Polyneuropathy - Treatment and prognosis

Treatment of polyneuropathy

Goals of treatment for polyneuropathy

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

Non-drug treatment of polyneuropathy

One of the important aspects of treatment is therapeutic exercise aimed at maintaining muscle tone and preventing contractures. In the case of respiratory disorders in Guillain-Barré syndrome and diphtheritic polyneuropathy, artificial ventilation may be required.

Drug treatment of polyneuropathy

Hereditary polyneuropathies. There is no effective treatment. Vitamin preparations and neurotrophic agents are used for maintenance therapy, although their effectiveness has not been proven.

Porphyric polyneuropathy. Intravenous administration of glucose (500 ml of 5% solution) usually improves the condition. B vitamins, painkillers and other symptomatic drugs are also used.

Chronic inflammatory demyelinating polyneuropathy. Plasmapheresis, normal human immunoglobulin (intravenously at a dose of 0.4 mg/kg per day for 5 days) or prednisolone (methylprednisolone) (at a dose of 1 mg/kg per day every other day) are used. Usually, plasmapheresis and immunoglobulin are ineffective, therefore, if there are no contraindications, treatment should be started immediately with glucocorticoids. Improvement (clinical and according to EMG data) is usually noted after 20-30 days; after 2 months, a gradual reduction of the dose to a maintenance dose can be started. When reducing the dose of glucocorticoids, EMG monitoring is advisable (a sign of remission is regression of denervation spontaneous activity; an increase in spontaneous activity indicates the onset of an exacerbation, in which case the dose reduction is stopped). As a rule, it is possible to completely discontinue prednisolone within 9-12 months, if necessary - under the cover of azathioprine. In some cases, cyclosporine [5 mg/kg per day], mycophenolate mofetil (0.25-3 g/day), cyclophosphamide [1-2 mg/kg per day] are also used.

Multifocal motor mononeuropathy, Sumner-Lewis syndrome. The drug of choice is normal human immunoglobulin (intravenously at a dose of 0.4 mg/kg per day for 5 days). If possible, courses of immunoglobulin therapy should be repeated every 1-2 months. Glucocorticoids are not effective and in some cases cause deterioration. A positive effect can be achieved by a combination of two plasmapheresis sessions followed by a course of cyclophosphamide (1 g/m2 ^{intravenously} monthly for 6 months). A positive effect was also noted with rituximab at a dose of 375 mg/m2 ^once a week for 4 weeks.

Diabetic polyneuropathy. The main method of treatment is maintaining glycemia at a normal level. Tricyclic antidepressants, as well as pregabalin, gabapentin, lamotrigine, and carbamazepine are used to relieve pain. Thioctic acid preparations are widely used (intravenously by drip at 600 mg/day for 10-15 days, then orally at 600 mg/day for 1-2 months), and B vitamins (benfotiamine).

Uremic polyneuropathy. Regression of symptoms in the early stages occurs with correction of the level of uremic toxins in the blood (dialysis, kidney transplant). Of the drugs, vitamins of group B are used, in case of severe pain syndrome - tricyclic antidepressants, pregabalin.

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

Diphtheria polyneuropathy. When diphtheria is diagnosed, the introduction of antitoxic serum reduces the likelihood of polyneuropathy. When polyneuropathy develops, the introduction of serum is already ineffective, but acceptable. Treatment is mainly symptomatic.

Surgical treatment of polyneuropathy

In hereditary polyneuropathies, in some cases, surgical interventions are necessary due to the development of contractures and foot deformities. However, it is necessary to remember that prolonged immobility after surgery can negatively affect motor functions.

Forecast

In chronic inflammatory demyelinating polyneuropathy, the prognosis for life is favorable, fatal outcomes are extremely rare, but recovery is rare. Most patients (90%) achieve complete or partial remission against the background of immunosuppressive therapy, but the disease is prone to exacerbations, the use of immunosuppressive therapy can be significantly limited by its complications. In general, the prognosis is better with a remitting course, worse - with a progressive course.

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

In hereditary polyneuropathies, it is usually not possible to achieve an improvement in the condition; the course is slowly progressive, but in general, patients adapt to their condition and in almost all cases can move independently and take care of themselves until the very latest stages of the disease.

Diphtheritic polyneuropathy most often ends with complete or almost complete restoration of nerve function within 6-12 months after the onset of the disease, however, in severe cases, a severe motor defect remains, up to the loss of the ability to move independently.

The prognosis for toxic polyneuropathies, provided that intoxication ceases, is generally favorable; most often, complete restoration of nerve function occurs.

In diabetic polyneuropathy, if glycemia is carefully controlled and treatment is started in a timely manner, the prognosis is favorable, although the course of the disease is slowly progressive. In the late stages, severe pain syndrome can significantly worsen the quality of life.

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

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