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Q: Research on cervical diabetic (or non-diabetic) radiculoplexus neuropathy ( Answered 5 out of 5 stars,   2 Comments )
Subject: Research on cervical diabetic (or non-diabetic) radiculoplexus neuropathy
Category: Health > Conditions and Diseases
Asked by: winemaster-ga
List Price: $200.00
Posted: 12 Apr 2005 08:22 PDT
Expires: 12 May 2005 08:22 PDT
Question ID: 508334
I have been diagnosed with diabetic cervical rediculoplexus
neuropathy.  I have searched the regular search engines for
information on this and have found that it is sparse at best.  The
journal/research papers that I have found so far are:

1. Methylprednisolone May Imporve Lumbosacral Radiculoplexus
Neuropathy in The Canadian Journal of Neurological Sciences, P. James
B. Dyck, et. al. (Note: Lumbosacral Radiculoplexus Neuropathy is a
close relative to cervical and much more common.  Treatmenst, reseach,
etc. for this is acceptable by google researchers.)

2. Non-diabetic lumbosacral radicloplexus neuropathy, Brain, Vol 124,
No. 6, P James Dyck, et. al. (Note treatments information for
non-diabetic cervical or lumbosacral radiculplexus neuropathy
acceptabe by google researchers.)

3. Microvasculitis in non-diabetic lumbosacral radiculoplexus
neuropath (LSRPN): similarity to the diabetic variety (DLSRPN),
Journal of the Peripheral Nervous Sustem

4. Pulsed methylprednisolone is a safe and effective treatment for
diabetic amyotrophy (note amyotrophy is another name used for this
disease, you may want to find other synonyms used by the medical
establishment for this disease), Journal of Clinical Neuromuscular
Disease, Vol 4

My research needs:

1. Any information on past research, publications or current trials
for this disease.

2. Are there any current clinical trials for the use of pulsed
methylprednisolone in treatment of this disease.  Where?

I know that this is a difficult and complex research question and
therefore I am assigning the top price for this research but I expect,
and will not accept. anything less than professional results.

Request for Question Clarification by pafalafa-ga on 13 Apr 2005 12:02 PDT

From my searching thus far, it is clear that "radiculoplexus
neuropathy" is a rarely used term.  However, it seems to be a synonym
for some other, more commonly used, labels for a particular cluster of
symptoms, but it's not yet clear to me what the relevant related terms
might be.

I expect I will find them, as I continue to research this question. 
But I wanted to ask you directly, as well.

In the course of your diagnosis, have any other medical terms been
used to describe your condition?  If so, can you let me know as much
as possible about these terms, or any other information related to
your diagnosis.

Thanks...and best of luck to you.


Clarification of Question by winemaster-ga on 13 Apr 2005 18:33 PDT
OK, here we go with a torrent of other names for the condition:

Bruns-Garland syndrome, diabetic myelopathy, diabetic amyotrophy,
diabetic mononeuritis multiplex, diabetic polyradiculopathy, femoral
neuropathy of diabeties, diabetic motor or paralytic neuropathy,
proximal diabetic meuropathy and finally, diabetic lumbosacral

Also, methylprednisolone is in total called: methylprednisolone sodium
soccinate.  Brand names for the drug are Solu-medrol and A-methaPred. 
The medication is by intravenous injection only.

Thanks for the best wishes, this is a dreadful condition.

Request for Question Clarification by pafalafa-ga on 16 Apr 2005 08:17 PDT

I'm still looking into this.  The research is complicated by the
ironic situation that there's too little information on cervical
diabetic radiculoplexus neuropathy as a specific condition, and too
much information on related terms, such as diabetic amyotrophy.

However, I wanted to make sure you were aware of two overview papers
that are available, one of which is quite recent.

The first is from ADA:
Diabetic Neuropathies 
A statement by the American Diabetes Association 

Pay particular attention to Table 7 as it summarizes treatment
options, although I see that methylprednisolone is not included there.

