Dysimmune neuropathy diabetic

Genetico-diabetoid-2 dysimmune polyneuropathy is our term, which we have been using for 15 years to describe the same clinical and laboratory features in patients as in the above-mentioned "diabetes-2 dysimmune neuropathy," who themselves do not yet have detectable glucose dysmetaboUsm parameters that would be considered indicative of actual diabetes-2, but have a close family history of diabetes-2 [4] (and Engel, unpublished work). In such patients, we have found that their polyneuropathy can be manifest as long as 10 years... 

Treatment Because of the sensory abnormalities, dysschwannian nerve conductions, elevated CSF protein, aspects of denervation-reinnervation in the muscle biopsy, and the diabetes-2 in both parents, we considered that our patient probably had coexisting genetico-diahetoid-2 dysimmune neuropathy," a type of chronic immune dysschwannian polyneuropathy (CIDP) (sometimes less precisely called chronic inflammatory demyelinating polyneuropathy, Chapter 2). We therefore treated her using/WG, and she was remarkably benefited her walking ability and endurance greatly improved, she did not require frequent rests, and was able to ascend steps much more easily. 

Vignette 12. Treatable forms of "diabetic neuropathy" diabetes-2 dysimmune sensory-motor polyneuropathy, and genetico-diabetoid-2 dysimmune polyneuropathy... 

Engel, WK. (2002) In type-2 diabetes, diabetic neuropathy is usually responsive to intravenous IgG (IVIG) treatment, ergo presumably dysimmune. Acta Myologica 21, A79. 

Engel WK. (1997) Intravenous immunoglobulin (IVIG) - an often-overlooked treatment - produces rapid, remarkable, sustained benefit in "diabetic neuropathy complex", suggesting a dysimmune mechanism. Ann Neurol 42, 414. 

For many years, and even today, any neuropathy occurring in a diabetes-2 patient has, simplisticaUy, incorrectly, and pessimistically often been called "nntreatable diabetic nenropathy." However, our 1993 demonstration of the widely occurring and heqnently gratifyingly treatable diabetes-2 dysimmune polyneuropathy, nsnally associated with elevated CSF protein, has led to onr benefiting many patients dismissed by others. IVIG is especially beneficial... 

Comment For therapeutic purposes, it is important to distinguish between a focal mechanical neuropathy and a generalized neuropathy, or the coexistence of both. One should consider various peripheral neuropathies (such as potentially treatable dys-immune diabetes-dysimmune and B12 insufficiency neuropathies), because even subtle ones probably can predispose to mechanical neuropathies of the median and ulnar nerves, as well as to cervical and lumbosacral radiculopathies from mechanical "spondylotic" changes. 

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