Skip to main content

Diabetic Neuropathies

  • Chapter
  • First Online:
Neuromuscular Disorders in Clinical Practice
  • 5930 Accesses

Abstract

Diabetic neuropathy is the most common neuropathy seen in clinical practice, particularly by internists and general physicians. This chapter covers all types of diabetic neuropathies including diabetic polyneuropathy, diabetic amyotrophy (proximal motor neuropathy, diabetic lumbosacral radiculoplexus neuropathy), diabetic truncal neuropathies, diabetic cranial neuropathies, and entrapment syndromes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 449.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Feldman E. Pathogenesis and prevention of diabetic polyneuropathy. In: UpToDate, Basow DS, editors. UpToDate. Waltham; 2012.

    Google Scholar 

  2. Lewellyn J, Tomlinson D, Thomas P. Diabetic neuropathies. In: Dyck P, Thomas P, editors. Peripheral neuropathies, vol. 2. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1951–91.

    Google Scholar 

  3. Tesfaye S, Boulton A. Diabetic neuropathy. New York: Oxford University Press; 2009.

    Google Scholar 

  4. Zochodne D, Kline G, Smith E, Hill M. Diabetic neurology. London: Informa Healthcare; 2010.

    Google Scholar 

  5. The DCCT/EDIC Research Group. Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration. Arch Intern Med. 2009;169:1307–16.

    Google Scholar 

  6. Kaufman RJ. Beta-cell failure, stress, and type 2 diabetes. N Engl J Med. 2011;365:1931–3.

    PubMed  CAS  Google Scholar 

  7. Harris M, Klein R, Welborn T, et al. Onset of NIDDM occurs at least 4–7 years before clinical diagnosis. Diabetes Care. 1992;15:815–9.

    PubMed  CAS  Google Scholar 

  8. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes. www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf (checked 03/01/2013).

  9. American Diabetes Association. Standards of medical care in diabetes - 2012. Diabetes Care. 2012;35(1):S11–63.

    Google Scholar 

  10. Cowie C, Rust K, Byrd-Holt D, et al. Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. Population in 1988–2006. Diabetes Care. 2010;33:562–8.

    PubMed  Google Scholar 

  11. Low P. Clinical autonomic disorders. 2nd ed. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  12. Lyons T. Management of diabetic foot complications. In: Veves A, Malik R, editors. Diabetic neuropathy: clinical management. 2nd ed. Totowa: Humana Press; 2007. p. 473–506.

    Google Scholar 

  13. Abbott C, Carrington A, Ashe H, et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabetes Med. 2002;19:377–84.

    CAS  Google Scholar 

  14. Ellenberg M. Diabetic neuropathic cachexia. Diabetes. 1974;23:418–22.

    PubMed  CAS  Google Scholar 

  15. Archer A, Watkins P, Thomas P, et al. The natural history of acute painful diabetic neuropathy in diabetes mellitus. J Neurol Neurosurg Psychiatry. 1983;46:491–9.

    PubMed  CAS  Google Scholar 

  16. Ellenberg M. Diabetic neuropathy precipitating after institution of diabetic control. Am J Med Sci. 1958;236:466–71.

    PubMed  CAS  Google Scholar 

  17. Llewelyn J, Thomas P, Fonseca V, et al. Acute painful diabetic neuropathy precipitated by strict glycaemic control. Acta Neuropathol (Berl). 1986;72:157–63.

    CAS  Google Scholar 

  18. Gibbons C, Freeman R. Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy. Ann Neurol. 2010;67:534–41.

    PubMed  Google Scholar 

  19. Greene D, Arezzo J, Brown M, et al. Effect of aldose reductase inhibition on nerve conduction and morphometry in diabetic neuropathy. Neurology. 1999;53:580–91.

    PubMed  CAS  Google Scholar 

  20. Brown MJ, Martin JR, Asbury AK. Painful diabetic neuropathy: a morphometric study. Arch Neurol. 1976;33:164–71.

    PubMed  CAS  Google Scholar 

  21. Giannini C, Dyck P. Pathologic alterations in human diabetic neuropathy. In: Dyck P, Thomas P, editors. Diabetic neuropathy. Philadelphia: WB Saunders; 1999. p. 279–95.

    Google Scholar 

  22. Johnson P, Doll SC, Cromey DW. Pathogenesis of diabetic neuropathy. Ann Neurol. 1986;19:450–7.

    PubMed  CAS  Google Scholar 

  23. Dyck P, Karnes J, O-Brien P, et al. The spatial distribution of fiber loss in diabetic polyneuropathy suggests ischemia. Ann Neurol. 1986;19:440–50.

    PubMed  CAS  Google Scholar 

  24. Behse F, Buchthal F, Carsen F. Nerve biopsy and conduction studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1977;40:1072–82.

    PubMed  CAS  Google Scholar 

  25. Malik R, Kallinikos P, Abbott C. Corneal confocal microscopy: a non-invasive surrogate of nerve fiber damage and repair in diabetic patients. Diabetologia. 2003;46:683–8.

    PubMed  CAS  Google Scholar 

  26. Wilbourn AJ. Diabetic neuropathies. In: Brown WF, Bolton CF, editors. Clinical electromyography. Boston: Butterworth-Heinemann; 1993. p. 477–515.

    Google Scholar 

  27. Duabe JR. Electrophysiologic testing in diabetic neuropathy. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. 2nd ed. Philadelphia: WBSaunders; 1999. p. 222–38.

