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Title of Journal: J Neurol

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Abbravation: Journal of Neurology

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D. Steinkopff-Verlag

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DOI

10.1007/s10147-011-0327-y

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1432-1459

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Sensory loss pains motor deficit and axonal rege

Authors: G Said D Baudoin K Toyooka
Publish Date: 2008/09/25
Volume: 255, Issue: 11, Pages: 1693-
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Abstract

In order to learn more on the occurrence of pains and motor deficit in severe diabetic polyneuropathy we reviewed the data of a series of 30 diabetic patients with an uncommonly severe lengthdependent diabetic polyneuropathy LDDP Extensive sensory loss predominated with pains and temperature sensations and affected all four limb extremities anterior trunk in all plus the top of the scalp in 9 patients and the cauda equina territory in 2 Twenty patients had neuropathic pains Symptomatic autonomic dysfunction was present in 28/30 patients mild distal motor deficit in 12 patients severe in only one Vibratory sensation was impaired in the lower limbs in 18 patients position sense in 8 In the 10 nerve biopsy specimens the density of myelinated axons was reduced to 23 and that of unmyelinated axons to 85 of control values Regenerating axons accounted for 324 ± 198 of the myelinated fibres On teased fibre preparations 139 of fibres were undergoing axonal degeneration while 294 of fibres showed focal abnormalities of the myelin sheathWe conclude that distal motor deficit occurs only after major loss of sensory fibres in LDDP the unmyelinated axons are predominantly affected absence of clinical improvement contrasts with the high proportion of regenerating axons detection of alteration of pain and temperature sensation in the feet seems the best method for neuropathy screening in diabetic patients

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