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Abstract Details

Autonomic Dysfunction in Diabetic and Non-diabetic Lumbosacral Radiculoplexus Neuropathy
Neuromuscular and Clinical Neurophysiology (EMG)
P6 - Poster Session 6 (12:00 PM-1:00 PM)
1-004

Diabetic (DLRPN) and non-diabetic (non-DLRPN) lumbosacral radiculoplexus neuropathy are conditions of pain, numbness, weakness primarily involving the lower limbs and are associated with weight loss. Autonomic symptoms, findings and formal autonomic testing have been described in small numbers of DLRPN and non-DLRPN cases.

To describe the autonomic symptoms and findings from a large cohort of diabetic and non-diabetic lumbosacral radiculoplexus neuropathy ( DLRPN and non-DLRPN) cases.

DLRPN and non-DLRPN cases were identified through a retrospective chart review.  Included cases had to have a lower limb predominant neuropathy characterized by pain, numbness or weakness with involvement on EMG of segments from at least 2 peripheral nerves and at least 2 nerve root levels.  Structural causes were excluded. All included cases had to have undergone an autonomic reflex screen.

Three hundred cases of DPRPN and one hundred cases of non-DLRPN were identified.  The cases were similar with presentations of pain, numbness and weakness and prominent autonomic abnormality. Autonomic dysfunction was present in 50% of cases for both DLRPN and non-DLRPN. When involved, composite autonomic severity score (CASS) scores ranged between 2 to 9 with a mean of 5.6 for DLRPN and between 1 to 9 with a mean of 4.1 for non-DLRPN. Means of CASS subsets (postganglionic sympathetic sudomotor, cardiovagal, cardiovascular adrenergic) were (1.9, 1.7, 1.9) and (1.5, 1.5, 1.3) for DLRPN and non-DLRPN, respectively.

Autonomic abnormalities are very common in both DLRPN and non-DLRPN. The high rates of autonomic abnormalities in the non-diabetic form means that the likely underlying mechanism for the autonomic neuropathy is not the diabetes mellitus but the inflammatory neuropathy. 

Authors/Disclosures
Kamal Shouman, MD (Mayo Clinic)
PRESENTER
The institution of Dr. Shouman has received research support from dysautonomia international.
Marcus Vinicius R. Pinto, MD (Mayo Clinic) Dr. Pinto has nothing to disclose.
Mariana Suarez No disclosure on file
Wolfgang Singer, MD (Mayo Clinic) Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theravance. The institution of Dr. Singer has received research support from NIH. The institution of Dr. Singer has received research support from FDA. The institution of Dr. Singer has received research support from Michael J. Fox Foundation. Dr. Singer has received intellectual property interests from a discovery or technology relating to health care.
Peter J. Dyck, MD, FAAN (Mayo Clinic) Dr. Dyck has nothing to disclose.
Phillip A. Low, MD, FAAN (Mayo Clinic) Dr. Low has nothing to disclose.
P. James B. Dyck, MD, FAAN (Mayo Clinic) Dr. Dyck has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akcea/Ionis.