    Google Scholar 

  28. Downie MB, Newell MA. Sensory nerve conduction in patients with diabetes and controls. Neurology. 1961;11:876–82.

    PubMed  CAS  Google Scholar 

  29. Mulder DW, Lambert EH, Bastron JA, et al. The neuropathies associated with diabetes mellitus. Neurology. 1961;11:276–84.

    Google Scholar 

  30. Gregersen G. Diabetic neuropathy: influence of age, sex, metabolic control and duration of diabetes on motor conduction velocity. Neurology. 1967;17:972–80.

    PubMed  CAS  Google Scholar 

  31. Dyck PJ, Karnes JL, O’Brien PC, et al. The Rochester Diabetic Neuropathy Study: reassessment of tests and criteria of diagnosis. Neurology. 1992;42:1164–70.

    PubMed  CAS  Google Scholar 

  32. Hendriksen PH, Oey PL, Wieneke GH, et al. Subclinical diabetic neuropathy: similarities between electrophysiological results of patients with type 1 (insulin-dependent) and type 2 (non-insulin dependent) diabetes mellitus. Diabetologia. 1992;35:690–5.

    PubMed  CAS  Google Scholar 

  33. Eng GD, Hung W, August GP, et al. Nerve conduction velocity determinations in juvenile diabetics: continuing study of 190 patients. Arch Phys Med Rehabil. 1976;57:1–5.

    PubMed  CAS  Google Scholar 

  34. Kimura J, Yamada T, Stevland NP. Distal slowing of motor nerve conduction velocity in diabetic polyneuropathy. J Neurol Sci. 1979;42:291–302.

    PubMed  CAS  Google Scholar 

  35. Graf RJ, Halter JB, Pfeifer MA, et al. Glycemic control and nerve conduction abnormalities in non-insulin dependent diabetic subjects. Ann Intern Med. 1981;94:307–11.

    PubMed  CAS  Google Scholar 

  36. Troni W, Carta Q, Cantello R, et al. Peripheral nerve function and metabolic control in diabetes mellitus. Ann Neurol. 1984;16:178–83.

    PubMed  CAS  Google Scholar 

  37. Judzewitsch RG, Jaspan JB, Polonsky KS, et al. Aldose reductase inhibition improves nerve conduction velocity in diabetic patients. N Engl J Med. 1983;308:119–25.

    PubMed  CAS  Google Scholar 

  38. Bromberg MB. Comparison of electrodiagnostic criteria for primary demyelination in chronic polyneuropathy. Muscle Nerve. 1991;14:968–76.

    PubMed  CAS  Google Scholar 

  39. Abu-Shakra SR, Cornblath DR, Avila OL, et al. Conduction block in diabetic neuropathy. Muscle Nerve. 1991;14:858–62.

    PubMed  CAS  Google Scholar 

  40. Olney RK. AAEM consensus criteria for the diagnosis of partial conduction block. Muscle Nerve. 1999;22 suppl 8suppl 8:S225–9.

    Google Scholar 

  41. Trojaborg W, Smith T, Jacobsen J, Rasmussen K. Cardiorespiratory reflexes, vibratory and thermal thresholds, sensory and motor conduction in diabetic patients with end-stage nephropathy. Acta Neurol Scand. 1994;90:1–4.

    PubMed  CAS  Google Scholar 

  42. Lamontagne A, Buchthal F. Electrophysiologic studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry. 1970;33:442–52.

    PubMed  CAS  Google Scholar 

  43. LeQuesne PM, Fowler CJ, Parkhouse N. Peripheral neuropathy profile in various groups of diabetics. J Neurol Neurosurg Psychiatry. 1990;53:558–63.

    CAS  Google Scholar 

  44. Shefner JM, Buchthal F, Krarup C. Slowly conducting myelinated fibers in peripheral neuropathy. Muscle Nerve. 1991;14:534–42.

    PubMed  CAS  Google Scholar 

  45. Horowitz SH. Correlation of near-nerve sural conduction and quantified sensory testing in patients with diabetic neuropathy. Muscle Nerve. 1995;16:1202–4.

    Google Scholar 

  46. Bril V, Werb MR, Greene DA, Sima AAF. Single-fiber electromyography in diabetic peripheral polyneuropathy. Muscle Nerve. 1996;19:2–9.

    PubMed  CAS  Google Scholar 

  47. Low PA. Diabetic autonomic neuropathy. Semin Neurol. 1996;16:143–51.

    PubMed  CAS  Google Scholar 

  48. England JD, Gronseth GS, Franklin G, et al. Practice parameter: evaluation of distal polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Neurology. 2009;72:177–84.

    PubMed  CAS  Google Scholar 

  49. Pfeifer M. Cardiovascular assessment. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders; 1999. p. 171–83.

    Google Scholar 

  50. Tesfaye S, Boulton AJM, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285–93.

    PubMed  Google Scholar 

  51. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97.

    PubMed  Google Scholar 

  52. Ziegler D, Dannehl K, Muhlen H, et al. Prevalence of cardiovascular autonomic dysfunction assessed by spectral analysis, vector analysis, and standard tests of HR variation and blood pressure responses at various stages of diabetic neuropathy. Diabet Med. 1992;9:806–14.

    PubMed  CAS  Google Scholar 

  53. Pfeifer MA, Weinberg CR, Cool DR, et al. Autonomic neural dysfunction in recently diagnosed diabetic subjects. Diabetes Care. 1984;7:447–53.

    PubMed  CAS  Google Scholar 

  54. Low PA, Caskey PE, Tuck RR, et al. Quantitative sudomotor axon reflex test in normal and neuropathic subjects. Ann Neurol. 1983;14:573–80.

