Lumbosacral Radiculoplexus Neuropathy

Abstract

Objective:To determine whether community Lumbosacral Radiculoplexus Neuropathy (LRPN) patients have milder neuropathy than referral patients, we characterize the outcomes and survival of population-based compared to referral-based LRPN cohorts .Background:Previously, we found that the incidence of LRPN is 4.16/100,000/year, a frequency greater than other inflammatory neuropathies. The survival of LRPN is uncharacterized.Materials/Methods:62 episodes in 59 LRPN patients were identified over 16 years (2000-2015). Clinical findings were compared to previous referral-based LRPN cohorts. Survival data were compared to age-gender matched controls.Results:At LRPN diagnosis, median age was 70 years, median neuropathy impairment score (NIS) 22 points, 92% had pain, 95% weakness, 23% were wheelchair-bound and median modified Rankin scale (mRS) was 3 (1-4). At last follow-up, median NIS improved to 17 points (p<0.001) with 56% having ≥4 points improvement, 16% were wheelchair-bound, and median mRS was 2. Compared to referral-based LRPN cohorts, community LRPN had less impairment, less bilateral disease (37% vs 92%) and less wheelchair usage (23% vs 49%). LRPN survival was 86% at 5 years and 55% at 10 years. Compared to age-gender matched controls, LRPN patients had 76% increased risk of death (p=0.016). In multivariate analysis, diabetes mellitus, age, stroke, chronic kidney disease, peripheral artery disease, and coronary artery disease were significant mortality risk factors but LRPN was not.Conclusions:LRPN is a painful, paralytic, asymmetric, monophasic, sometimes bilateral pan-plexopathy that improves over time but leaves patients with impairment. Although having LRPN increases mortality, this increase is probably due to comorbidities (diabetes mellitus) rather than LRPN itself.

Neurologic Complications of Endocrine Disorders

“…Treatment is otherwise supportive, and patients often gradually improve over several months to a year or more, as illustrated in case 8-2 . Most patients have residual neurologic deficits, with up to 16% requiring continued use of a wheelchair 79 …”

“…80,81 However, more recent evidence has demonstrated similar motor outcomes regardless of treatment, although pain does seem to improve more rapidly with corticosteroid therapy. 79,82 Treatment is otherwise supportive, and patients often gradually improve over several months to a year or more, as illustrated in CASE 8-2. Most patients have residual neurologic deficits, with up to 16% requiring continued use of a wheelchair.…”

“…Most patients have residual neurologic deficits, with up to 16% requiring continued use of a wheelchair. 79 Treatment-Induced Neuropathy of Diabetes Rapid correction of hyperglycemia in patients with historically poor glycemic control may lead to another spectrum of acute painful and autonomic neuropathic syndromes with or without anorexia or weight loss. These are referred to collectively as treatment-induced neuropathy of diabetes.…”

“…Lumbosacral paraspinal muscles are usually affected. 78,79 Early pathologic descriptions of microvasculitis and perceived response to corticosteroid therapy led to the conclusion that diabetic lumbosacral radiculoplexus neuropathy is a microvasculitic condition requiring immunosuppressive therapy. 80,81 However, more recent evidence has demonstrated similar motor outcomes regardless of treatment, although pain does seem to improve more rapidly with corticosteroid therapy.…”

“…Early pathologic descriptions of microvasculitis and perceived response to corticosteroid therapy led to the conclusion that diabetic lumbosacral radiculoplexus neuropathy is a microvasculitic condition requiring immunosuppressive therapy 80,81 . However, more recent evidence has demonstrated similar motor outcomes regardless of treatment, although pain does seem to improve more rapidly with corticosteroid therapy 79,82 . Treatment is otherwise supportive, and patients often gradually improve over several months to a year or more, as illustrated in case 8-2 .…”