Updates on Diabetic Lumbosacral Radiculoplexus Neuropathy
presented by Dr. P. James B. Dyck
an open access webinar sponsored by the Peripheral Nerve Society
Tuesday, 11 January 2022
08.00 PST • 10.00 CST • 11.00 EST • 16.00 GMT • 17.00 CET • 01.00 JST (12 Jan) • 03.00 AET (12 Jan)
Lumbosacral radiculoplexus neuropathies (LRPN) are conditions that involve the roots, plexus and nerves of the lower limb. They occur in diabetic patients (DLRPN) and in non-diabetic patients (non-DLRPN). They start focally with pain in the upper lumbar (hip/thigh) more commonly than lower lumbosacral (foot/leg) plexus and evolve into a more widespread and often bilateral illness. They typically have associated weight loss and extreme pain although painless varieties can occur. DLRPN is due to ischemic injury from microvasculitis. A controlled trial of intravenous corticosteroids in DLRPN did not achieve the primary endpoint but many secondary endpoints of pain and positive neuropathic symptoms showed improvement. In an epidemiological study in Olmsted County MN, the incidence of LRPN was found to be 4.16/100,000/year which makes LRPN a more common inflammatory neuropathy than CIDP or GBS in the same population. Diabetic people were 8 times more likely to develop LRPN than non-diabetic people. The clinical features of the epidemiological LRPN cohort were essentially the same as the referral-based cohorts with spontaneous improvement although the community cohort had less severe disease. Long term survival is reduced in LRPN patients and in multivariate analysis diabetes mellitus, age and stroke were mortality risk factors but having an episode of LRPN was not.
P. James B. Dyck, MD, Mayo Clinic, Rochester, MN, USA
P. James B. Dyck, M.D. is a consultant in Neurology and a Professor of Neurology at the Mayo Clinic College of Medicine, Rochester, MN. Jim received his medical doctorate from the University of Minnesota; did a neurology residency at Washington University, St. Louis, MO; and did peripheral nerve, EMG and research fellowships at the Mayo Clinic. In 1999, he joined the neurology faculty at Mayo Clinic. Jim is director of the Neuromuscular (Peripheral Nerve) Pathology Laboratory; the head of the peripheral nerve section; and former head of the United Council of Neurologic Subspecialties Examination Committee for certification in clinical neuromuscular pathology. He is a member of the American Neurological Association and is a fellow of the American Academy of Neurology and has taught at many of their courses. He is the president of the World Federation of Neurology specialty interest group on Neuromuscular Disease / ICNMD meeting.
Overall Jim has published 170 peer-reviewed papers and is a coeditor of the textbook Companion to Peripheral Neuropathy. His main research interests have focused on the clinical features, pathology and treatment of inflammatory diabetic neuropathies most specifically diabetic (DLRPN) and non-diabetic (LRPN) lumbosacral radiculoplexus neuropathy. Jim helped recognize that peripheral neuropathies occur from malnutrition after bariatric (weight loss) surgery and described a form of sensory CIDP (chronic inflammatory sensory polyradiculopathy [CISP]) confined to sensory nerve roots. In a multi-disciplinary approach, Jim has used high resolution MRI to identify focal proximal nerve lesions (root, plexus or nerve) that are then biopsied. This targeted fascicular nerve biopsy approach represents a major advance in diagnosis and management of focal neuropathies. He helped recognize that an inflammatory polyradiculoneuropathy occurred among pork plant workers as an autoimmune reaction to aerosolized porcine brains. Jim was involved in the observation that not all neuropathies occurring after surgery are due to compression or stretch and some are secondary to an inflammatory attack and really are “post-surgical inflammatory neuropathies”. He has also been involved in the study of gene silencers in transthyretin amyloidosis (hATTR).
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