    PubMed  CAS  Google Scholar 

  55. Low PA, Fealey RD. Sudomotor neuropathy. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders; 1999. p. 191–9.

    Google Scholar 

  56. Baba M, Watahiki Y, Matsunaga M, Takabe K. Sympathetic skin response in healthy man. Electromyogr Clin Neurophysiol. 1988;28:277–83.

    PubMed  CAS  Google Scholar 

  57. Elie B, Guiheneuc P. Sympathetic skin response: normal results in different experimental conditions. Electroencephalogr Clin Neurophysiol. 1990;76:258–67.

    PubMed  CAS  Google Scholar 

  58. Schondorf R, Gendron D. Properties of electrodermal activity recorded from nonpalmar/plantar skin sites. Neurology. 1990;40:128–32.

    Google Scholar 

  59. Fagius J, Jameson S. Effects of aldose reductase inhibitor treatment in diabetic neuropathy: a clinical and neurophysiological study. J Neurol Neurosurg Psychiatry. 1981;44:991–5.

    PubMed  CAS  Google Scholar 

  60. Shahani BT, Halperin JJ, Boulu P, Cohen J. Sympathetic skin response: a method of assessing unmyelinated axon dysfunction in peripheral neuropathies. J Neurol Neurosurg Psychiatry. 1984;47:536–42.

    PubMed  CAS  Google Scholar 

  61. Knezevic W, Bajada S. Peripheral autonomic surface potential: a quantitative technique for recording sympathetic conduction in man. J Neurol Sci. 1985;67:239–51.

    PubMed  CAS  Google Scholar 

  62. Niakan E, Harati Y. Sympathetic skin response in diabetic peripheral neuropathy. Muscle Nerve. 1988;11:261–4.

    PubMed  CAS  Google Scholar 

  63. Fagius J. Sympathetic reflex latencies and conduction velocities in diabetic polyneuropathy. J Clin Physiol. 1985;5(Suppl):49–53.

    Google Scholar 

  64. Bril V, Nyunt M, Ngo M. Limits of the sympathetic skin response in patients with diabetic polyneuropathy. Muscle Nerve. 2000;23:1427–30.

    PubMed  CAS  Google Scholar 

  65. Skjiarevski V. Historical aspects of diabetic neuropathies. In: Veves A, Malik RA, editors. Diabetic neuropathy; clinical management. 2nd ed. Totowa: Humana Press; 2007. p. 1–5.

    Google Scholar 

  66. Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care. 1973;1:166–88. and 252–63.

    Google Scholar 

  67. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Google Scholar 

  68. UKPDS Group. UK Prospective Diabetes Study 33: intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837–53.

    Google Scholar 

  69. Morley G, Mooradian AD, Levine AS, et al. Mechanism of pain in diabetic peripheral neuropathy: effect of glucose on pain perception in humans. Am J Med. 1984;77:19–85.

    Google Scholar 

  70. Bolton A, Drury J, Clarke B, et al. Continuous subcutaneous insulin infusion in the management of painful diabetic neuropathy. Diabetes Care. 1982;5:386–90.

    Google Scholar 

  71. Greene D, Obrosova I, Stevens M, et al. Pathways of glucose-mediated oxidative stress in diabetic neuropathy. In: Packer I, Rosen P, Tritschler H, editors. Antioxidants in diabetes management. New York: Marcel Kekker; 2000. p. 111–9.

    Google Scholar 

  72. Sugimoto K, Yasujima M, Yagihashi S. Role of advanced glycation end products in diabetic neuropathy. Curr Pharm Des. 2008;14:953–61.

    PubMed  CAS  Google Scholar 

  73. Delaney C, Feldman E. Insulin-like growth factor-I and apoptosis in glial cell biology. Neuroscientist. 2000;6:39–47.

    CAS  Google Scholar 

  74. Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43:817–24.

    PubMed  CAS  Google Scholar 

  75. Dyck PJ, Albers JW, Andersen H, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Daibetes Metab Res Rev. 2011;27:620–8.

    Google Scholar 

  76. England JD, Gronseth GS, Franklin G, et al. Distal symmetric polyneuropathy: a definition for clinical research. Neurology. 2005;64:199–207.

    PubMed  CAS  Google Scholar 

  77. Dyck PJ, Carter RE, Litchy WJ. Modeling nerve conduction criteria for diagnosis of diabetic polyneuropathy. Muscle Nerve. 2011;44:340–5.

    PubMed  Google Scholar 

  78. Feldman EL, Stevens MJ, Thomas PK, et al. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17:1281–9.

    PubMed  CAS  Google Scholar 

  79. Dyck PJ, Davies JL, Litchy WJ, O’Brien PC. Longitudinal assessment of diabetic polyneuropathy using a composite score in the Rochester Diabetic Neuropathy Study cohort. Neurology. 1997;49:229–39.

    PubMed  CAS  Google Scholar 

  80. Dyck PJ, Hughes RAC, O’Brien PC. Quantitating overall neuropathic symptoms, impairments, and outcomes. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1031–52.

    Google Scholar 

  81. Cornblath DR, Chaudhry V, Carter K, et al. Total neuropathy score: validation and reliability study. Neurology. 1999;53:1660–4.

    PubMed  CAS  Google Scholar 

  82. Singleton JR, Bixby B, Russell JW, et al. The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy. J Peripher Nerv Syst. 2008;13:218–27.

