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Role of pathogenetic therapy for diabetic polyneuropathy

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In our country, alpha-lipoic acid is widely used as a pathogenetic therapy for diabetic polyneuropathy (DPN).

Objective: to compare the efficiency and safety of using oral and injectable α-lipoic acid for DPN.

Patients and methods. The investigation enrolled 47 patients with a verified diagnosis of DPN, who were divided into two groups. Group 1 included 23 patients (10 men and 13 women; mean age, 62.9±7.5 years), Group 2 consisted of 24 patients (9 men and 15 women, mean age, 65.5±7.9 years). All the patients used Berlithione: Group 1 received its intravenous doses of 600 mg for 14 days, then oral ones of 600 mg for other 16 days; Group 2 took oral doses of 600 mg for 30 days. The therapy results were assessed using the digital rating scale (DRS), the Douleur Neuropathique 4 (DN4) neuropathic pain rating scale, and the neurological soft signs (NSS), and electroneuromyography (ENMG) data.

Results and discussion. Berlithione was found to have a good tolerability. No adverse reactions were detected in any case; and there was no need to discontinue this drug. On day 21 of therapy, there were statistically significant differences in the indicators of pain intensity on DRS in Group 1 patients (p<0.05), some of them (n=8) had positive clinical changes as a reduction in the severity of hypesthesia. Both groups showed a tendency to improve ENMG parameters as a certain increase in excitation propagation velocity and M-response amplitude; however, these changes did not reach a statistical significance level. At the same time, in 6 out of the 8 patients in Group 1 with positive clinical changes, the described ENMG changes correlated with a reduction in the severity of hypesthesia. There were no significant changes on the NSS scale after 3 weeks of therapy. On day 30 of treatment, both groups were recorded to have statistically significant changes in pain intensity measures versus the baseline values, but no significant inter-group differences.

Conclusion. Thus, Berlithione demonstrated its efficacy in both patient groups, but its positive effect occurred 1 week earlier in the step therapy group. It is noted that it is expedient to use this drug long (>1 month) for DPN.

About the Authors

D. A. Iskra
Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia
Russian Federation
2, Litovskaya St., Saint Petersburg 194100

V. V. Kovalchuk
Saint Petersburg Center of Medical Rehabilitation, N.A. Semashko City Hospital Thirty-Eight
Russian Federation

Vitaly Vladimirovich Kovalchuk

7/2, Gospitalnaya St., liter A, Town of Pushkin, Saint Petersburg 196602

E. R. Barantsevich
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation
6-8, Lev Tolstoy St., Saint Petersburg 197022


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For citation:

Iskra D.A., Kovalchuk V.V., Barantsevich E.R. Role of pathogenetic therapy for diabetic polyneuropathy. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):44-50. (In Russ.)

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