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Journal of Neurology

, 255:1693 | Cite as

Sensory loss, pains, motor deficit and axonal regeneration in length-dependent diabetic polyneuropathy

  • G. Said
  • D. Baudoin
  • K. Toyooka
ORIGINAL COMMUNICATION

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 length-dependent 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 8.5 % of control values. Regenerating axons accounted for 32.4 ± 19.8 % of the myelinated fibres. On teased fibre preparations 13.9 % of fibres were undergoing axonal degeneration, while 29.4 % of fibres showed focal abnormalities of the myelin sheath.

We 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.

Key words

diabetic polyneuropathy pains nerve biopsy axonal regeneration neuropathy screening 

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Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Fédération de NeurologieCHU Pitié-SalpétrièreParisFrance
  2. 2.Aix-en-ProvenceFrance
  3. 3.OsakaJapan

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