- Distal symmetric sensory polyneuropathy
- Clinical
- Sensory symptoms
- Common features
- Distal symmetrical sensory loss; : stocking glove sensory loss pattern with proximal progression
- Numbness
- Tingling
- Dysesthesia (e.g., burning feet syndrome with symptoms that worsen at night)
- Less common features
- Motor weakness:
- Fibre loss – numbness/weakness
- Doesn’t effect large fibres – motor/power should not be affected
- Worse at night
- Autonomic symptoms
- are not prominent early in disease
- characterized by damage to small fiber autonomic nerves; multiple organ systems are susceptible.
- Genitourinary autonomic neuropathy
- Sexual dysfunction (e.g., erectile dysfunction)
- Neurogenic bladder e.g.: Urinary retention, Incomplete bladder emptying, Bladder distention, overflow incontinence, Poor urinary stream)
- Cardiovascular autonomic neuropathy
- Early: decreased heart variability
- Late: Orthostatic hypotension, Tachycardia at rest
- Gastrointestinal autonomic neuropathy
- Diabetic gastroparesis
- Stool changes (e.g., diarrhea, fecal incontinence, constipation)
- Esophageal dysmotility
- Other autonomic neuropathies
- Impaired pupillary tone
- Sudomotor dysfunction: Dry skin. Heat intolerance, Abnormal sweating (e.g., anhidrosis)
- Hypoglycemia unawareness
- Examination to assess peripheral neuropathy
- Small fibre (unmyelinated fibres – thermal, autonomic, pain)
- Loss of protective sensation
- Pinprick sensation -10g monofilament under great toes and metatarsal joints
- Large fibre (myelinated- weakness, wasting, impaired vibration)
- Impaired vibration – Vibration – 128 Hz
- Loss of joint position
- Ankle reflexes
- Treatment
- Amitryptilline first line painful neuropathy
- Anticonvultants – pregabalin/gabapentin/valproate
- Anti-depressants – amitryptilin, duloxetine, venlafaxine
- Topical nitrate spray
- Opiates
- Capasicin cream
- Complications
- Foot ulcers
- Atrophy of foot muscles – claw foot deformity
Related