Polyneuropathy: treatment and prognosis

Treatment of polyneuropathy

Objectives of treatment polyneuropathy

In hereditary polyneuropathies treatment is symptomatic. In autoimmune polyneuropathies, the goal of treatment is to achieve remission; and in the Guillain-Barre syndrome, the support of vital functions is of fundamental importance. With diabetic, uremic, alcoholic and other chronic progressive polyneuropathies treatment is reduced to a decrease in the severity of symptoms (including pain) and slowing the course of the process.

Non-drug treatment of polyneuropathy

One of the important aspects of treatment is exercise therapy, aimed at maintaining muscle tone and preventing contractures. In the case of development of respiratory disorders with Guillain-Barre syndrome and diphtheria polyneuropathy, ventilation may be required.

Medicamentous treatment of polyneuropathy

Hereditary polyneuropathies. Effective treatment does not exist. For maintenance therapy, vitamin preparations and neurotrophic agents are used, although their effectiveness has not been proven.

Porphyria polyneuropathy. Intravenous injection of glucose (500 ml of a 5% solution) usually causes an improvement in the condition. B vitamins, analgesics and other symptomatic medications are also used.

Chronic inflammatory demyelinating polyneuropathy. Apply plasmapheresis, human immunoglobulin (intravenously at a dose of 0.4 mg / kg per day for 5 days) or prednisolone (methylpredni-zolon) (at a dose of 1 mg / kg per day every other day). Usually, the effectiveness of plasmapheresis and immunoglobulin is inadequate; therefore, if there are no contraindications, treatment should begin immediately with glucocorticoids. Improvement (clinical and according to EMG data) is usually noted after 20-30 days; After 2 months, a gradual dose reduction to a maintenance dose can be started. With a decrease in the dose of glucocorticoids, EMG control is advisable (a sign of remission is the regression of denaturing spontaneous activity, an increase in spontaneous activity indicates a beginning of exacerbation, in this case, the dose reduction ceases). As a rule, it is possible to completely cancel prednisolone within 9-12 months, if necessary - under the cover of azathioprine. In some cases, also used are cyclosporine [5 mg / kg per day], mycophenolate mofetil (0.25-3 g / day), cyclophosphamide [1-2 mg / kg per day].

Multifocal motor mononeuropathy, Sumner-Lewis syndrome. The drug of choice is human immunoglobulin normal (intravenously at a dose of 0.4 mg / kg per day for 5 days). If possible, immunoglobulin therapy should be repeated every 1-2 months. Glucocorticoids are not effective and in some cases cause impairment. Positive effect can be achieved using a combination of two sessions of plasmapheresis with subsequent course of cyclophosphamide (at 1 g / m ² intravenously monthly for 6 months). There was also a positive effect of rituximab in a dose of 375 mg / m ² once a week for 4 weeks.

Diabetic polyneuropathy. The main method of treatment is maintaining glycemia at a normal level. To stop the pain syndrome used tricyclic antidepressants, as well as pregabalin, gabapentin, lamotrigine, carbamazepine. Widely used drugs tioktovoy acid (intravenously drip 600 mg / day in 10-15 days, then oral 600 mg / day for 1-2 months), vitamins B (benfotiamin).

Uremic polyneuropathy. The regression of symptoms at an early stage occurs when the level of uremic toxins in the blood is corrected (dialysis, kidney transplantation). Of the drugs used are B vitamins, with severe pain syndrome - tricyclic antidepressants, pregabalin.

Toxic polyneuropathy. The main therapeutic approach is to stop contact with a toxic substance. With dose-dependent drug polyneuropathies (for example, caused by amiodarone), it is necessary to adjust the dose of the corresponding drug. It is advisable to use group B vitamins, antioxidants.

Diphtheria polyneuropathy. When establishing the diagnosis of diphtheria, the administration of antitoxic serum reduces the likelihood of polyneuropathy. With the development of polyneuropathy, the introduction of serum is already ineffective, but it is permissible. Treatment is mostly symptomatic.

Surgical treatment of polyneuropathy

In hereditary polyneuropathies, in some cases, surgical interventions are necessary in connection with the development of contractures and deformities of the feet. However, it must be remembered that prolonged immobility after surgery can adversely affect motor functions.

Forecast

With chronic inflammatory demyelinating polyneuropathy, the prognosis for life is favorable, lethal outcomes are extremely rare, but recovery is rare. The majority of patients (90%) against immunosuppressive therapy achieve complete or incomplete remission, but the disease is prone to exacerbation, the use of immunosuppressive therapy can be significantly limited by its complications. In general, the prognosis is better with remittent, worse - with progressive flow.

With multifocal motor mononeuropathy, a positive effect in the treatment with immunoglobulin is observed in 70-80% of patients.

With hereditary polyneuropathies, it is usually impossible to improve the condition, the flow is slowly progressing, but in general the patients adapt to their condition and in almost all cases can independently move and service themselves to the latest stages of the disease.

Diphtheria polyneuropathy often ends with a complete or almost complete restoration of the function of the nerves within 6-12 months after the onset of the disease, but in severe cases, in some cases, there remains a severe motor defect, up to loss of ability to move independently.

The prognosis of toxic polyneuropathies, provided that the intoxication is terminated, is generally favorable, most often a complete restoration of the function of nerves occurs.

With diabetic polyneuropathy, if you carefully monitor glycemia and start treatment in time, the prognosis is favorable, although the course of the disease is slowly progressing. In advanced stages, severe pain syndrome can significantly impair the quality of life.

With uremic polyneuropathy, the prognosis depends entirely on the severity of chronic renal failure; timely initiated dialysis or kidney transplantation leads to complete or almost complete regression of polyneuropathy.

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