winemaster-ga,
Thank you for your patience as I researched your challenging question.
I hope the information I've provided will be useful for you. As you
suspected, there is not a great deal of information that pertains to
your very specific condition. However, there is information on the
more general category of diabetic neuropathies, and I've tried to
target the materials that come closest to meeting your needs.
I want to reiterate my earlier comment about Peter Dyck at the Mayo
Clinic. Dr. Dyck's name and papers show up all over the place in
searching this topic. I have emailed him for more information, but
have not yet received a reply. If and when he does answer, I will be
sure to provide the updated information here.
As a reminder, here is a link to Dr. Dyck's articles, many of which
touch on issues pertaining to your condition:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=PureSearch&db=PubMed&details_term=%28dyck%20pj%5BAuthor%5D%20AND%20mayo%5BAll%20Fields%5D%29
In the course of my research, I did see mention of cases of diabetic
neuropathy that substantially resolved over the course of months --
with or without explicit treatements -- largely as a result of careful
blood sugar management. I certainly hope your experience is one of
rapid improvement.
If, after reviewing this answer, you find you would like additional
information on any particular study or topic, just let me know. I'll
be more than happy to continue researching this until we've pretty
much exhausted the information that's out there.
All the best,
pafalafa-ga
===============
CLINICAL TRIALS
There are several good sources of information for searching for
information on clinical trials. In my opinion, the best and most
comprehensive source is the one maintained by the National Institutes
of Health:
http://www.clinicaltrials.gov/
I conducted several different searches pertaining to your question.
As I suspected, though, there were no clinical trials that were
directly relevant either to your condition, or to the use of
methyprednisolone as a treatment for diabetic neuropathy.
The search for [ methylprednisolone ] gave the result "31 studies
were found", which can be seen in the link here:
http://www.clinicaltrials.gov/ct/search;jsessionid=E7FD982DD98CE75F17B11B7C3411D539?term=methylprednisolone&submit=Search
[NOTE: you can see additional studies that are no longer accepting
patients by clicking on the box near the top of the page that says:
"Include trials that are no longer recruiting patients" ]
I've included these in case you want to look them over for any that
may be of interest.
When I combined a search for the terms [ methylprednisolone and
neuropathy ] there were no results of clinical trials that involved
both these terms.
However, a more general search on [ neuropathy ] resulted in 24
studies (and again, you can see even more by clicking the "no longer
recruiting" box) -- some of these looked like they might be relevant
to your interests, even though they don't focus on methylprednisolone.
You can see the full list for the 24 studies here:
http://www.clinicaltrials.gov/ct/search?term=neuropathy
although some of the more interesting-looking studies required you to
check off the "no longer recruiting" box (the results of which I can't
link to directly).
Here are some of the clinical trials of note:
http://www.clinicaltrials.gov/ct/show/NCT00058968?order=1
Investigational compound versus Placebo in the Treatment of Painful
Diabetic Neuropathy
Drug: Duloxetine hydrochloride
This study has been completed
http://www.clinicaltrials.gov/ct/show/NCT00001344?order=5
Dextromethorphan Versus Placebo for Neuropathic Pain
This study has been completed.
In our current clinical trial, we are comparing the effects of two
NMDA receptor antagonists to placebo in patients with painful distal
symmetrical diabetic neuropathy or post-herpetic neuralgia. The
treatments in this three-period crossover study are dextromethorphan,
up to 920 mg/day (about 8 times the antitussive dose), memantine,
30-50 mg/day, and placebo. Memantine is an NMDA antagonist used in
Europe to treat Parkinson's disease and Alzheimer's disease. The
underlying hypothesis, based on studies of painful neuropathies in
animal models, is that neuropathic pain is caused largely by
sensitization of central nervous system neurons caused by excitatory
amino acid neurotransmitters, acting largely through NMDA receptors. A
previous small trial of dextromethorphan suggested efficacy in
diabetic neuropathy pain.
http://www.clinicaltrials.gov/ct/show/NCT00004407?order=1
Randomized Study of Intravenous Immunoglobulin (IVIg) in Patients with
Subacute Proximal Diabetic Neuropathy
This study is no longer recruiting patients.
[NOTE: This study was done out of the Mayo Clinic]
OBJECTIVES: I. Determine the effect of intravenous immunoglobulin on
recovery time of patients with proximal diabetic neuropathy. II.
Determine whether rate of response is dose dependent in these
patients.
Disease Characteristics...Diagnostically proven proximal diabetic
neuropathy with any of the following symptoms: Severe thigh, hip, or
leg pain Greater than 20% weight loss Progressive proximal weakness in
the painful leg Weakness in the contralateral lower limb Thoracic or
cervical root distribution Symmetric distal polyneuropathy or
autonomic neuropathy may be mild or absent
Study chairs or principal investigators
Anthony J. Windebank, Study Chair, Mayo Clinic
There are two other sites that are useful for searching for
information on clinical trials, and I looked into these as well, but
did not uncover any additional information. The sites are:
http://www.centerwatch.com
http://www.biospace.com
There was one item at the biospace site that you may want to take note of:
http://www.biospace.com/ccis/detail.cfm?ClinicalID=1163120
LYRICA
Description: Pregabalin is indicated for the management of neuropathic
pain associated with diabetic peripheral neuropathy (DPN) and
postherpetic neuralgia (PHN).
