Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Diabetic Lumbosacral Plexopathy

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Robert H Meier, III, MD  more...
 
Updated: Oct 20, 2015
 

Background

Proximal neuropathy in diabetes mellitus (DM) is a condition in which patients develop severe aching or burning and lancinating pain in the hip and thigh. This is followed by weakness and wasting of the thigh muscles, which often occur asymmetrically. This disabling condition occurs in type 1 and type 2 DM. Bruns first described the disorder in patients with DM in 1890.[1] In 1955, Garland coined the term diabetic amyotrophy, although the name Bruns-Garland syndrome is also used to describe the condition.[2, 3, 4]

Diabetic amyotrophy, which is distinct from other types of diabetic neuropathy, usually has its onset during or after middle age (although it can occur in younger individuals). Concomitant distal, predominantly sensory neuropathy may exist. The results of most electrodiagnostic studies are consistent with the presence of a neurogenic lesion that could be associated with lumbosacral plexopathy, radiculopathy, or proximal crural neuropathy.[5, 6, 7, 8] However, the exact cause of diabetic lumbosacral plexopathy is not known.[9]

For more information, see Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetic Neuropathy, and Electrophysiology.

Next

Pathophysiology

The underlying pathogenesis of diabetic lumbosacral plexopathy and the site of the lesion are not clearly understood and remain subjects of controversy.[5, 10] The condition is most likely caused by inflammatory, immune-mediated vascular radiculoplexopathy.[11, 12, 13, 14] Most authors now favor an immune vasculopathy as the cause of diabetic amyotrophy. Studies suggest a role for immunomodulating agents in certain types of diabetic neuropathy, including diabetic amyotrophy.[15]

Previous
Next

Epidemiology

In the United States, the overall prevalence of diabetic lumbosacral plexopathy among individuals with diabetes is 0.08%, although the condition occurs more frequently in persons with type 2 diabetes (1.1%) than in those with the type 1 disease (0.3%).

Morbidity related to diabetic lumbosacral plexopathy is mainly secondary to pain, proximal muscle wasting, and weakness, causing difficulty getting up from a chair and climbing stairs.

No race or sex predilection exists for diabetic lumbosacral plexopathy; however, the condition occurs most commonly in patients aged 50 years or older. In a series of 12 cases reported by Casey and Harrison, no patient was younger than 50 years, and 10 patients were older than 60 years.[16] In a large series of 105 patients with diabetic amyotrophy reported by Bastron and Thomas, the age of onset ranged from 36 to 83 years; symptoms progressed over an average of 6.2 months, with 9.5% of patients having painless muscle weakness.[17] Diabetic lumbosacral plexopathy is rare in children; only 3 cases of the condition in children aged 13-16 years have been reported in the literature.

Previous
Next

Prognosis

Good functional recovery within 12-24 months is expected in 60% of patients with diabetic lumbosacral plexopathy, although mild weakness, discomfort, and stiffness often persist for years. Occasional relapses can occur.

Previous
Next

Patient Education

The patient should be educated in the importance of good glycemic control in conjunction with proper diet and exercise.[18] During rehabilitation, in order to improve functional recovery, the patient should be taught exercises to regain strength in the affected muscle groups.

Previous
 
 
Contributor Information and Disclosures
Author

Divakara Kedlaya, MBBS Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aishwarya Patil, MD Physiatrist (Rehabilitation Physician), Vice Chair, Immanuel Rehabilitation Center

Aishwarya Patil, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Association of Physicians of India

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Teresa L Massagli, MD Professor of Rehabilitation Medicine, Adjunct Professor of Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References
  1. Bruns L. Uberneuritsche lahmungen beim diabetes mellitus. Berl Klin Wochenschr. 1890. 27:509-15.

  2. GARLAND H. Diabetic amyotrophy. Br Med J. 1955 Nov 26. 2(4951):1287-90. [Medline]. [Full Text].

  3. Asbury AK. Proximal diabetic neuropathy. Ann Neurol. 1977 Sep. 2(3):179-80. [Medline].

  4. Locke S, Lawrence DG, Legg MA. Diabetic amyotrophy. Am J Med. 1963 Jun. 34:775-85. [Medline].

  5. Sander HW, Chokroverty S. Diabetic amyotrophy: current concepts. Semin Neurol. 1996 Jun. 16(2):173-8. [Medline].

  6. Tracy JA, Dyck PJ. The spectrum of diabetic neuropathies. Phys Med Rehabil Clin N Am. 2008 Feb. 19(1):1-26, v. [Medline]. [Full Text].

  7. Raff MC, Asbury AK. Ischemic mononeuropathy and mononeuropathy multiplex in diabetes mellitus. N Engl J Med. 1968 Jul 4. 279(1):17-21. [Medline].

  8. Taylor BV, Dunne JW. Diabetic amyotrophy progressing to severe quadriparesis. Muscle Nerve. 2004 Oct. 30(4):505-9. [Medline].

  9. Brown MJ, Asbury AK. Diabetic neuropathy. Ann Neurol. 1984 Jan. 15(1):2-12. [Medline].

  10. Williams IR, Mayer RF. Subacute proximal diabetic neuropathy. Neurology. 1976 Feb. 26(2):108-16. [Medline].

  11. Dyck PJ, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology. 1999 Dec 10. 53(9):2113-21. [Medline].

  12. Harrison MJ, Casey EB. Diabetic amyotrophy. Br Med J. 1972 Jul 29. 3(5821):293. [Medline]. [Full Text].

  13. Pascoe MK, Low PA, Windebank AJ, Litchy WJ. Subacute diabetic proximal neuropathy. Mayo Clin Proc. 1997 Dec. 72(12):1123-32. [Medline].

