Peripheral neuropathy ( PN ) is damage or disease affecting the nerves, which can interfere with sensation, movement, gland or organ function, or other health aspects, depending on the type of nerve affected. Common causes include systemic diseases (such as diabetes or leprosy), hyperglycemia glycemia, vitamin deficiency, medications (eg chemotherapy, or commonly prescribed antibiotics including metronidazole and fluoroquinolone antibiotic classes (Ciprofloxacin, Levaquin, Avelox, etc.), Traumatic injuries, including ischaemia , radiation therapy, excessive alcohol consumption, immune system diseases, Celiac disease, or viral infections. It may also be genetic (present at birth) or idiopathic (unknown cause). In conventional medical use, the word neuropathy (neuro-, "nervous system" and sympathy, "disease") without modifiers usually mean peripheral neuropathy .
Neuropathy affects only one nerve called "mononeuropathy" and neuropathy involving nerves around the same area on both sides of the body is called "symmetric polyneuropathy" or simply "polyneuropathy". When two or more (usually only a few, but sometimes many) separate nerves in different areas of the affected body are called "multiplex mononeuritis", "multifocal mononeuropathy", or "double mononeuropathy".
Peripheral neuropathy may be chronic (long-term conditions when symptoms begin smoothly and slowly) or acute (sudden onset, rapid progress, and slow resolution). Acute neuropathy demands an urgent diagnosis. Motor nerves (which control the muscles), sensory nerves, or autonomic nerves (which control automatic functions such as heart rate, body temperature, and breathing) may be affected. More than one type of nerve can be affected at the same time. Peripheral neuropathy can be classified by the type of nerve that is mostly involved, or by the underlying cause.
Neuropathy can cause painful cramps, fasciculation (smooth muscle twitching), muscle loss, bone degeneration, and changes in the skin, hair, and nails. In addition, motor neuropathy may cause disturbed balance and coordination or, most commonly, muscle weakness; sensory neuropathy can cause numbness to touch and vibration, reduce position sensitivity leading to poorer coordination and balance, reduce sensitivity to temperature changes and pain, spontaneous tingling or burning pain, or skin allodynia ( severe pain from usually painless stimuli, such as light touch); and autonomic neuropathy can produce various symptoms, depending on the affected glands and organs, but common symptoms are poor bladder control, abnormal blood pressure or heart rate, and a normally reduced sweating ability.
Video Peripheral neuropathy
Classification
Peripheral neuropathy can be classified according to the number and distribution of affected nerves (mononeuropathy, mononeuritis multiplex, or polyneuropathy), the type of nerve fibers that are predominantly affected (motor, sensory, autonomic), or processes affecting the nerves; eg, inflammation (neuritis), compression (compression of neuropathy), chemotherapy (peripherally induced peripheral neuropathy).
Mononeuropathy
Mononeuropathy is a type of neuropathy affecting only a single nerve. Diagnostically, it is important to distinguish it from polyneuropathy because when a single nerve is affected, it is more likely due to trauma or local infection.
The most common cause of mononeuropathy is nerve physical compression, known as compression neuropathy. Carpal tunnel syndrome and paralytic nerve paralysis are examples. Direct injury to the nerves, impaired blood supply (ischemia), or inflammation can also cause mononeuropathy.
Polyneuropathy
" Polneuropathy " is a pattern of nerve damage that is very different from mononeuropathy, often more serious and affects more areas of the body. The term "peripheral neuropathy" is sometimes used loosely to refer to polyneuropathy. In the case of polyneuropathy, many nerve cells in different parts of the body are affected, regardless of the nerve they pass; not all nerve cells are affected in certain cases. In a distal axonopathy, a common pattern is that neuron cells remain intact, but the axons are affected proportionately by their length; the longest axons are the most affected. Diabetic neuropathy is the most common cause of this pattern. In the demyelinating polineuropathy, the myelin sheath around the axon is damaged, affecting the ability of the axon to perform electrical impulses. The third and least common pattern affects the body cells of the neurons directly. This usually takes either a motor neuron (known as motor neurone disease) or sensory neuron (known as sensory neuronopathy) or dorsal root ganglionopathy ).
The effect of this is to cause symptoms in more than one part of the body, often symmetrical on the left and right. Like neuropathy, major symptoms include motor symptoms such as weakness or stiffness of movement; and sensory symptoms such as unusual or unpleasant sensations such as tingling or burning; reducing the ability to feel sensations such as texture or temperature, and balance disorders when standing or walking. In many polyneuropathy, these symptoms occur first and most severe in the legs. Autonomic symptoms may also occur, such as dizziness on standing, erectile dysfunction, and difficulty in controlling urination.
Polineuropathy is usually caused by processes that affect the body as a whole. Diabetes and impaired glucose tolerance are the most common causes. The induced formation of hyperglycemia from late glycemic end products (AGEs) is associated with diabetic neuropathy. Other causes are associated with certain types of polyneuropathy, and there are many different causes of each type, including inflammatory diseases such as Lyme disease, vitamin deficiency, blood disorders, and toxins (including alcohol and certain prescribed drugs).