    PubMed  Google Scholar 

  83. The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122:561–8.

    Google Scholar 

  84. Amthor KF, Dahl-Jorgensen K, Berg TJ, et al. The effects of 8 years of strict glycemic control on peripheral nerve function in IDDM patients: the Oslo Study. Diabetologia. 1994;37:579–84.

    PubMed  CAS  Google Scholar 

  85. Bril V, Ellison R, Ngo M, et al. Electrophysiological monitoring in clinical trials. Muscle Nerve. 2000;21:1368–73.

    Google Scholar 

  86. Brown MJ, Bird SJ, Waitling S, et al. Natural progression of diabetic peripheral neuropathy in the zenarestat study population. Diabetes Care. 2004;27:1153–9.

    PubMed  Google Scholar 

  87. Bird SJ, Brown MJ, Spino C, et al. Value of repeated measures of nerve conduction and quantitative sensory testing in a diabetic neuropathy trial. Muscle Nerve. 2006;34:214–24.

    PubMed  Google Scholar 

  88. Santiago JV, Sonksen PH, Boulton AJM, et al. Withdrawal of the aldose reductase inhibitor tolrestat in patients with diabetic neuropathy: effect on nerve function. J Daibetes Complications. 1993;7:170–8.

    CAS  Google Scholar 

  89. Sundkvist G, Armstrong FM, Bradbury JE, et al. Peripheral and autonomic nerve function in 259 diabetic patients with peripheral neuropathy treated with ponalrestat (an aldose reductase inhibitor) or placebo for 18 months. J Diabetes Complications. 1992;6:123–30.

    PubMed  CAS  Google Scholar 

  90. Valensi P, Attali JR, Gagant S, et al. Reproducibility of parameters for assessment of diabetic neuropathy. Diabet Med. 1993;10:933–9.

    PubMed  CAS  Google Scholar 

  91. Shy ME, Frohman EM, So YT, et al. Quantitative sensory testing: report of the Therapeutics and Technology Subcommittee of the American Academy of Neurology. Neurology. 2003;60:898–904.

    PubMed  CAS  Google Scholar 

  92. Dyck PJ, O’Brien PC, Johnson DM, et al. Quantitative sensory testing. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1063–94.

    Google Scholar 

  93. Young MJ, Breddy JL, Veyes A, et al. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. Diabetes Care. 1994;17:557–60.

    PubMed  CAS  Google Scholar 

  94. Steiness IB. Vibratory perception in diabetics: a biothesiometric study. Acta Med Scand. 1957;158:327–35.

    PubMed  CAS  Google Scholar 

  95. Dyck PJ, Zimmerman I, Gillen DA, et al. Cool, warm, and heat-pain detection thresholds: testing methods and inference about anatomic distribution of receptors. Neurology. 1993;43:1500–8.

    PubMed  CAS  Google Scholar 

  96. Sosenko JM, Kato M, Soto RA, et al. Specific assessments of warm and cool sensitivities in adult diabetic patients. Diabetes Care. 1988;11:481–3.

    PubMed  CAS  Google Scholar 

  97. Dyck PJ, Zimmerman IR, Johnson DM, et al. A standard test of heat-pain responses using CASE IV. J Neurol Sci. 1996;136:54–63.

    PubMed  CAS  Google Scholar 

  98. Dyck PJ, Kratz KM, Lehman KA, et al. The Rochester Diabetic Neuropathy Study: design, criteria for types of neuropathy, selection bias, and reproducibility of tests. Neurology. 1991;41:799–807.

    PubMed  CAS  Google Scholar 

  99. Kinkaid JC, Price KL, Jimenez MC, Skljarevski V. Correlation of vibratory quantitative sensory testing and nerve conduction studies in patients with diabetes. Muscle Nerve. 2007;36:821–7.

    Google Scholar 

  100. Quattrini C, Tavakoli M, Jeziorska M, et al. Surrogate markers of small fiber damage in human diabetic neuropathy. Diabetes. 2007;56:2148–54.

    PubMed  CAS  Google Scholar 

  101. Joint Task Force of the EFNS and the PNS. European Federation of Neurological Sciences/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. J Peripher Nerv Syst. 2010;15:79–92.

    Google Scholar 

  102. Ahmed A, Bril V, Orszag A, et al. Detection of diabetic sensorimotor polyneuropathy by corneal confocal microscopy in type 1 diabetes. Diabetes Care. 2012;35:821–8.

    PubMed  CAS  Google Scholar 

  103. Hertz P, Bril V, Orszag A, et al. Reproducibility of in vivo corneal confocal microscopy as a novel screening test for early diabetic sensorimotor polyneuropathy. Diabet Med. 2011;28:1253–60.

    PubMed  CAS  Google Scholar 

  104. Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic ­neuropathy: mechanisms to management. Pharmacol Ther. 2008;120:1–34.

    PubMed  CAS  Google Scholar 

  105. Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanisms as therapeutic targets. Nat Rev Neurol. 2011;7:573–83.

    PubMed  CAS  Google Scholar 

  106. Tomlinson DR. Role of aldose reductase inhibitors in the treatment of diabetic polyneuropathy. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders; 1999. p. 330–40.

    Google Scholar 

  107. Obrosova IG, Van Huysen C, Fathallah L, et al. An aldose reductase inhibitor reverses early diabetes-induced changes in peripheral nerve function, metabolism, and antioxidative defense. FASEB J. 2002;16:123–33.

    PubMed  CAS  Google Scholar 

  108. Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy (review). Cochrane Database Syst Rev. 2007:CD004572.

