PubMed · 4598963
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B Otnes, W Mathisen. 1974-05-10. [Cystometry].. https://pubmed.ncbi.nlm.nih.gov/4598963/
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STUDY DESIGN: In an open, multicentric observational study involving 234 doctors in private practice, the evolution of symptoms and the tolerability of a vitamin B preparation (Neurotrat forte) used as treatment in 1,149 patients with polyneuropathy, neuralgia, radiculopathy and neuritis associated with pain and paresthesias, were observed. The form of administration (ampoules, dragées), dosage and duration of treatment were left to the individual care-providing physician. The target symptoms evaluated were intensity of pain, muscle weakness affecting the legs, and paresthesia. RESULTS: Under treatment, there was a clear improvement in these symptoms. At a second examination approximately three weeks after initiation of treatment, a positive effect on pain in particular was observed in 69% of the cases. Similar observations were also made for paresthesias and muscular weakness in the legs.
None of the classifications of diabetic neuropathy already published is perfect. "Experts" now recommend an operational classification based on the quantification of signs and neurological deficits, on an electrophysiological investigation and on an easy exploration of autonomic neuropathy. Quantitative evaluation of symptoms can be performed with questionnaires or scales. Quantitative evaluation of deficits can be performed with devices which quantify vibratory and thermic sensations; reproducibility of the results is not yet perfect, but it represents a clear progress over clinical examination. Investigation of the autonomic control of cardiovascular system with standardized tests is the simplest way of exploring the vegetative nervous system; these tests have a fair sensitivity and an excellent reproducibility. Therapeutic trials, particularly with aldose reductase inhibitors or gangliosides, require this wide panel of neurological investigations.
Diabetic neuropathies form a group of diverse conditions, which can be distinguished between those which recover (acute painful neuropathies, radiculopathies, mononeuropathies) and those which progress (sensory and autonomic neuropathies). These two main groups can be distinguished in several ways: sensory and autonomic neuropathies are classic diabetic complications progressing gradually in patients with long-standing diabetes who often have other specific complications, while the reversible neuropathies do not have these features. The latter are characterised by their occurrence at any stage of diabetes, often at diagnosis, they may be precipitated on starting insulin treatment, and they are more common in men; they can occur at any age, though more often in older patients, and are unrelated to other diabetic complications. The two groups of neuropathies also show differences in nerve structural abnormalities and with regard to distinctive blood flow responses. The underlying mechanisms responsible for these very different forms of neuropathy remain speculative, but evidence for an immunological basis for the development of severe symptomatic autonomic neuropathy is presented.