Diabetic Lumbosacral Plexopathy
- Author: Divakara Kedlaya, MBBS; Chief Editor: Robert H Meier, III, MD more...
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. 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.
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.
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. 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. 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.
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.
The patient should be educated in the importance of good glycemic control in conjunction with proper diet and exercise. During rehabilitation, in order to improve functional recovery, the patient should be taught exercises to regain strength in the affected muscle groups.
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