[ NOTE: this is a drug recently out to market ]
==============
In addition to the clinical trials, I also conducted several searches
in a number of medical literature databases, as well as on the
internet. I cannot provide direct links to most of the articles,
since they are not generally freely available on the internet.
However, a number of items came to my attention as responsive to your
question:
http://www.emedicine.com/pmr/topic39.htm
Diabetic lumbosacral plexopathy
Author: Divakara Kedlaya, MBBS, Associate Professor, Department of
Physical Medicine and Rehabilitation, Loma Linda University Medical
Center
Three common neuralgias Opioids for chronic noncancer pain Tailoring
therapy to fit the patient and the pain;
Avi Ashkenazi, MDMorris Levin, MD Hussam Antoin, MD Ralph D. Beasley,
MD. Postgraduate Medicine. Minneapolis: Sep 2004. Vol. 116, Iss. 3; p.
16
Focal Entrapment Neuropathies in Diabetes
Aaron Vinik, Anahit Mehrabyan, Lawrence Colen, Andrew Boulton.
Diabetes Care. Alexandria: Jul 2004. Vol. 27, Iss. 7; p. 1783
Diabetic Somatic Neuropathies
Andrew J M Boulton, Rayaz A Malik, Joseph C Arezzo, Jay M Sosenko.
Diabetes Care. Alexandria: Jun 2004. Vol. 27, Iss. 6; p. 1458
Symptomatic diabetic and non-diabetic neuropathies in a series of 100
diabetic patients
Pierre Lozeron, Laurence Nahum, Catherine Lacroix, Angèle Ropert, et
al. Journal of Neurology. New York: May 2002. Vol. 249, Iss. 5; p. 569
----------
The diabetic neuropathies: Types, diagnosis and management
J Gareth Llewelyn. Journal of Neurology, Neurosurgery and Psychiatry.
London: Jun 2003. pg. II15
--Diabetic lumbosacral radiculoplexus neuropathy (Bruns-Garland syndrome)
Previously termed diabetic amyotrophy, this clinical entity has had a
variety of other names. The most recent attempt to define the
condition is somewhat of a mouthful for everyday clinical use, and it
may be simpler to use the eponym "Bruns-Garland syndrome" (after Bruns
who initially described the syndrome in 1890, and Garland who
rediscovered it and coined the term "amyotrophy"). It is most common
in older patients with type 2 DM and is rarely encountered in those
with type 1 DM.
...The clinical features are outlined in table 9. The evolution of
symptoms can be quite variable, and may progress to generalised lower
limb paresis ("diabetic paraplegia"). A clinically indistinguishable
syndrome occurs in patients without diabetes.
...The main differential diagnosis to consider is that of an
infiltrative pelvic malignancy, particularly when there is profound
weight loss and unilateral weakness. A similar picture can be seen as
a complication of radiotherapy. If there is no pain associated with
progressive asymmetric leg weakness, the diagnosis is more likely to
be CIDP.
...Suggested investigations arc outlined (table 9). Neurophysiology is
helpful, but CSF examination and nerve biopsy should only be
considered if an alternative diagnosis is considered. Examination of
nerve biopsies has shown evidence of micro-vasculitis and endoneurial
inflammatory infiltration but these findings do not influence
management. It is uncertain whether these inflammatory changes arc
primary or secondary phenomena to possible ischaemic injury.
...There does appear to be a rarer brachial radiculoplexus neuropathy,
reported in association with the Bruns-Garland syndrome in diabetic
patients.
...Treatment is centred initially around pain control (table 8). This
can be difficult and often requires opiates. Physiotherapy and
orthotic assessments are helpful in selected, often more severely
affected cases. Although the suspected pathogenic mechanism is
inflammatory change in the nerve or epineurial vessels, it is not
established whether immunosuppression (steroids or intravenous
immunoglobulin) has any role to play in the treatment of a syndrome,
which eventually spontaneously recovers, albeit that this may be
incomplete in a number of patients.
----------
Bruns-Garland syndrome (diabetic amyotrophy)
Russell A Davidson, Michael T Travis, Renee M Bernier. Orthopedics.
Thorofare: Jan 2003.Vol.26, Iss. 1; pg. 87
Diabetic amyotrophy: a brief review.
Natl Med J India. 2004 Jul-Aug;17(4):200-2. Related Articles, Links
Idiculla J, Shirazi N, Opacka-Juffry J, Ganapathi.
CASE REPORT
Diagnosis and management of diabetic peripheral neuropathy
Isabel Illa. European Neurology. Basel: Feb 1999. Vol. 41, Iss. S1; p. 3
Again, I sincerely hope this information is useful to you in deciding
your options at this point. If there's anything else I can do for
you, just let me know.
All the best,
pafalafa-ga |
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