Advances in diagnosis and management of distal sensory polyneuropathies

Abstract

Distal sensory polyneuropathy (DSP) is characterised by length-dependent, sensory-predominant symptoms and signs, including potentially disabling symmetric chronic pain, tingling and poor balance. Some patients also have or develop dysautonomia or motor involvement depending on whether large myelinated or small fibres are predominantly affected. Although highly prevalent, diagnosis and management can be challenging. While classic diabetes and toxic causes are well-recognised, there are increasingly diverse associations, including with dysimmune, rheumatological and neurodegenerative conditions. Approximately half of cases are initially considered idiopathic despite thorough evaluation, but often, the causes emerge later as new symptoms develop or testing advances, for instance with genetic approaches. Improving and standardising DSP metrics, as already accomplished for motor neuropathies, would permit in-clinic longitudinal tracking of natural history and treatment responses. Standardising phenotyping could advance research and facilitate trials of potential therapies, which lag so far. This review updates on recent advances and summarises current evidence for specific treatments.

Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

“…206 In contrast, distal lower limb CMAP prolongation can be seen in up to 66% of DSPN cases and temporal dispersion in 19%, based on a single cohort. 207 Skin biopsy performed for the examination of intraepidermal nerve fiber density (IENFD) is primarily used in the setting of small fiber neuropathy 145 ; however, its utility has expanded to a wider range of neurological conditions. 208 In patients with DSPN specifically, a large prospective cohort of patients recently diagnosed with diabetes found abnormal IENFD in 16.7% of individuals with Type 1 and 20.3% of individuals with Type 2 diabetes at baseline, which increased to 33.3% and 30.4% respectively after 5 years.…”

“…The causes of peripheral polyneuropathy are myriad, and each neuropathy subtype has unique components to the diagnostic process. In this review, we focus on the diagnoses of Guillain‐Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy, and diabetic neuropathy noting that controversies exist in the diagnosis of other neuropathy types, such as distal sensory neuropathy 145 …”

Modern view on the use of alpha lipoic acid in neurological practice

“…ДПН -наиболее часто встречающееся осложнение сахарного диабета (СД), которое характеризуется нарушением функции периферических нервов. Диагноз ДПН выставляется при условии исключения иных причин полинейропатии, что может быть достаточно затруднительным, учитывая наличие коморбидных или мультиморбидных состояний [37]. Особенно сложными для диагностики являются пациенты с сочетанной патологией, например, случаи когда у одного и того же пациента имеется ДПН и радикулопатия [38].…”