Clinical and Electrophysiological Evaluation of Patients with Diabetic Neuropathy.

Peripheral neuropathy caused by Diabetes (DM) was recognised only in 1864 by Marchel de Calvi. Till then it was assumed that diabetes was caused by disease of the nervous system. However, once the relationship was rightly recognized, much documentary evidence soon emerged regarding the various clinical manifestations occurring in diabetic peripheral neuropathy. Thus, the loss of tendon reflexes in the legs was described by Bouchard (1887) similarities to tabes stressed by Althaus (1885), spontaneous pain and hyperesthesia by Pavy (1885)(1904) and motor manifestations by Bruns (1890) and Charcot (1890) and cranial nerve involvement by Ogle (1896). While Leyden (1893) and Pryce (1893) set out a classification of the different manifestations of the disease, is was Rundles11 who in 1945 first drew attention to the autonomic nerve involvement in diabetes. Later, scientists turned their interest to the etiopathogenetic mechanisms resulting in peripheral neuropathy. This in turn gave impetus to the experimental production of diabetic neuropathy (DN) in order to understand the evolution of the disease. Though a large volume of work has been carried out in this regard and many problems solved, many questions still remain unanswered. There is a need, therefore, for more comprehensive studies of the prevalence, severity, natural history, and cause of specific types of diabetic neuropathy. To assess the incidence of various types of Diabetic Neuropathies To examine the Clinical Profile of each type of Diabetic Neuropathy To study the Neurophysiologic patterns in each type of Diabetic Neuropathy and the extent of their clinical correlation. Conclusions: 1) Among the different types of Diabetic neuropathy, chronic sensorimotor neuropathy was the commonest, with a prevalence of 48%. Autonomic neuropathy had a prevalence of 31.4%. AN was almost always associated with sensory neuropathy. Among the focal neuropathies CIDP was the commonest 2) 65% of patients with clinical neuropathy showed abnormalities on nerve conduction studies and the remaining had normal NCS but they had features of small fiber neuropathy with autonomic signs. Nearly 30% of patients with no upper limb symptoms showed abnormalities in NCS. showing a discordance between symptoms and nerve conduction studies 3) Longer duration of DM strongly correlated with abnormalities in NCS, the mean duration of 7.4 years in patients with NCS abnormalities compared to 3.1 years in those with only lower limb NCS changes. 4) Prolonged poorly controlled diabetes was an important risk factor associated with diabetic neuropathy. Aggressive/strict control of blood glucose is the key in the ultimate prevention of diabetic neuropathy