Pathogenesis, evaluation and pathogenetic therapy of diabetic polyneuropathy

Neuropathic pain (NP) is not uncommon in clinical practice. NP can occur when various neural structures are damaged, such as peripheral nerves, spinal roots, spinal cord, and brain structures. Depending on the level of damage, NP is divided into central and peripheral. At the same time, peripheral NP is more common. When diagnosing NP, the results of a physical examination of the patient are the most valuable. In order to study the state of the peripheral neuromotor apparatus, patients undergo stimulation electromyography with an analysis of the conduction along motor fibers and sensory fibers caused by the skin sympathetic potential, and EMG using needle electrodes is often used to verify the level and stage of the pathological process. Difficulties in making a diagnosis arise when a patient has a combination of several types of neuropathic pain and comorbid pathology. For the treatment of NP, antidepressants, anticonvulsants, opioid analgesics, drugs for local anesthesia, botulinum toxin type A are used. Alpha-lipoic (thioctic) acid preparations are used in the treatment of diabetic polyneuropathy. The presence of several nosologies in a patient, each of which has individual manifestations of NP, determines the tactics of treating a particular patient, which is considered on the example of two clinical cases.

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

Khaibullina,

Maksimov,

Khaibullina

2024

Medicinskij sovet

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Alpha lipoic acid (ALA) is an essential cofactor for mitochondrial enzymes, a powerful antioxidant, and an important component of many metabolic processes. Most research on ALA has focused specifically on its antioxidant properties. A number of conditions – aging, atherosclerosis, liver cirrhosis, diabetes mellitus, various types of polyneuropathy, psoriasis and others can significantly reduce the level of ALA in the body. The article analyzes modern literature (107 sources, including 17 systematic reviews and meta-analyses). Traditionally, ALA is used in complex therapy of patients suffering from diabetic and alcoholic polyneuropathy. However, the analysis of studies conducted around the world is not limited to these two nosological forms. The use of ALA as adjuvant therapy for a number of conditions and diseases is justified, as confirmed by clinical studies, systematic reviews and meta-analyses. All studies assessed not only the effectiveness of ALC, but also its safety and the incidence of adverse events and showed that ALC has a high safety profile. ALA has not only a pronounced antioxidant effect, but also the ability to chelate toxic metals, increase intracellular glutathione levels, reduce blood glucose levels, overcome insulin resistance, participate in mitochondrial metabolism, stimulate the production of cAMP, normalize the lipid profile, reduce the level of inflammatory markers, etc. Based on Because of the positive effect of using ALC in the treatment of various symptoms and nosologies, the list of indications requires revision, expansion and addition.

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Pathogenesis, evaluation and pathogenetic therapy of diabetic polyneuropathy

Cited by 3 publications

References 27 publications

Comorbid disorders and risk factors for neiropathic pain in distal diabetic polyneuropathy

Comorbid disorders and risk factors for neiropathic pain in distal diabetic polyneuropathy

Radiculopathy in diabetic polyneuropathy patients: difficulties in the diagnosis and therapy

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

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