    Google Scholar 

  109. Zochodne DW. Neurotrophins and other growth factors in diabetic neuropathy. Semin Neurol. 1996;16:153–61.

    PubMed  CAS  Google Scholar 

  110. Tomlinson DR, Fernyhough P, Diemel LT. Role of neurotrophins in diabetic neuropathy and treatment with nerve growth factors. Diabetes. 1997;46:S43–9.

    PubMed  CAS  Google Scholar 

  111. Apfel SC, Kessler JA, Adornato BT, et al. Recombinant human nerve growth factor in the treatment of diabetic polyneuropathy. Neurology. 1998;51:695–702.

    PubMed  CAS  Google Scholar 

  112. Zochodne DW, Said G. Recombinant human nerve growth factor and diabetic polyneuropathy. Neurology. 1998;51:662–3.

    PubMed  CAS  Google Scholar 

  113. Hills CE, Brunskill NJ. Cellular and physiologic effects of C-peptide. Clin Sci. 2009;116:565–74.

    PubMed  CAS  Google Scholar 

  114. Ekberg K, Brismar T, Johansson BL, et al. Amelioration of sensory nerve dysfunction by C-peptide in patients with type 1 diabetes. Diabetes. 2003;52:536–41.

    PubMed  CAS  Google Scholar 

  115. Ekberg K, Johansson BL. Effects of C-peptide on diabetic neuropathy in patients with type 1 diabetes. Exp Diabetes Res. 2008;2008:ID457912.

    Google Scholar 

  116. Greene DA, Brwon MJ, Braunstein SN, et al. Comparison of clinical course and sequential electrophysiological tests in diabetics with symptomatic polyneuropathy and its implications for clinical trials. Diabetes. 1981;30:139–47.

    PubMed  CAS  Google Scholar 

  117. Gregersen G, Borsting H, Theil P, Servo C. Myoinositol and function of peripheral nerve in human diabetes: a controlled clinical trial. Acta Neurol Scand. 1978;58:241–4.

    PubMed  CAS  Google Scholar 

  118. Wile D, Toth C. Association of metformin, elevated homocysteine, and methylmalonic acid levels and clinically worsened diabetic peripheral neuropathy. Diabetes Care. 2010;33:156–61.

    PubMed  CAS  Google Scholar 

  119. Lozeron P, Nahum L, Lacroix C, et al. Symptomatic diabetic and non-diabetic neuropathies in a series of 100 diabetic patients. J Neurol. 2002;249:569–75.

    PubMed  Google Scholar 

  120. Ziegler D, Amentov A, Barinov A, et al. Oral treatment with α (alpha) -lipoic acid improves symptomatic polyneuropathy; the Sydney 2 trial. Diabetes Care. 2006;29:2365–70.

    PubMed  CAS  Google Scholar 

  121. Daousi C, MacFarlane IA, Woodward A, et al. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004;21:976982.

    Google Scholar 

  122. Bril V, England JD, Franklin GM, et al. Evidence-based guideline: treatment of painful diabetic neuropathy – report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine & Rehabilitation. Muscle Nerve. 2011;43:910–7.

    PubMed  Google Scholar 

  123. Max MB, Lynch SA, Muir J, et al. Effects of desipramine, amitriptyline and fluoxetine on pain in diabetic neuropathy. N Engl J Med. 1992;326:1250–6.

    PubMed  CAS  Google Scholar 

  124. Freeman R, Durso-Decruz E, Emir B. Efficacy, safety and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care. 2008;31:1448–54.

    PubMed  CAS  Google Scholar 

  125. Gilron I, Bailey JM, Tu D, et al. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomized controlled crossover trial. Lancet. 2009;374:1252–61.

    PubMed  CAS  Google Scholar 

  126. Tesfaye S, Vileikyte L, Rayman G, et al. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. 2011;27:629–38.

    Google Scholar 

  127. Shakher J, Stevens MJ. Update on the management of diabetic polyneuropathies. Daibetes Metab Syndr Obes. 2011;4:289–305.

    Google Scholar 

  128. Wright RA, Kaufmann HC, Perera R, et al. A double-blind, dose–response study of midodrine in neurogenic orthostatic hypotension. Neurology. 1998;51:120–4.

    PubMed  CAS  Google Scholar 

  129. Krendel DA, Costigan DA, Hopkins LC. Successful treatment of neuropathies in patients with diabetes mellitus. Arch Neurol. 1995;52:1053–61.

    PubMed  CAS  Google Scholar 

  130. Sharma KR, Cross J, Farronay O, et al. Demyelinating neuropathy in diabetes mellitus. Arch Neurol. 2002;59:758–65.

    PubMed  Google Scholar 

  131. Laughlin RS, Dyck PJ, Melton LJ, et al. Incidence and prevalence of CIDP and the association of diabetes mellitus. Neurology. 2009;73:39–45.

    PubMed  CAS  Google Scholar 

  132. Stewart JD, McKelvey R, Durcan L, et al. Chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetics. J Neurol Sci. 1996;142:59–64.

    PubMed  CAS  Google Scholar 

  133. Gorson KC, Ropper AH, Adelman LS, Weinberg DH. Influence of diabetes mellitus on chronic inflammatory demyelinating polyneuropathy. Muscle Nerve. 2000;23:37–43.

    PubMed  CAS  Google Scholar 

  134. Haq RU, Pendlebury WW, Fries TJ, Tandan R. Chronic inflammatory demyelinating polyneuropathy in diabetic patients. Muscle Nerve. 2003;27:465–70.

    PubMed  Google Scholar 

  135. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders. 2nd ed. Philadelphia: Elsevier; 2005.

