Immunotherapy for diabetic amyotrophy

 

Abstract

Background

People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy, or diabetic lumbosacral radiculoplexus neuropathies. Some studies suggest that it may be due to immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves. Immunotherapies would therefore be expected to be beneficial.

Objectives

We aimed to review the evidence from randomised trials for the efficacy of any form of immunotherapy in the treatment of diabetic amyotrophy.

Search methods

We searched the Cochrane Neuromuscular Disease Group Trials Register (searched April 2 2009), MEDLINE (searched January 1966 to April 2 2009), EMBASE (searched January 1980 to April 2 2009) and contacted authors of relevant publications and other experts to obtain additional references, unpublished trials, and ongoing trials.

Selection criteria

We intended to include all randomised and quasi-randomised trials of any immunotherapy in participants with the condition fulfilling all the following: diabetes mellitus as defined by internationally recognised criteria, acute or subacute onset of pain and lower motor neuron weakness involving predominantly the proximal muscles of the lower limbs, weakness that is not confined to one nerve or nerve root distribution and exclusion of other causes of lumbosacral radiculopathies and plexopathy.

Data collection and analysis

Two authors independently examined all references retrieved by the search to select those meeting the inclusion criteria.

Main results

We found only one completed controlled trial using intravenous methylprednisolone in diabetic amyotrophy (Dyck 2006). The results have not been fully published and were not available for analyses.

Authors' conclusions

There is presently no evidence from randomised trials to support any recommendation on the use of any immunotherapy treatment in diabetic amyotrophy.

 

Plain language summary

Immunotherapy for diabetic amyotrophy

Results from trials are awaited to show whether corticosteroids, immunoglobulin or other treatments that act on the immune system are beneficial in diabetic amyotrophy.

Diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathy is an uncommon disorder of the peripheral nerves associated with diabetes mellitus. It causes pain and weakness in the lower limbs. Some researchers have found inflammatory cells near blood vessels and suggested that these interrupt blood supply to the nerves. They suggest that medications that reduce the inflammatory cells may be helpful. We found only one completed trial but the results have not been fully published and were not available for analysis. There is presently no evidence from any trial to show whether immunotherapies may benefit people with this condition.

 

摘要

背景

糖尿病肌萎縮之免疫療法

糖尿病患，有時會出現下肢近端肌肉急性或亞急性、漸進且不對稱的疼痛和無力。這種情況被稱為糖尿病肌萎縮或糖尿病腰薦神經根神經叢病變。有些研究認為肇因於免疫反應導致微血管炎，進而形成神經的缺血性傷害。故本篇研究預期免疫療法將會有所幫助。

目標

搜尋隨機實驗的相關證據以確認任何關於糖尿病肌萎縮的免疫療法之療效。

搜尋策略

我們搜尋 Cochrane Neuromuscular Disease Group Trials Register (2009年4月2日), MEDLINE (1966年1月至2009年4月2日), EMBASE (1980 年1月至2009年4月2日)。 並且連絡相關文獻的作者和其他專家以獲得更多文獻、未發表或正在進行的實驗資料。

選擇標準

糖尿病以國際間認定的標準定義，並有急性或亞急性下肢近端肌肉的疼痛及下運動神經元無力，無力的範圍並非沿著單一神經或神經根分布，並排除其他原因造成的腰薦神經根和神經叢病變。有關免疫療法且均符合以上條件的隨機或半隨機實驗，將會被收錄於本篇研究。

資料收集與分析

兩位作者分別檢視所收集的資料並選出符合收錄條件的部分

主要結論

僅發現一篇有完成的對照試驗，關於使用靜脈注射methylprednisolonem於糖尿病肌萎縮病患。研究結果並未完全發表，也無從取得分析。

作者結論

目前仍無隨機試驗的相關證據支持使用免疫療法治療糖尿病肌萎縮

翻譯人

本摘要由新光醫院彭馨婷翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以皮質類固醇、免疫球蛋白、或其他免疫療法，治療糖尿病肌萎縮是否有效，仍有待更多試驗的資料。糖尿病肌萎縮或糖尿病腰薦神經根神經叢病變，於糖尿病相關的周邊神經病變中並不常見。這種疾病會造成下肢疼痛及無力。有些研究發現血管附近的發炎細胞，可能影響神經的血管供應。減低發炎細胞的藥物可能有用。我們僅發現一篇有完成的對照試驗，但其研究結果並未完全發表，也無從取得分析。目前沒有任何試驗顯示有關免疫療法對糖尿病肌萎縮病患有益的證據。