DR Medhat MRCP

• Common examples for peripheral neuropathy :
Diabetic neuropathy.
Guillain–Barré syndrome (GBS)
Chronic inflammatory demyelinating polyneuropathy (CIDP).
Diabetic neuropathy
• Pathogenesis :
- D.neuropathy occurs due to affection (microangiopathy,atherosclerosis &vit B12
deficiency ) of vasa nervosa supplying the peripheral nerves.
• Clinical picture :
Early (pre-diabetic)
)stage
Mononeuropathy
Frank DM
Polyneuropathy
Lower limbs
1. Common
peroneal n.
2. Tibial n.
3. Sciatic n.
4. Femoral n.
Upper limbs
1. Median n.
2. Ulnar n.
3. Radial n.
Cranial nerves
1. 3 rd nerve.
2. 4 th nerve.
3. 7 th nerve.
1. Mainly sensory (the 1 st
sensation lost is vibration
sense)
2. Motor (LMN) .
3. Autonomic.
- Impotence
- Postural hypotension
- Gastroparesis .
- Neuropathic d. foot.
• Management : NICE guidance on the management of DM neuropathy of 2010:
First-line: oral duloxetine. Oral amitriptyline if duloxetine is contraindicated.
Second-line treatment:
a) If first-line treatment was with duloxetine: switch to amitriptyline or
pregabalin, or combine with pregabalin.
b) If first-line treatment was with amitriptyline, switch to or combine with
pregabalin.
Other options: pain management clinic, tramadol (not other strong opioids),
If patients unable to take oral medication Consider capsaicin ointment (red pepper
extract) local application or topical lidocaine for localised pain.
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