  14. Kawamura N, Dyck PJ, Schmeichel AM, Engelstad JK, Low PA, Dyck PJ. Inflammatory mediators in diabetic and non-diabetic lumbosacral radiculoplexus neuropathy. Acta Neuropathol. 2008 Feb. 115(2):231-9. [Medline].

  15. Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve. 2002 Apr. 25(4):477-91. [Medline].

  16. Casey EB, Harrison MJ. Diabetic amyotrophy: a follow-up study. Br Med J. 1972 Mar 11. 1(5801):656-9. [Medline]. [Full Text].

  17. Bastron JA, Thomas JE. Diabetic polyradiculopathy: clinical and electromyographic findings in 105 patients. Mayo Clin Proc. 1981 Dec. 56(12):725-32. [Medline].

  18. Gulve EA. Exercise and glycemic control in diabetes: benefits, challenges, and adjustments to pharmacotherapy. Phys Ther. 2008 Nov. 88(11):1297-321. [Medline].

  19. Russell JW, Berent-Spillson A, Vincent AM, Freimann CL, Sullivan KA, Feldman EL. Oxidative injury and neuropathy in diabetes and impaired glucose tolerance. Neurobiol Dis. 2008 Jun. 30(3):420-9. [Medline]. [Full Text].

  20. Barohn RJ, Sahenk Z, Warmolts JR, Mendell JR. The Bruns-Garland syndrome (diabetic amyotrophy). Revisited 100 years later. Arch Neurol. 1991 Nov. 48(11):1130-5. [Medline].

  21. Gupta G, Massie R, Doherty TJ, et al. Diabetic Cranio-Cervico-Radiculoplexus Neuropathy. PM R. 2015 May 12. [Medline].

  22. O'Neill BJ, Flanders AE, Escandon SL, Tahmoush AJ. Treatable lumbosacral polyradiculitis masquerading as diabetic amyotrophy. J Neurol Sci. 1997 Oct 22. 151(2):223-5. [Medline].

  23. Matsuda N, Kobayashi S, Ugawa Y. [Skeletal muscle magnetic resonance imaging study in a patient with diabetic lumbosacral radiculoplexus neuropathy]. Rinsho Shinkeigaku. 2014. 54(9):751-4. [Medline].

  24. Deroide N, Bousson V, Mambre L, et al. Muscle MRI STIR signal intensity and atrophy are correlated to focal lower limb neuropathy severity. Eur Radiol. 2014 Sep 26. [Medline].

  25. Younger DS. Diabetic lumbosacral radiculoplexus neuropathy: a postmortem studied patient and review of the literature. J Neurol. 2011 Jul. 258(7):1364-7. [Medline].

  26. Tracy JA, Engelstad JK, Dyck PJ. Microvasculitis in diabetic lumbosacral radiculoplexus neuropathy. J Clin Neuromuscul Dis. 2009 Sep. 11(1):44-8. [Medline].

  27. Tataroglu C, Bicerol B, Kiylioglu N, Ozkul A, Akyol A. Proximal femoral conductions in patients with lumbosacral radiculoplexus neuropathy. Clin Neurol Neurosurg. 2007 Oct. 109(8):654-60. [Medline].

  28. Subramony SH, Wilbourn AJ. Diabetic proximal neuropathy. Clinical and electromyographic studies. J Neurol Sci. 1982 Feb. 53(2):293-304. [Medline].

  29. Kazamel M, Dyck PJ. Sensory manifestations of diabetic neuropathies: anatomical and clinical correlations. Prosthet Orthot Int. 2015 Feb. 39 (1):7-16. [Medline].

  30. Fernandes Filho JA, Nathan BM, Palmert MR, Katirji B. Diabetic amyotrophy in an adolescent responsive to intravenous immunoglobulin. Muscle Nerve. 2005 Dec. 32(6):818-20. [Medline].

  31. Kawagashira Y, Watanabe H, Oki Y, Iijima M, Koike H, Hattori N, et al. Intravenous immunoglobulin therapy markedly ameliorates muscle weakness and severe pain in proximal diabetic neuropathy. J Neurol Neurosurg Psychiatry. 2007 Aug. 78(8):899-901. [Medline]. [Full Text].

  32. Wada Y, Yanagihara C, Nishimura Y, Oka N. A case of diabetic amyotrophy with severe atrophy and weakness of shoulder girdle muscles showing good response to intravenous immune globulin. Diabetes Res Clin Pract. 2007 Jan. 75(1):107-10. [Medline].

  33. Kilfoyle D, Kelkar P, Parry GJ. Pulsed methylprednisolone is a safe and effective treatment for diabetic amyotrophy. J Clin Neuromuscul Dis. 2003 Jun. 4(4):168-70. [Medline].

  34. Dyck PJB, O’Brien P, Bosch EP, et al. The multi-center, double-blind controlled trial of IV methylprednisolone in diabetic lumbosacral radiculoplexus neuropathy. Neurology. Feb 2006. 66(5 Suppl 2):A191.

  35. Chan YC, Lo YL, Chan ES. Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev. 2009 Jul 8. CD006521. [Medline].

  36. Chan YC, Lo YL, Chan ES. Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev. 2012 Jun 13. 6:CD006521. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.