The second paper is here:

and is a bit older (2003) but has some useful overview information.

Let me know if these are useful at all, or conversely, if their too
generic, or too familiar to you already.

Your feedback will help to focus my research further.



Request for Question Clarification by pafalafa-ga on 16 Apr 2005 16:58 PDT
Another item of possible interest:
Antioxidant Alpha Lipoic Acid (ALA) Significantly Improves Symptoms of
Diabetic Neuropathy

Again, let me know if these seem on or off target...I'm still not sure
how to best focus my efforts on this one.


Request for Question Clarification by pafalafa-ga on 18 Apr 2005 15:16 PDT
Hello...just checking in.  Any thoughts on the links I posted?

Clarification of Question by winemaster-ga on 18 Apr 2005 16:13 PDT
Sorry it took so long to respond, I was quite ill and not using the
computer at all.  The, of course, a massive backlog of email to
respond to.

The articles you forwarded are not exactly what I am looking for but
they are getting close.  Diabetic newuropathies are a very broad
topic.  I have and have had very well controlled blood sugars.  It is
typical of patients like myself to develop DCRPN after a large weight
loss (in my case 30 pounds from have to have two major operations in 3
months).  In further discussions with my neurologist I find that the
significant feature I did not relay to you was the development of
microvasculitis of the blood vessels feeding the plexi and main nerves
leaving the cervical spine (in my case the 5th, 6tth and 7th).  This
leads to all of the dreadful symptoms.

Regular diabetic neuropathies are common and not in the answer I am
looking for.  If you need any more clarifications I am now feeling
much better and will answer within a day.

Thanks for the work so far but we are not there yet.

Request for Question Clarification by pafalafa-ga on 20 Apr 2005 11:51 PDT
Thanks for getting back to me, and now that you are feeling much
better, please stay that way!

Your feedback is quite a help.  Give me a few days to do some more
looking around, and I'll let you know what I come up with.


Clarification of Question by winemaster-ga on 21 Apr 2005 20:41 PDT
See my previous comment in which I responded to a comment by alexanderc-ga.

Request for Question Clarification by pafalafa-ga on 22 Apr 2005 19:30 PDT

In life, there are setbacks both large and small.

I've had a small setback today.  My computer crashed, and in the
process, I lost the content of the file I had been putting together to
answer your question.

Ordinarily, I save my files quite often, but for some reason, this one
got away from me -- in more ways than one.

I'll try to recreate the materials so I can still provide an answer to
your question.  Again, though, I'll have to ask your patience for a
few days.

But in the mean time, one thing that seemed very clear from my
research is this.  One of the key authorities in the world on
conditions such as the one you are suffering is Dr. Peter Dyck at the
Mayo Clinic.

Dyck is the author of several of the papers you noted in your original
question.  You can read a bit about him and his research interests

and you can see a pretty comprehensive list of his publications --
several of which should be of interest to you -- here:

I've already e-mailed Dr. Dyck to ask him about any updates on
methylprednisolone, or clinincal trials.  I'll let you know what I
hear back from him.

But in the mean time, you may want to consider having your own doctor
consult with Dr. Dyck about your treatment options, or you may want to
think about contacting him yourself.

Stay tuned,

Subject: Re: Research on cervical diabetic (or non-diabetic) radiculoplexus neuropathy
Answered By: pafalafa-ga on 25 Apr 2005 12:42 PDT
Rated:5 out of 5 stars

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:

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,




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:

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:;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:

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:

Investigational compound versus Placebo in the Treatment of Painful
Diabetic Neuropathy
Drug: Duloxetine hydrochloride
This study has been completed
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.
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

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:

There was one item at the biospace site that you may want to take note of:
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
Diabetic lumbosacral plexopathy
Author: Divakara Kedlaya, MBBS, Associate Professor, Department of
Physical Medicine and Rehabilitation, Loma Linda University Medical

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.

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

...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.