    Google Scholar 

  136. Jaspan JB, Wollman RL, Bernstein L, et al. Hypoglycemic peripheral neuropathy in association with insulinoma: implication of glucopenia rather than hyperinsulinemia. Medicine. 1982;61:33–44.

    PubMed  CAS  Google Scholar 

  137. Barohn RJ, Sahenk Z, Warmolts JR, Mendell JR. The Bruns-Garland syndrome (diabetic amyotrophy): revisited 100 years later. Arch Neurol. 1991;48:1130–5.

    PubMed  CAS  Google Scholar 

  138. Garland H, Traverner D. Diabetic myelopathy. Br Med J. 1953;1:1405–8.

    PubMed  CAS  Google Scholar 

  139. Garland H. Diabetic amyotrophy. Br Med J. 1955;2:1287–90.

    PubMed  CAS  Google Scholar 

  140. Goodman JL. Femoral neuropathy in relation to diabetes mellitus: report of 17 cases. Diabetes. 1954;3:266–73.

    PubMed  CAS  Google Scholar 

  141. Skanse B, Gydell K. A rare type of femoral-sciatic neuropathy in diabetes mellitus. Acta Med Scand. 1956;155:463–8.

    PubMed  Google Scholar 

  142. Raff MC, Sangalang V, Asbury AK. Ischemic mononeuropathy multiplex associated with diabetes mellitus. Arch Neurol. 1968;18:487–99.

    PubMed  CAS  Google Scholar 

  143. Raff MC, Asbury AK. Ischemic mononeuropathy and mononeuropathy multiplex in diabetes mellitus. N Engl J Med. 1968;279:17–22.

    PubMed  CAS  Google Scholar 

  144. Asbury AK. Proximal diabetic neuropathy. Ann Neurol. 1977;2:179–80.

    PubMed  CAS  Google Scholar 

  145. Bastron JA, Thomas JE. Diabetic polyradiculopathy: clinical and electromyographic findings in 105 patients. Mayo Clin Proc. 1981;56:725–32.

    PubMed  CAS  Google Scholar 

  146. Chokroverty S. Proximal nerve dysfunction in diabetic proximal amyotrophy. Arch Neurol. 1982;39:403–7.

    PubMed  CAS  Google Scholar 

  147. Dyck PJB, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology. 1999;53:2113–21.

    PubMed  CAS  Google Scholar 

  148. Dyck PJB, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve. 2002;25:477–91.

    PubMed  Google Scholar 

  149. Williams IR, Mayer RF. Subacute proximal diabetic neuropathy. Neurology. 1976;26:108–16.

    PubMed  CAS  Google Scholar 

  150. Said G, Thomas PK. Proximal diabetic neuropathy. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders; 1999. p. 474–80.

    Google Scholar 

  151. Garces-Sanchez M, Laughlin RS, Dyck PJ, et al. Painless diabetic motor neuropathy: a variant of diabetic lumbosacral radiculoplexus neuropathy? Ann Neurol. 2011;69:1043–54.

    PubMed  Google Scholar 

  152. Said G. Focal and multifocal diabetic neuropathies. Arq Neuropsiquiatr. 2007;65:1272–8.

    PubMed  Google Scholar 

  153. Dyck PJB. Radiculoplexus neuropathies: diabetic and nondiabetic varieties. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1993–2016.

    Google Scholar 

  154. Said G, Goulon-Goeau C, Lacroix C, Moulonguet A. Nerve biopsy findings in different patterns of proximal diabetic neuropathy. Ann Neurol. 1994;35:559–69.

    PubMed  CAS  Google Scholar 

  155. Said G, Elgrably F, Lacroix C, et al. Painful proximal diabetic neuropathy: inflammatory nerve lesions and spontaneous favorable outcome. Ann Neurol. 1997;41:762–70.

    PubMed  CAS  Google Scholar 

  156. Llewelyn JG, Thomas PK, King RHM. Epineurial microvasculitis in proximal diabetic neuropathy. J Neurol. 1998;45:159–65.

    Google Scholar 

  157. Kelkar P, Masood M, Parry GJ. Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy). Neurology. 2000;55:83–8.

    PubMed  CAS  Google Scholar 

  158. Coppack SW, Watkins PJ. The natural history of diabetic femoral neuropathy. Q J Med. 1991;79:307–13.

    PubMed  CAS  Google Scholar 

  159. Chokroverty S, Reyesw MG, Rubino FA, et al. The syndrome of diabetic amyotrophy. Ann Neurol. 1977;2:181–94.

    PubMed  CAS  Google Scholar 

  160. Casey EB, Harrison MJG. Diabetic amyotrophy: a follow-up study. Br Med J. 1992;1:656–70.

    Google Scholar 

  161. Pascoe MK, Low PA, Windebank AJ, Litchy WJ. Subacute diabetic proximal neuropathy. Mayo Clin Proc. 1997;72:1123–32.

    PubMed  CAS  Google Scholar 

  162. Subramony SH, Wilbourn AJ. Diabetic proximal neuropathy. J Neurol Sci. 1982;53:293–304.

    PubMed  CAS  Google Scholar 

  163. Locke S, Lawrence DG, Legg MA. Diabetic amyotrophy. Am J Med. 1963;34:775–80.

    PubMed  CAS  Google Scholar 

  164. Leedman PJ, Davis S, Harrison LC. Diabetic amyotrophy: reassessment of the clinical spectrum. Aust N Z J Med. 1988;18:768–73.

    PubMed  CAS  Google Scholar 

  165. Katz JS, Saperstein DS, Wolfe G, et al. Cervicobrachial involvement in diabetic radiculoplexopathy. Muscle Nerve. 2001;24:794–8.

