwent biopsy,with perivascular or vascular inflammation seen in seven patients.Six patients had demyelinating neuropathy by electrophysiologic criteria(group B).All those patients had insulin-dependent diabetes mellitus,and no one had weight loss.The process was asymmetric in three patients aNd involved thoracic or abdominal regions in two patients.Onion bulbs were seen in all four patients who underwent biopsy,but no vascular inflammation or occlusion was seen.In all patients in both groups,worsening of their conditions stopped and improvement started after beginning treatments.Neuropathies responsive to anti-inflammatory and/or anti-immune therapy in patients with diabetes mellitus include(1)multifocal axonal neuropathy caused by inflammatory vasculopathy,predominantly in patients with non-insulin dependent diabetes mellitus,indistinguishable from diabetic proximal neuropathy or mononeuropathy multiplex,and(2)demyelinating neuropathy indistinguishable from chronic inflammatory demyelinating polyneuropathy,predominantly in patients with insulin-dependent diabetes mellitus. |
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diabetes mellitus
diabetic amyotrophy
gammaglobulin therapy,intravenous
immunosuppressive agents
neuropathy,diabetic
neuropathy,peripheral,treatment
neuropathy,vasculitic,nonsystemic
plasmapheresis
polyneuropathy
polyneuropathy,chronic inflammatory demyelinating
treatment of neurologic disorder
vasculopathy
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