Acute Symmetrical Motor Neuropathy in Diabetes Mellitus

The main clinical features in 12 patients with acute motor neuropathy associated with diabetes mellitus were, acute onset of symmetrical motor weakness of limbs predominantly distal, affecting lower limbs more than upper limbs, sluggish or absent tendon jerks, lack of sensory involvement and absence of respiratory paralysis. Five patients had long standing diabetes mellitus, four of whom had a recent history of poor control of diabetes. In the remaining seven patients, glucose tolerance test was abnormal. Mild to moderate elevation of cerebrospinal fluid protein, and normal motor and sensory conduction were observed. Two different types of neuropathy at different time points in 3 patients and a second episode of acute motor neuropathy in one patient were observed. The common precipitating factor was escape from control of diabetes. Recovery of motor power and function to varying degrees was seen in all the 12 cases within a period of 5 to 15 weeks and was temporally related to control of hyperglycemia. These observations suggest that metabolic disturbances may have a role in the pathogenesis of acute motor neuropathy.