Most types of polyneuropathy take place slowly, months or years, but rapidly progressive polyneuropathy also occurs. It is important to know that at one time it was estimated that many cases of small fiber peripheral neuropathy with typical symptoms of tingling, pain, and loss of sensation in the feet and hands were due to glucose intolerance before the diagnosis of diabetes or pre-diabetes. However, in August 2015, the Mayo Clinic published a scientific study in the Journal of Neurological Sciences that showed "no significant increase... symptoms... in the prediabetes group", and stated that "Searching for alternative causes of neuropathy is required in patients with prediabetes. "
The treatment of polyneuropathy is aimed first of all to eliminate or control the cause, secondly to maintain muscle strength and physical function, and thirdly to control symptoms such as neuropathic pain.
Mononeuritis multiplex
Mononeuritis multiplex , sometimes called multiplex polyneuritis , is the simultaneous or sequential involvement of individual noncontiguous nerve rods, either partially or completely, evolved over several days to years and usually with acute or subacute loss of sensory and motor function of individual nerves. The pattern of engagement is asymmetrical, however, as the disease develops, the deficit (s) becomes more confluent and symmetrical, making it difficult to distinguish from polyneuropathy. Therefore, attention to early symptom patterns is important.
Multiplex mononeuritis can also cause pain, which is characterized as deep pain, worse pain at night and often in the lower back, hips, or legs. In people with diabetes mellitus, multiplex mononeuritis is usually found as acute, unilateral, and heavy thigh pain followed by anterior muscle weakness and loss of knee reflex.
The study of electrodiagnostic treatment will show multifocal multifocal multifocal axial multifocal axial neuropathy.
This is caused by, or related to, some medical conditions:
Autonomic neuropathy
Autonomic neuropathy is a form of polyneuropathy that affects the non-voluntary, non-sensory (ie, autonomic nervous system) nervous system, affecting most internal organs such as bladder muscles, the cardiovascular system, the gastrointestinal tract, and the genital organs. These nerves are not under one's control and functionality automatically. Autonomic nerve fibers form large collections in the thorax, abdomen, and pelvis outside the spinal cord. They have connections with the spinal cord and eventually the brain. Autonomic neuropathy is most commonly seen in people with long-standing type 1 and 2 diabetes mellitus. In most - but not all - cases, autonomic neuropathy occurs simultaneously with other forms of neuropathy, such as sensory neuropathy.
Autonomic neuropathy is one of the causes of damage to the autonomic nervous system, but not the only one; some conditions that affect the brain or spinal cord may also cause autonomic dysfunction, such as multiple system atrophy, and therefore, may cause symptoms similar to that of autonomic neuropathy.
Signs and symptoms of autonomic neuropathy include the following:
- Bladder conditions: bladder incontinence or urinary retention
- Gastrointestinal tract: dysphagia, abdominal pain, nausea, vomiting, malabsorption, fecal incontinence, gastroparesis, diarrhea, constipation
- Cardiovascular system: heart rate disorders (tachycardia, bradycardia), orthostatic hypotension, inadequate elevation of heart rate while working
- Respiratory system: interference with signals associated with respiratory and gas exchange settings (central sleep apnea, hypopnea, bradypnea).
- Other areas: unconscious hypoglycemia, genital impotence, sweat disorder
Neuritis
Neuritis is a general term for nerve inflammation or general inflammation of the peripheral nervous system. Symptoms depend on the nerves involved, but may include pain, paresthesia (pin-and-needle), paresis (weakness), hypoesthesia (numbness), anesthesia, paralysis, wasting, and loss of reflexes.
The causes of neuritis include:
Maps Peripheral neuropathy
Signs and symptoms
Those who have their disease or neural dysfunction can present with problems in any of the normal nerve functions. Symptoms vary depending on the type of nerve fibers involved. In terms of sensory function, symptoms usually include loss of function ("negative") symptoms, including numbness, tremors, balance disorders, and gait disorders. The function benefits (positive) include symptoms of tingling, pain, itching, crawling, and pin-and-needle. Motor symptoms include loss of function ("negative") symptoms of weakness, fatigue, muscle atrophy, and gait disorders; and acquired the function ("positive") symptoms of cramps, and muscle twitch (fasikulasi).
In the most common form, peripheral long-hanging neuropathy, pain and parasthesia occur symmetrically and generally in the longest nerve terminals, which are in the lower legs and feet. Sensory symptoms generally develop before motor symptoms such as weakness. The symptoms of peripheral neuropathy that depend on the length make the foot climb slow, while the symptoms never appear in the upper extremities; if they do, it will be around when the leg symptom reaches the knee. When the nerves of the autonomic nervous system are affected, symptoms may include constipation, dry mouth, difficulty urinating, and dizziness when standing.
