Saturday, October 24, 2009

Is diabetic neuropathy always peripheral?

If so, why? Why doesn't it also involve the CNS?
Definition of Diabetic neuropathy

Our Diabetic neuropathy Main Article provides a comprehensive look at the who, what, when and how of Diabetic neuropathy

Diabetic neuropathy: A family of nerve disorders caused by diabetes. Diabetic neuropathies cause numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Neurologic problems in diabetes may occur in every organ system, including the digestive tract, heart, and genitalia. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater is the risk. About half odf diabetics have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years. Diabetic neuropathy is more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. Diabetic neuropathies are classified as peripheral, autonomic, proximal, and focal. Peripheral neuropathy causes pain or loss of feeling in the toes, feet, legs, hands, and arms. Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration and can also affect the nerves that serve the heart and control blood pressure. Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs. Focal neuropathy results in the sudden weakness of one nerve, or a group of nerves, causing muscle weakness or pain. Any nerve in the body may be affected. The blood glucose levels should be brought within the normal range to prevent further nerve damage. Although symptoms may get worse when blood glucose is first brought under control, maintaining lower blood glucose levels over times helps lessen neuropathic symptoms and prevent further problems. Good foot care is mandatory. Analgesics, low doses of antidepressants, and some anticonvulsant medications may be prescribed for relief of pain, burning, or tingling. Some patients may find that walking regularly, taking warm baths, or using elastic stockings may help relieve leg pain.Common Misspellings: diabetic nuropathy, diabetic neurophathy
Causes and Risk Factors of Diabetic Neuropathy
Scientists do not know how diabetic neuropathy occurs, but it is likely that several factors come into play. High blood glucose causes chemical changes in nerves, impairing their ability to transmit nerve signals. High blood glucose also damages blood vessels that carry oxygen and nutrients to the nerves. Also, inherited factors probably unrelated to diabetes may make some people more susceptible to nerve disease than others. Diabetic neuropathy appears to be more common in smokers, people over 40 years of age, and those who have had problems controlling the levels of glucose in their blood.and here is a study about CNS
Public release date: 5-Jul-2001
[ Print Article | E-mail Article | Close Window ]Contact: Dr. Solomon Tesfaye
Lancet Diabetic neurological disease could affect central nervous system
Damage to the nervous system associated with diabetes could influence the central nervous system in addition to the peripheral nervous system, suggest authors of a pilot study published in this week's issue of THE LANCET.
The origins of the neurological disorder diabetic neuropathy (distal symmetrical polyneuropathy), that affects a third of all people with diabetes, is poorly understood. There is no treatment for the disorder which is characterised by numbness and/or pain in the feet that can result in foot ulceration and amputation. However, there is some evidence that the disease process may extend beyond the peripheral nervous system. Simon Eaton and colleagues from the Royal Hallamshire Hospital and Sheffield University, UK, used magnetic resonance imaging (MRI) to measure spinal cord cross-sectional area to assess central nervous system impairment. Analysis of 19 diabetic patients with diabetic neuropathy was compared with 10 diabetic patients without diabetic neuropathy, and a group of 10 healthy controls. There were significant differences in spinal cord area between the groups in specific cervical and thoracic regions (C4/5 and T3/4), with a lower cord area in those with diabetic neuropathy compared to controls. Solomon Tesfaye (one of the investigators) comments: "This research is a pilot study with small numbers of participants, so there is a limit to the conclusions that can be drawn. Further work is required to improve the sensitivity of the measures and prove conclusively that the changes we found are due to a neuropathic process rather than simply the diabetes itself. Additionally, relating the cord area to the severity of neuropathy may help to understand the time course of spinal cord involvement. Our observation of extensive, and potentially irreversible, nerve damage in diabetic neuropathy suggests an important new direction for further research, concentrating on detecting the neuropathic process at an earlier stage, where potential new therapies are more likely to succeed."
Contact: Dr Solomon Tesfaye, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, UK; T) +44 (0)114 271 3479; F) +44 (0)114 271 3708; E) ###
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Yes. The CNS is tangential to the corrollary of the inverse square of the distance from impulse to final sensory output/input sequences with a distinct modification of the transverse sublimal sphygmoid ancillary body.
Peripheral nerve injuries may affect cranial nerves or nerves from the spinal column and their branches. This type of neuropathy (nerve injury) tends to develop in stages. Early on, intermittent pain and tingling is noted in the extremities, particularly the feet. In later stages, the pain is more intense and constant. Finally, a painless neuropathy develops when pain sensation is lost to an area. This greatly increases the risk of severe tissue injury because pain no longer alerts the person to injury.
Autonomic neuropathies affect the nerves that regulate vital functions, including the heart muscle and smooth muscles. Low blood pressure, diarrhea, constipation, sexual impotence, and other symptoms can be caused by autonomic neuropathies
Please see the webpages for more details on Diabetic neuropathy.
By "peripheral," they mean hands and feet, not as an opposite of "central (nervous system)."Diabeteics often get bowel movement disorders and may not feel the chest pain associated with a heart attack due to neuropathy. So it's not just peripheral.
Diabetic neuropathy is basically a typical diabetic microangiopathy - that is to say diabetes causes damage to small blood vessels, including those that supply nerves. Diabetes isn't always peripheral. Diabetic retinopathy (eye damage) is very common and the retina itself is part of the central nervous system. Other central nerves can also be affected by diabetes. The frequency of the neuropathy appears to some extent to be related to the length of the nerve involved (hence diabetic neuropathy starts in the toes). It can also affect the autonomic nervous system (e.g. in erectile dysfunction). Nerves in the central nervous system are generally much shorter. this partially explains the reduced incidence.

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