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Klinische Neurophysiologie 2021; 52(02): 92-104
DOI: 10.1055/a-1335-1086
Originalia

Stellenwert klinischer, funktioneller und bildgebender Diagnostik zur Früherkennung, Differenzialdiagnose und Verlaufskontrolle diabetischer Neuropathien

The Role of Clinical, Functional, and Imaging Diagnostics for Early Detection, Differential Diagnosis, and Monitoring of Diabetic Neuropathies
Maike F. Dohrn
1   Neurologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
,
Natalie Winter
2   Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
,
Christina Dumke
1   Neurologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
,
Friederike Bähr
1   Neurologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
,
Annabelle Ouwenbroek
1   Neurologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
,
Barbara Hoppe
3   Neurologie, Klinikum Köln-Merheim, Köln, Deutschland
,
Karlheinz Reiners
4   Neurologie, Hermann-Josef-Krankenhaus Erkelenz, Erkelenz, Deutschland
,
Manuel Dafotakis
1   Neurologie, Uniklinik der RWTH Aachen, Aachen, Deutschland
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Zusammenfassung

Von weltweit mehr als 400 Mio. Menschen mit Diabetes mellitus entwickeln bis zu 50% im Laufe ihrer Erkrankung eine Neuropathie. Trotz oder gerade wegen dieser Häufigkeit darf jedoch nicht jede Neuropathie, die in Koinzidenz mit einem Diabetes mellitus auftritt, unkritisch als diabetische Neuropathie diagnostiziert werden. Eine präzise Ausschluss- und Ausmaßdiagnostik ist entscheidend, um andere behandelbare Erkrankungen wie z. B. die Chronisch Inflammatorische Demyelinisierende Polyradikuloneuropathie oder die hereditäre Transthyretin-Amyloidose nicht zu übersehen. Einfache, nicht-invasive, preiswerte und allzeit verfügbare Screeningmethoden stellen Anamnese und klinische Untersuchung dar. Ergänzend ist in frühen Erkrankungsstadien die Quantitativ Sensorische Testung hilfreich zur Eingrenzung einer Small Fiber-Dysfunktion. Sind, typischerweise im Verlauf, große Nervenfasern geschädigt, so ist das charakteristische elektrophysiologische Bild das einer längenabhängigen, axonalen, sensibel betonten oder sensomotorischen Neuropathie. Die Nervensonografie kann zur Unterscheidung von autoimmun-demyelinisierenden Neuropathien hilfreich sein. Moderne Untersuchungsverfahren wie die MR-Neurografie können auch proximale Nervenabschnitte bis auf Faszikelebene darstellen, sind allerdings nur an wenigen Zentren verfügbar. Haut- und Nervenbiopsien sind v. a. bei untypischen Verläufen zur Abgrenzung von Differenzialdiagnosen hilfreich. Diabetische Neuropathien können zu einer erheblichen Reduktion von Lebensqualität und Lebensdauer führen. Zur frühest- und bestmöglichen ursächlichen und symptomatischen Therapieeinleitung ist eine präzise Diagnostik essentiell.

Abstract

Out of 400 million individuals with diabetes mellitus worldwide, up to 50% will develop some form of neuropathy during the course of the disease. However, not every neuropathy occurring along with diabetes mellitus can be considered as diabetic neuropathy. Precise diagnostic methods are required not to miss other treatable diseases, e. g., chronic inflammatory demyelinating polyradiculoneuropathy or hereditary transthyretin-related amyloidosis. Patient history and neurological examinations constitute easy, non-invasive, cost-efficient, and readily available screening tools. In early stages, quantitative sensory testing is helpful in evaluating small fiber dysfunction. When large fibers are damaged, nerve conduction studies show a length-dependent, axonal, sensory or sensorimotor neuropathy. The nerve ultrasound can be helpful to distinguish diabetic from autoimmune neuropathy. MRI neurography has the potential to depict even proximal nerve sections up to fascicle levels, but is available at highly specialized centers only. Skin and nerve biopsies are still of use to identify competing causes in atypical cases. Diabetic neuropathies can drastically reduce the span and quality of life. Precise diagnostic procedures are essential for identifying the best and earliest causative and symptomatic treatment.

Schlüsselwörter

Diabetische Neuropathie - Neurologische Differenzialdiagnostik - Elektroneurographie - Quantitativ Sensorische Testung - Autonome Funktionsdiagnostik

Key words

Diabetic neuropathy - neurological differential diagnostic - nerve conduction studies - quantitative sensory testing - autonomic diagnostic


Publication History

Article published online:
25 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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