[Diabetic somatic polyneuropathy. Pathogenesis, clinical manifestations and therapeutic concepts].

摘要: Diabetic polyneuropathy is the most frequent neuropathy in western countries. In Germany, there are 3.5 to 4 million diabetic patients. Diagnosis should rule out other polyneuropathies and assess two of five diagnostic criteria: neuropathic symptoms, deficits, pathological nerve conduction studies, quantitative sensory testing autonomic testing. So far, pathophysiology remains be fully understood. Among various pathophysiological concepts Sorbitol-Myo-Inositol hypothesis attributing Myo-Inositol depletion accumulation Sorbitol Fructose, concept deficiency essential fatty acids with reduced availability gamma-linolenic-acid prostanoids, pseudohypoxia- hypoxia-hypothesis endothelial axonal dysfunction structural lesions increased oxidative stress free radical production. Obviously, hyperglycemia induced generation advanced glycation end products (AGEs) also contributes dysfunctions lesions. Elevated levels circulating immune complexes activated T-lymphocytes as well identification autoantibodies against vagus or sympathetic ganglia support an mediated neuropathy. The reduction neurotrophic factors such growth factor, neurotrophin-3 insulin-like seems further symmetrical, distally pronounced predominantly far more than symmetrical predominant motor weakness asymmetrical painless manifests impaired light touch sensation, position sense, vibratory perception diminished absent ankle deep tendon reflexes. painful primarily affects small fibers accounts for decreased temperature paresthesias. proximal, amyotrophy evolves subacutely acutely, induces proximal thigh buttock muscles painful. Cranial III-neuropathy has acute onset. Truncal radiculopathy follows distribution truncal roots frequently causes intense pain. Autonomic occurs without somatic important therapy attempt optimal blood glucose control, reduce body weight hyperlipidemia. Symptomatic includes alpha-lipoic acid treatment, antioxidant improve symptoms. Aldose reductase inhibitors might sorbitol fructose production normalize myo-inositol levels. However, no aldose available Europe yet. Evening primrose oil, containing gamma-linolenic acid, velocities, perception, muscle strength, reflexes function. Substitution factor showed promising results pilot studies but failed a large-scale multicenter study. pain treatment can achieved tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants carbamazepine, gabapentin lamotrigine, anti-arrhythmic drugs mexiletine. Topical capsaicin application local discomfort beginning therapy. Vasoactive substances, so have not proven major benefit Physical thorough footcare primary importance allow prevention secondary complications foot amputations.