Neurological manifestations of Diabetes

 Neurological Manifestations of Diabetes

"Diabetic Polyneuropathy"

 

Pathogenesis:

1. Diabetic microangiopathy of the vasa nervosa.
2. Ischaemia of the nerves, 2ry to atherosclerosis of vasa nervosa.
3. Nutritional 2ry to hypovitaminosis (vit. B1, B6 and B12).
4. Metabolic due to production of toxic ketonic bodies, leading to nerve damage.

Clinical Picture:

1. In early diabetes  or in the pre-diabetic stage, the neuropathy is of mononeuritic type which may affect the sciatic. femoral, lateral popliteal, ulnar or median nerves or cranial 3,6,7 nerves.
2. In the frank diabetes, the neuropathy is of the poly neuritic type.
3. The polyneuropathy is mainly sensory with pain and parathesia specially in the lower limbs followed by superficial sensory loss of stock and glove type. the deep sensations are also lost early in the disease,resulting in loss of deep reflexes and sensory ataxia.
4. The muscle sense is increased at first resuting in tender calf followed later on by lost muscle sense.
5. Motor weakness may occur late in the disease.
6. Autonomic manifestations:

• Impotence.
• Sensory, motor or autonomic bladder.
• Postural hypotention.
• Silent myocardial infarction.
• Gastroparesis diabeticorum: indigestion and delayed gastric emptying.
• Hyperhydrosis.
• Trophic skin changes: Ulcers, loss of hair, brittle nails, charcot's neuropathic joint.

Treatment:

1. Proper management of diabetes: diet, oral hypoglycemic drugs or insulin.
2. Vasodilator as Piribedil(Trivastal) 50 mg daily.
3. Capillary modulators: Ca Dobesilate(Doxium).
4. Vitamins B1 100 mg daily, B6 200 mg daily, B12 1000 micro gram  dailyand A.T.P.(Adnoplex).
5. Carbamazepine(Tegretol) 200 mg twice daily or Gabapentine(Neurontine) 400 mg twice daily for neuropathic pain.
6. Physiotherapy if motor weakness is present.