    PubMed  CAS  Google Scholar 

  166. Chopra JS, Hurwitz LJ. Femoral conduction in diabetes and chronic occlusive vascular disease. J Neurol Neurosurg Psychiatry. 1968;31:48–53.

    Google Scholar 

  167. Thaisetthawatkul P, Dyck PJB. Treatment of diabetic and nondiabetic lumbosacral radiculoplexus neuropathy. Curr Treat Options Neurol. 2010;12:95–9.

    PubMed  Google Scholar 

  168. Chan YC, Lo YL, Chan E. Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev. 2009;(3):CD006521.

    Google Scholar 

  169. Kilfoyle D, Kelkar P, Parry G. Pulsed methylprednisolone is a safe and effective treatment for diabetic amyotrophy. J Clin Neuromuscul Dis. 2003;4:168–70.

    PubMed  CAS  Google Scholar 

  170. Watanabe K, Hagura R, Akanuma Y, et al. Characteristics of cranial nerve palsies in diabetic patients. Diabetes Res Clin Pract. 1990;10:19–27.

    PubMed  CAS  Google Scholar 

  171. Trigler L, Siatkowski RM, Oster AS, et al. Retinopathy in patients with diabetic ophthalmoplegia. Ophthalmology. 2003;110:1545–50.

    PubMed  Google Scholar 

  172. Richards BW, Jones FR, Younge BR. Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol. 1992;113:489–99.

    PubMed  CAS  Google Scholar 

  173. Asbury AK, Aldredge H, Hershberg R, Fisher CM. Oculomotor palsy in diabetes mellitus: a clinico-pathological study. Brain. 1970;93:555–66.

    PubMed  CAS  Google Scholar 

  174. Liu GT, Volpe NJ, Galetta SL. Eye movement disorders: third, fourth, and sixth nerve palsies and other causes of diplopia and ocular misalignment. In: Liu GT, Volpe NJ, Galetta SL, editors. Neuro-ophthalmology: diagnosis and management. 2nd ed. Philadelphia: Saunders Elsevier; 2010. p. 491–545.

    Google Scholar 

  175. Brazis PW. Isolated palsies of cranial nerves III, IV and VI. Semin Neurol. 2009;29:14–28.

    PubMed  Google Scholar 

  176. Goldstein JE, Cogan DG. Diabetic ophthalmoplegia with special reference to the pupil. Arch Ophthalmol. 1960;64:592–600.

    PubMed  CAS  Google Scholar 

  177. Aminoff MJ, Miller AL. The prevalence of diabetes mellitus in patients with Bell’s palsy. Acta Neurol Scand. 1972;48:381.

    PubMed  CAS  Google Scholar 

  178. Pecket P, Schattner A. Concurrent Bell’s palsy and diabetes mellitus: a diabetic mononeuropathy? J Neurol Neurosurg Psychiatry. 1982;45:652–5.

    PubMed  CAS  Google Scholar 

  179. Adour KK, Wingerd J, Doty HE. Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell’s palsy). Diabetes. 1975;24:449–51.

    PubMed  CAS  Google Scholar 

  180. Korczyn AD. Bell’s palsy and diabetes mellitus. Lancet. 1971;1:108–9.

    PubMed  CAS  Google Scholar 

  181. Bosco D, Plastino M, Bosco F, et al. Bell’s palsy: a manifestation of prediabetes? Acta Neurol Scand. 2011;123:68–72.

    PubMed  CAS  Google Scholar 

  182. Adour KK, Bell DN, Wingerd J. Bell palsy: dilemma of diabetes mellitus. Arch Otolaryngol. 1974;99:114–7.

    PubMed  CAS  Google Scholar 

  183. Monini S, Lazzarino AI, Iacolucci C, et al. Epidemiology of Bell’s palsy in an Italian Health District: incidence and case–control study. Acta Otorhinolaryngol Ital. 2011;30:198–204.

    Google Scholar 

  184. Thomander L, Stalberg E. Electroneurography in the prognostication of Bell’s palsy. Acta Laryngol. 1981;92:221–8.

    CAS  Google Scholar 

  185. Stewart JD. Thoracic spinal nerves. In: Stewart JD, editor. Focal peripheral neuropathies. 4th ed. Vancouver: JBJ Publishing; 2010. p. 592–605.

    Google Scholar 

  186. Sun SF, Streib EW. Diabetic thoracoabdominal neuropathy: clinical and electrodiagnostic features. Ann Neurol. 1981;9:75–9.

    PubMed  CAS  Google Scholar 

  187. Watkins PJ, Thomas PK. Diabetic radiculoplexus neuropathies. In: Dyck PJ, Thomas PK, editors. Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders; 1999. p. 468–73.

    Google Scholar 

  188. Longstreth GF, Newcomer AD. Abdominal pain caused by diabetic radiculopathy. Ann Intern Med. 1977;86:166–8.

    PubMed  CAS  Google Scholar 

  189. Longstreth GF. Diabetic thoracic polyradiculopathy: ten patients with abdominal pain. Am J Gastroenterol. 1997;92:502–5.

    PubMed  CAS  Google Scholar 

  190. Stewart JD. Diabetic truncal neuropathy: topography of the sensory deficit. Ann Neurol. 1989;25:233–8.

    PubMed  CAS  Google Scholar 

  191. Boulton AMJ, Angus E, Ayyar DR. Diabetic thoracic polyradiculopathy presenting as an abdominal swelling. Br Med J. 1984;289:798–9.

