Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy.

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Version: Final published version
Serval ID
serval:BIB_D7566BA100A9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy.
Journal
Swiss Medical Weekly
Author(s)
Tran C., Philippe J., Ochsner F., Kuntzer T., Truffert A.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
145
Pages
w14131
Language
english
Notes
Publication types: Journal Article Publication Status: epublish
Abstract
INTRODUCTION: Acute painful diabetic neuropathy (APDN) is a distinctive diabetic polyneuropathy and consists of two subtypes: treatment-induced neuropathy (TIN) and diabetic neuropathic cachexia (DNC). The characteristics of APDN are (1.) the small-fibre involvement, (2.) occurrence paradoxically after short-term achievement of good glycaemia control, (3.) intense pain sensation and (4.) eventual recovery. In the face of current recommendations to achieve quickly glycaemic targets, it appears necessary to recognise and understand this neuropathy.
METHODS AND RESULTS: Over 2009 to 2012, we reported four cases of APDN. Four patients (three males and one female) were identified and had a mean age at onset of TIN of 47.7 years (±6.99 years). Mean baseline HbA1c was 14.2% (±1.42) and 7.0% (±3.60) after treatment. Mean estimated time to correct HbA1c was 4.5 months (±3.82 months). Three patients presented with a mean time to symptom resolution of 12.7 months (±1.15 months). One patient had an initial normal electroneuromyogram (ENMG) despite the presence of neuropathic symptoms, and a second abnormal ENMG showing axonal and myelin neuropathy. One patient had a peroneal nerve biopsy showing loss of large myelinated fibres as well as unmyelinated fibres, and signs of microangiopathy.
CONCLUSIONS: According to the current recommendations of promptly achieving glycaemic targets, it appears necessary to recognise and understand this neuropathy. Based on our observations and data from the literature we propose an algorithmic approach for differential diagnosis and therapeutic management of APDN patients.
Pubmed
Web of science
Open Access
Yes
Create date
12/06/2015 16:39
Last modification date
20/08/2019 15:57
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