There seems to be two distinct types of Diabetic Neuropathy (DM) – Multifocal and Symmetrical. The former “showed a marked improvement in severe pain”; the symmetrical did not.
J Clin Neurosci. 2010 Aug;17(8):1003-8.
Differential response to intravenous immunoglobulin (IVIg) therapy among multifocal and polyneuropathy types of painful diabetic neuropathy.
Kawagashira Y, Watanabe H, Morozumi S, Iijima I, Koike H, Hattori N, Sobue G. abstract here
- focal/multifocal neuropathy includes head, limb, and trunk neuropathy – Inflammatory vasculopathy
(inflamed blood vessels) might be more common in this group.
Initial symptoms:- pain in trunk or lower limbs with worsening over several months.
- One side more affected than other. especially near trunk areas.
- Burning and aching.
- Light touch is uncomfortable.
- Temperature and vibration senses are lessened
- Reflexes are decreased or absent
- average 7 months duration
- Nerve biopsies NO HELP – “Although inflammatory infiltration or vasculitis were not detected in sural nerve biopsy specimens from our patients, the ability of IVIg therapy to relieve pain would also suggest that a focal inflammatory process, not involved in the sural nerve, is required to develop this type of neuropathy”
- symmetric polyneuropathy – more small fiber axonal damage often distally
- bilateral pain – more distal and numbness in feet.
- pain with sense of heat in bottom of feet
- deep sensory loss of all types
- diminished or absent reflexes
- RX – IV Immunoglobulin therapy (0.4 g/kg for 5 days).
- Results – this includes examples of two responders – a typical pattern – (pains level from 0-10 over time)
These two examples required a second course one month later.
- Those with symmetric peripheral neuropathy showed no improvement.
- suggested actions of Immunoglobulins:
- neutralising proinflammatory cytokines,
- blocking Fc receptors on macrophages
- blocking inhibition-activated complement
Comment:
- IV immunoglobulins have been shown to help in other pain diseases – including Complex Regional Pain – see: Immunoglobulin Infusion Improves Complex Regional Pain
- I have a patient with diffuse sensory polyneuropathy, part inflammatory and part post-chemotherapy. Vasculitis was suspected but biopsy was negative – which now appears to mean nothing. On wonders if that would work here… convincing a hematologist might be a problem and one always has to worry about reactions:
- Reactions to the IV. – In:
Neurology 2001;57:1699-1701
Rapid infusion of intravenous immune globulin in patients with neuromuscular disorders
J. A. Grillo, MD, K. C. Gorson, MD, A. H. Ropper, MD, J. Lewis, RN and R. Weinstein, MD abstract here
26% had some reaction though only 3.5% requiring hospitalization.
Any comments?
IVIG works wonders for this disease process. Years of living with it, when nothing else has worked, (refractory), is very convincing. It works wonders for my weakness, as well. The price and availability, or I should say, price BECAUSE of the high demand for such a scarcely available therapy is of major concern to both patients and doctors alike. However, it is of my own personal opinion, based solely on my own experiences in dealing with such a painful and often debilitating disease process, that I.V.I.G. is a therapy which should be offered for those patients whom seem refractory to all other, (and there really aren’t many, save for chemotherapeutic agents which can also cause more problems with neuropathy, peripheral, autonomic, and focal alike), in and of themselves. It is so damned hard to find any information on that of entrapment neuropathy, which can happen from anything from that of a systemic disease process, (autoimmune in nature), but much is written about that of compartmental neural impingement, such as that from a broken bone might levy. I decided to do my own research, and that research has led me to begin studies as a physician’ assistant. Years later, I just want to scream out to the world that whether your pain and debilitation stem from that of a true compartmental emergency from that of a broken bone, OR, that of a nerve impingement from that of direct contact pressure which happens because of anatomical landmarks, (such as was the case for myself when my sciatic nerve became inflamed and swollen to the point that it directly became impinged upon itself next to ITS anatomical landmark, that of the piriformis muscle. Trying to convince a surgeon that while my piriformis muscle itself was fine and unaffected, however, HAD to be removed so as to allow my swollen sciatic nerve the room it needed to end the impingement and allow for a complete decompression, was a major pain in the ass, (literally). Thank God I found the right surgeon. I did have to pay an arm and a leg to undergo that of a M.R.N. (a magnetic resonance NEUROGRAM), which confirmed that while my piriformis muscle in my right buttock was perfectly fine and unaffected, without so much as a bipartite variant, my sciatic nerve next to it was completely squashed and inflamed! The fact that I do indeed have that of multiple autoimmune diseases, (vasculitis which causes my nerves to be swollen and painful-neuritis a byproduct of that fact), it really made sense to me to have a widespread decompression of my right buttocks. After my piriformis muscle was removed a full decompression was achieved. I went home that same day, a feat I was told was never heard of. I can honestly say that the pain from that decompression surgery just wasn’t at all as painful as my days living with my sciatic nerve being squashed almost paper thin for too many years. I went on to have both of my lower legs compartments decompressed as well. Once again, the results were so amazing I would consider it nothing less than a complete MIRACLE! Why, oh WHY, isn’t there more written about this? Why…WHY do doctors not consider decompression a FIRST line therapy, (CURE), when it comes to relieving that of compression due to auto-immunity such as that which comes from vasculitides? This was written in the hopes that somewhere there is a doctor whom might actually read this and apply it to helping the next patient so desperate for help…just as I was. God bless you all.
My comment directly related to that of Mononeuritis Multiplex caused by that of a Vasculitide, however, “the ability of IVIg therapy to relieve pain would also suggest that a focal inflammatory process”, exists with patients with the same kind of inflammatory process for those patients pertaining to this study, (people who have diabetes). Just to clarify. Had a few e-mails. God bless you all.