Cause
The causes are broadly grouped as follows:
Diagnosis
Peripheral neuropathy may be first considered when a person reports symptoms of numbness, tingling, and pain in the legs. After excluding lesions of the central nervous system as a cause, the diagnosis can be performed on the basis of symptoms, laboratory and additional testing, clinical history, and detailed examination.
During physical examination, especially neurological examination, those with generalized peripheral neuropathies generally have distal or motor sensory and sensory loss, although those with pathologic (neural) problems may be normal; can show proximal weakness, as in some inflammatory neuropathy, such as Guillain-Barrà ©  © © syndrome; or may indicate a focal sensory disorder or weakness, as in mononeuropathies. Classically, ankle reflexes are absent in peripheral neuropathy.
Physical examination will involve deep ankle reflex examination and foot examination for each ulceration. For large fiber neuropathies, the examination will usually show an abnormal sensation of vibration, tested with a 128-Hz tuning fork, and a slight touch of touch sensation when touched by a nylon monofilament.
Diagnostic tests include electromyography (EMG) and neural conduction studies (NCSs), which assess large nerve myelin fibers. Tests for small fibrous peripheral neuropathy are often associated with the functioning of the autonomic nervous system of thin, non-bermyelin thin fibers. These tests include sweat tests and table tilt tests. The diagnosis of small fiber involvement in peripheral neuropathy may also involve a skin biopsy in which a 3 mm skin patch is removed from the calf with a punch biopsy, and is used to measure the density of the intraepidermal skin fibers (IENFD), the neural density in the outer layer of the skin. The reduced density of the small nerves in the epidermis supports the diagnosis of small fibrous peripheral neuropathy.
Laboratory tests include blood tests for vitamin B-12 levels, full blood count, measurement of thyroid stimulating hormone levels, comprehensive metabolic panel screening for diabetes and pre-diabetes, and serum immunofection tests, which test antibodies in the blood.
Treatment
Treatment of peripheral neuropathy varies based on the cause of the condition, and treating the underlying conditions may be helpful in neuropathic management. When peripheral neuropathy occurs due to diabetes mellitus or prediabetes, blood sugar management is the key to treatment. Especially prediabetes, tight blood sugar control can significantly alter the direction of neuropathy. In peripheral neuropathy derived from immune-mediated diseases, the underlying condition is treated with intravenous immunoglobulin or steroids. When peripheral neuropathy occurs due to vitamin deficiency or other disorders, they are treated as well.
Drugs
Various drugs that work on the central nervous system have been found to be beneficial in managing neuropathic pain. Commonly used treatments include tricyclic antidepressants (such as nortriptyline or amitriptyline), serotonin-norepinephrine reuptake inhibitors (SNRIs) of duloxetine drugs, and antiepileptic treatments such as gabapentin, pregabalin, or sodium valproate. Several studies have examined whether nonsteroidal anti-inflammatory drugs are effective in treating peripheral neuropathy.
Relieve symptoms for peripheral neuropathic pain can be obtained with topical capsaicin application. Capsaicin is a factor that causes heat in chili. Evidence showing that capsaicin applied to the skin reduces pain for peripheral neuropathy is moderate to low quality and should be interpreted with caution before using this treatment option. Local anesthesia is often used to combat the initial discomfort of capsaicin. Several current studies on animal models suggest that the depletion of neurotropin-3 can counteract the demyelination that exists in some peripheral neuropathy by enhancing myelin formation.
Evidence supports the use of cannabinoids for some forms of neuropathic pain.
Medical devices
Transcutaneous electrical nerve stimulation therapy may be effective and safe in the treatment of diabetic peripheral neuropathy. A recent review of three trials involving 78 patients found some increase in pain scores after 4 and 6, but not 12 weeks of treatment and overall improvement in neuropathic symptoms at 12 weeks. Another review of four trials found significant improvements in pain and overall symptoms, with 38% of patients in one trial being asymptomatic. Treatment remains effective even after prolonged use, but symptoms return to baseline within one month after discontinuation of treatment.
See also
- Scrambler therapy
References
Further reading
- Latov N (2007). Peripheral Neuropathy: When Numbness, Weakness, and Pain Will Not Stop . New York: American Academy of Neurology Press Demos Medical. ISBNÃ, 1-932603-59-X.
- "Practice advice for prevention of perioperative peripheral neuropathy: report by the American Society of Anesthesiologists Task Force on Prevention of Peripheral Peripheral Neuropathy". Anesthesiology . 92 (4): 1168-82. April 2000. doi: 10.1097/00000542-200004000-00036. PMID 10754638.
External links
- Peripheral Neuropathy from US NIH
- Neuropathy: Causes, Symptoms and Treatment of Medical News Today
- Peripheral Neuropathy at Mayo Clinic
Source of the article : Wikipedia
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