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,


Clarification of Answer by pafalafa-ga on 26 Apr 2005 14:35 PDT

Thanks so much.  From our brief interactions, you strike me as someone
who is patient and generous, as well as in possesion of a good mind --
all traits that will help you prevail over your condition, I'm sure.

Best of luck with your new treatment options.  If the thought occurs
to you, perhaps you can post a follow-up comment here in a few months
to let me know how things are going.

All the best.

winemaster-ga rated this answer:5 out of 5 stars and gave an additional tip of: $100.00
As I suspected the information available in answer to my question was
limited.  The researcher did a fine job in obtaining what little
information there was on my particular condition.  In addition, there
were some other benefits to all of his research.  One, he found a
study on diabetic neuropathy that used alpha lipoic acid as a
treatment for a very painful condition that I also suffer from,
diabetic neuropathy of the feet, which has been very painful for me. 
I have already started treatment with this drug.

Two, and far more important, my neurologist agreed to give me the
pulsed methylprednisolone treatments I had been seeking a clinical
trial for and I have started those as well.  The limited articles I
had obtained and the information the researcher obtained convinced him
that it was worth trying.  I have my own mini-clinical trial of one!!!

Additionally, the information on available clinical trials and the
search sites that he provided are valuble future resources for myself.
 It appears that this researcher worked long and hard for his payment.
 Any lack of information on this treatment/condition appears to be
because there is little information available NOT because the
researcher did not work hard in finding it.

In the final analysis I am thrilled that his work made it possible for
me to start this pulsed methylprednisolone treatment and I got a big,
unexpected bonus in the alpha lipoic acid medication for my other
diabetic neuropathy of the feet!!

Subject: Re: Research on cervical diabetic (or non-diabetic) radiculoplexus neuropathy
From: alexanderc-ga on 20 Apr 2005 11:34 PDT
Chronic hyperglycemia can cause a form of diabetic neuropathy by
causing glucose to attach to your cellular proteins by a process
called glycosylation.  This process ocurrs much in nerve cells and
leads to nerve failure (roughly speaking).  The effects of this
process may be lessened by taking a regular dietary supplement of
vitamin B6; the vitamin supplement is converted into a form of B6 that
interferes with the molecules forming the end-products of
glycolyslation, and protects your nervous tissue.  Keep in mind that
overdosing on B6 will only make your problems worse by causing vitamin
B6-induced sensory neuropathy, but this can be avioded by following
the directions on the bottle, and don't consume more than 500% of your
RDA every day on a regular basis (that would be foolish).

If you don't have chronic hyperglycemia, this may not help too much...
Subject: Re: Research on cervical diabetic (or non-diabetic) radiculoplexus neuropathy
From: winemaster-ga on 21 Apr 2005 20:40 PDT
Reply to pafalafa-ga

Thanks for the positive vibes!  I am doing everything that I can to
stay healthy .  I really do appreciate the work you are doing
researching my malady...I hope that you will find more information but
regardless, I thank you for the effort.  I make my living with the
computer but I am not an expert at internet searching/research so I
hope that you will meet with more success than I did on finding
information about this strange and terrible disease.

Reply to comment by alexanderc-ga

My blood surgars are very well controlled with my fasting sugars in
the morning running from 75 to 120. They gave been well controlled for
some time EXCEPT during the period I was in the hospital for two major
surgeries.  At that time I had to go from oral medications to control
the diabetes to insulin.  However, fasting sugars were never over
160-180 which, although high for the long term, is not considered high
for the post operative stress that is normal for the major surgeries I
had to endure.

I have been taking a multivitamin for some years now that includes
100% of the recommended B6 (2mg).  This is, of course, in addition to
the B6 I receive from my normal, fairly balanced, diet.  Have you more
information on how much of the B6 is theraputic (what dose?), can you
give me some idea of where this information comes from??  I am always
willing to consider other forms of preventive medicine that could help
in maintaining what nerve health I do have.

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