Surgical Management of Complicated Peripheral Neuropathies in Diabetic Patients
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- Category: Vol. 83, September 2015
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Surgical Management of Complicated Peripheral Neuropathies in Diabetic Patients, AMR M. SAFWAT, AHMED A. TAHER, AHMED E. AHMED, DALIA R.A. ABD EL-RAHMAN and ABD EL-HAMID H. SHADY
Abstract
Background: The global prevalence of diabetes mellitus in 2011 was 366 million (8.3%), and this figure is also expected to increase to 552 million (9.9%) by 2030. Diabetic Peripheral Neuropathy (DPN) is a frequent complication of diabetes that affects up to 50% diabetic patients in United States. It is a major cause of morbidity and increased mortality, and is associated with duration of diabetes, hyperlipidemia, and poor glycemic control. The most common form of diabetic neur-opathy is the "Distal Sensorimotor Polyneuropathy (DSPN)", DPN is predominantly characterized by sensory symptoms in the "glove-and'stocking" distribution. Diabetic causes DPN by promoting neuronal apoptosis and inhibiting nerve regen-eration, which leads to significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Reduced or absent sensation in the foot can increase the risk of injury and wounds that may develop into serious infections requiring amputations. Diabetes can also affect autonomic nervous system causing autonomic neuropathy affecting the cardiovascular, vasomotor, sudomotor, and gastrointestinal systems. A common phenotype of DPN is Painful Diabetic Neuropathy (P-DPN), as a fairly significant proportion of diabetic population, ranging between 10-26%. Surgical de-compression of multiple peripheral nerves is being utilized as an alternative approach to treatment of symptomatic diabetic neuropathy. This is based on the hypothesis that diabetic nerves are more vulnerable to compressive injury at potential sites for entrapment.
Methods: This study was conducted in the Neurosurgery Department, Faculty of Medicine, Cairo University Hospitals in the period from December 2011 to November 2013. The study included fifty patients with complicated diabetic periph-eral neuropathy who are surgically managed by peripheral nerve decompssion in the region of the carpal and tarsal tunnels. All patients were subjected to: Full history taking, complete general medical examination, fasting blood sugar, postprandial blood sugar and electromyography. Surgical candidates were subjected to division of the flexor retinaculum in the hand or feet.
Results: The patients' age ranged from 35-75 years. The mean age was 58.5±10.3 years. There is a good clinical improvement of 80% of cases by surgical decompression of peripheral nerves. There is an improvement in nerve conduction velocity after decompression of affected peripheral nerves in 84% of patients surgically managed. The improvement was 80%. About 73% of the operated patients showed improvement of ischemia in the periphery as well as about 82% showed improvement of the neurologic condition as regarding neuro-pathic pain and muscle weakness improvement in the form of improved hand-grip and good walking.
Conclusions: It could be concluded that patients with complicated Diabetic Peripheral Neuropathy (DPN) could be surgically managed successfully by decompression of periph-eral nerves at site of compression in carpal and tarsal tunnels with good results in patients resistant to medical treatment.