Focal and multifocal diabetic neuropathies

diabetic neuropathy is the most common neuropathy in industrialized countries, with a remarkable range of clinical manifestations. the vast majority of the patients with clinical diabetic neuropathy have a distal symmetrical form that progress following a fiber-length dependent pattern, with predominant sensory and autonomic manifestations. this pattern of neuropathy is associated with a progressive distal axonopathy. patients are exposed to trophic changes in the feet, pains and autonomic disturbances. less often, diabetic patients may develop focal and multifocal neuropathy that includes cranial nerve involvement, limb and truncal neuropathies. this neuropathic pattern tends to occur after 50 years of age, mostly in patients with longstanding diabetes mellitus. the lddp does not show any trend to improvement and either relentlessly progresses or remain relatively stable over years. conversely the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self limited, sometimes after a relapsing course.