    CAS  Google Scholar 

  192. Parry GJ, Floberg J. Diabetic truncal neuropathy presenting as abdominal hernia. Neurology. 1989;39:1488–90.

    PubMed  CAS  Google Scholar 

  193. Waxman SG, Sabin TD. Diabetic truncal polyneuropathy. Arch Neurol. 1981;38:46–7.

    PubMed  CAS  Google Scholar 

  194. Kitka DG, Breuer AC, Wilbourn AJ. Thoracic root pain in diabetes: the spectrum of clinical and electromyographic findings. Ann Neurol. 1982;11:80–5.

    Google Scholar 

  195. Lauria G, McArthur JC, Hauer PE, et al. Neuropathological alteration in diabetic truncal neuropathy: evaluation by skin biopsy. J Neurol Neurosurg Psychiatry. 1998;65:762–6.

    PubMed  CAS  Google Scholar 

  196. Tracy JA, Dyck PJB. The spectrum of diabetic neuropathies. Phys Med Rehabil Clin N Am. 2008;19:1–25.

    PubMed  Google Scholar 

  197. Albers JW, Brown MB, Sima AAF, Greene DA. Frequency of median neuropathy in patients with mild diabetic neuropathy in the early intervention trial (EDIT). Muscle Nerve. 1996;19:140–6.

    PubMed  CAS  Google Scholar 

  198. Dyck PJ, Giannini C. Pathologic alterations in diabetic neuropathies of humans: a review. J Neuropathol Exp Neurol. 1996;55:1181–93.

    PubMed  CAS  Google Scholar 

  199. Geogheghan JM, Clark DI, Bainbridge LC, et al. Risk factors in carpal tunnel syndrome. J Hand Surg. 2004;29B:313–20.

    Google Scholar 

  200. Stevens JC, Beard CM, O’Fallon WM, Kurland LT. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc. 1992;67:541–8.

    PubMed  CAS  Google Scholar 

  201. Gulliford MC, Latinovic R, Charlton J, Hughes RA. Increased incidence of carpal tunnel syndrome up to 10 years before diagnosis of diabetes. Diabetes Care. 2006;29:1929–30.

    PubMed  Google Scholar 

  202. Vinik A, Mehrabyan A, Colen L, Boulton A. Focal entrapment neuropathies in diabetes. Diabetes Care. 2004;27:1783–8.

    PubMed  Google Scholar 

  203. Kapritskaya Y, Novak C, Mackinnon S. Prevalence of smoking, obesity, diabetes mellitus and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg. 2002;48:269–79.

    Google Scholar 

  204. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44:597–607.

    PubMed  Google Scholar 

  205. Stevens JC. Median neuropathy. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 1435–61.

    Google Scholar 

  206. Clayburgh RH, Benkenbaugh RD, Dobyns JH. Carpal tunnel release in patients with diffuse peripheral neuropathy. J Hand Surg. 1987;12A:380–3.

    Google Scholar 

  207. Ozkul Y, Sabunca T, Kobabey Y, Nazligul Y. Outcomes of carpal tunnel release in diabetic and non-diabetic patients. Acta Neurol Scand. 2002;106:168–72.

    PubMed  CAS  Google Scholar 

  208. Thomsen NO, Cederlund R, Rosen I, et al. Clinical outcomes of surgical release among diabetic patients with carpal tunnel syndrome: prospective follow-up with matched controls. J Hand Surg. 2009;34A:1177–87.

    Google Scholar 

  209. Al-Qattan MM, Manktelow RT, Bowen CVA. Outcome of carpal tunnel release in diabetic patients. J Hand Surg. 1994;19B:626–9.

    Google Scholar 

  210. Fry IK, Hardwick C, Scott CW. Diabetic neuropathy: a survey and follow-up on 66 cases. Guys Hosp Rep. 1962;111:113–29.

    PubMed  CAS  Google Scholar 

  211. Warner MA, Warner ME, Martin JT. Ulnar neuropathy: incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology. 1994;81:1332–40.

    PubMed  CAS  Google Scholar 

  212. Wadsworth TG. The external compression syndrome of the ulnar nerve at the cubital tunnel. Clin Orthop Relat Res. 1977;124:189–204.

    PubMed  Google Scholar 

  213. LeRoux PD, Ensign TD, Burchiel KJ. Surgical decompression without transposition for ulnar neuropathy: factors determining outcome. Neurosurgery. 1990;27:709–14.

    PubMed  CAS  Google Scholar 

  214. Schady W, Abuaisha B, Boulton AJ. Observations on severe ulnar neuropathy in diabetes. J Diabetes Complications. 1998;12:128–32.

    PubMed  CAS  Google Scholar 

  215. Katirji MB, Wilbourn AJ. Common peroneal neuropathy: a clinical and electrophysiological study of 116 cases. Neurology. 1988;38:1723–8.

    PubMed  CAS  Google Scholar 

  216. Aprile I, Caliandro P, La Torre G, et al. Multicenter study of peroneal mononeuropathy: clinical, neurophysiologic, and quality of life assessment. J Peripher Nerv Syst. 2005;10:259–68.

    PubMed  Google Scholar 

  217. Parisi TJ, Mandrekar J, Dyck JB, et al. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77:1538–42.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shawn J. Bird MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bird, S.J., Brown, M.J. (2014). Diabetic Neuropathies. In: Katirji, B., Kaminski, H., Ruff, R. (eds) Neuromuscular Disorders in Clinical Practice. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6567-6_31

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6567-6_31

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6566-9

  • Online ISBN: 978-1-4614-6567-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics