Progressive polyradiculoneuropathy in diabetes: correlation of variables and clinical outcome after immunotherapy

Objective-To quantify the progression of diabetic polyradiculoneuropathy-a condition in which immune factors have been implicated-after immunotherapy. Methods-The study evaluated 15 consecutive patients with this condition. Al l patients were older than 40. Four had type I diabetes and six were women. The duration of pre-existing diabetes varied from 2 to 20 years. The clini cal presentation was dominated by painful progressive motor weakness, with or without exacerbation of sensory symptoms. The weakness involved all limb s, but was often asymmetric. Results-Electrophysiological testing showed a predominantly axonal polyneur opathy, with more recent denervating polyradiculopathy. Analysis of CSF sho wed increased protein in 14 and oligoclonal bands in five. Quantitative aut onomic tests showed abnormalities in all patients. Sural nerve biopsy was p erformed in 14 patients; all showed fibre loss and segmental demyelination, four had occasional onion bulbs, and 10 showed various inflammatory infilt rates. After immunomodulating therapy, there was no further deterioration a nd clinical improvement occurred in all patients. Sweat responses, cardiova scular reflexes, and sural nerve fibre density correlated best with functio nal outcome. There was no significant difference between plasmapheresis and intravenous gammaglobulin. Conclusion-Immunotherapy may improve this condition, but only certain varia bles correlate with rapid therapeutic response.