AUTOIMMUNE DIABETIC NEUROPATHY

with diabetes mellitus and different methods.of clas~ification.~ ~~~~~~~~,~~,~~, 25,47,53,58,64,65 Distal symmetric polyneuropathy (DSPN) presents with distal neuropathic pain, paresthesia, sensory loss, and variable weakness. Proximal diabetic neuropathy (PDN) includes several disorders with the common feature of pelvifemoral muscle weakness, among them, diabetic lumbosacral plexopathy, lumbar polyradiculopathy, and diabetic amyotrophy, further differentiated from one another usually by associated clinical and electrophysiologic findings. Mononeuvopathy multiplex (MNM) is recognized by a stepwise pattern of weakness, wasting, sensory loss, and tendon hyporeflexia in the distribution of the affected nerves, and at a later stage, coalescence of lesions resembling severe DSPN. Neuropathy of the autonomic nervous system, cranial nerves, thoracoabdominal spinal segments, compressive neuropathy, and neuropathic cachexia also occur in diabetes mellitus.10~27~47~50~@ Since the earliest histologically published cases of diabetic neuropathy more than a century ag0,5~,~~ the cause or causes of the different neuropathic syndromes associated with diabetes mellitus has remained uncertain. i'wo concepts of the pathogenesis of diabetic neuropathy, the vascular and metabolic hypotheses of the effects of sustained hypergly