Peripheral Neuropathy

In the defeat of peripheral nerves in almost all cases diagnosed with "peripheral neuropathy" such a disease is often secondary and is associated with other morbid conditions. With peripheral neuropathy, the nerve fibers responsible for transporting pulses from the central nervous system to the musculature, skin and various organs are damaged.

At the initial stage of neuropathy, the patient may not be aware of the existence of a disease: for example, peripheral neuropathy of the limbs often begins to show tickling or tingling sensations in the fingers or toes. Then the symptoms become more disturbing, and only then the person thinks about visiting the doctor.

What do you need to know about peripheral neuropathy in order to identify the problem in time and prevent its further development? All the necessary points can be found in this article.

Epidemiology

Peripheral neuropathy is diagnosed in about 2.5% of people. If the disease is detected in childhood and adolescence, then the most frequent cause of it becomes hereditary predisposition. In older patients, peripheral neuropathy is found in 8% of cases.

The overwhelming category of patients suffering from peripheral neuropathy refers to the age of 35 to 50 years.

[1], [2], [3], [4], [5], [6],

Causes of the peripheral neuropathy

Different forms of neuropathy, in fact, begin their development with almost identical causes:

• contusion, dissection of the nerve;
• defeat of nerve fibers by the tumor process;
• a critical reduction in immune defense;
• critical shortage of vitamins;
• chronic intoxication, including alcohol;
• vascular disease, inflammatory changes in vascular walls;
• diseases of the circulatory system, thrombophlebitis;
• metabolic, endocrine disorders;
• microbial and viral infectious pathologies;
• long-term use of certain medications - for example, with chemotherapy;
• acute polyradiculoneuritis;
• hereditary damage to peripheral nerves.

Peripheral neuropathy after chemotherapy

The development of neuropathy after chemotherapy is often an adverse manifestation of a particular chemotherapy. However, this is not always the case: in many patients, the development of peripheral neuropathy after chemotherapy is associated with a toxic decay of the tumor process. It is believed that some end products can significantly accelerate the course of the systemic inflammatory process. In such a case, the patient complains of general weakness, sleep disturbance, loss of appetite. Laboratory toxic toxic decomposition of the tumor is reflected in all blood parameters.

Neurotoxic reaction is classified as a systemic consequence of all chemotherapeutic regimens. Therefore, to avoid such an effect is almost impossible: if you reduce the dosage of a chemical product or even cancel it, the treatment prognosis deteriorates significantly. To continue chemotherapy and alleviate the condition of the patient, doctors also prescribe strong analgesics and anti-inflammatory drugs. As an auxiliary treatment, vitamin preparations and immunosuppressants are used.

[7], [8], [9], [10]

Risk factors

Peripheral neuropathy occurs as a result of other factors and diseases, although in some cases the cause can not be determined.

To date, doctors have voiced almost two hundred factors that can lead to the development of peripheral neuropathy. Among them the following are particularly distinguished:

• Endocrine disorders, obesity, diabetes;
• long-term exposure to toxic substances (paints, solvents, chemicals, alcohol);
• Malignant diseases requiring chemotherapy;
• HIV, viral joint damage, herpes, chickenpox, autoimmune diseases;
• specific vaccination (for example, from rabies, influenza);
• possible traumatic nerve damage (for example, in road accidents, knife and gunshot wounds, open fractures, prolonged compression);
• chronic hypothermia, vibration;
• long-term treatment with anticonvulsants, antibiotics, cytostatics;
• insufficient nutrition, insufficient intake of B-group vitamins;
• hereditary predisposition.

[11], [12], [13], [14], [15],

Pathogenesis

At the heart of peripheral neuropathy is a degenerative degenerative process. That is, nerve fibers are destroyed simultaneously with the deterioration of trophism, intoxication.

The destruction of the shell neurons, axons (nerve rods).

Peripheral neuropathy affects the nerve fibers located outside the brain and spinal cord. The most often diagnosed neuropathy of the lower extremities, which is associated with a greater length of nerve fibers. These fibers are responsible for overall sensitivity, for tissue trophism and muscular function.

In many patients peripheral neuropathy proceeds, "masquerading" for other diseases. If the disease is not detected in time, then the nerve can collapse up to the central parts of the nervous system. If this happens, the violations will already become irreversible.

[16], [17], [18], [19], [20], [21], [22], [23]

Symptoms of the peripheral neuropathy

The clinical picture of peripheral neuropathy depends on the type of affected nerve fibers. Symptoms can manifest themselves far from immediately: the disease manifests itself on an increasing schedule, aggravated for many days, months and even years.

The main symptom that patients pay attention to is muscle weakness - a person quickly becomes tired, for example, when walking or during physical work. Other symptoms include pain and cramps in the muscles (in the initial stages, seizures are often manifested by small twitchings of superficial muscle fibers).

Then the clinical symptoms expand. There are muscular atrophic changes, degenerative processes in bone tissues. Violated the structure of the skin, hair, nail plates. Such disorders are usually caused by damage to sensory or autonomic fibers.

The defeat of sensory nerves is characterized by a number of typical signs, because such nerves perform strictly specific functions. For example, the ability of vibrational sensitivity may deteriorate: a person ceases to feel touch, limbs and especially the fingers begin to "dumb". Often a patient can not feel if he wears gloves or socks. They also find it difficult to determine the size and shape of objects by touch. Over time, such problems lead to a loss of reflexes, to a distortion of the sense of the spatial position of the trunk.

Strong neuropathic pains gradually "loosen" the psychoemotional state of the patient, the household activity and quality of life worsen. If pain is manifested primarily at night, then insomnia, irritability, and disability may result.

If the nervous structures responsible for pain and temperature sensitivity are affected, the patient becomes immune to pain and temperature irritants. Less often, on the contrary - when the patient even a slight touch perceives, as a strong and intolerable pain.

If damage to accumulation of autonomic nerve fibers, the consequences can become more dangerous - for example, if such nerves innervate the respiratory organs or the heart, then there may be malfunctions with breathing, arrhythmia, etc. Often the function of the sweat glands is disrupted, the urinary function is broken, pressure, depending on which nerves are affected.

The first signs are most often manifested by pain in the limbs and muscles, but it happens that peripheral neuropathy reveals itself as other symptoms:

• loss of sensitivity of the fingers or limbs (it can be a pain, temperature or tactile sensitivity);
• increased sensitivity of the fingers or limbs;
• sensation of "goosebumps", burning sensations on the skin;
• spastic pain;
• shakiness of gait, impaired motor coordination and balance;
• increasing muscular weakness;
• problems with breathing, cardiac activity, urination, erection.

Other, nonspecific manifestations of peripheral neuropathy are possible, which must be reported to the doctor.

Peripheral neuropathy in children

The appearance of peripheral neuropathy in childhood is most often hereditary. Such neuropathies in many children are manifested by the development of a symmetrical, increasing muscle atrophy, predominantly of the distal type.

For example, Charcot-Marie-Toot's disease is transmitted autosomal dominantly and occurs most often. Pathology is characterized by demyelination of damaged nerve fibers, with further remyelination and hypertrophy, which leads to deformation of nerves. This often affects the lower extremities.

Acute children's polyradiculoneuropathy is less common. This kind of childhood neuropathy occurs 15-20 days after the infectious disease. Complication is manifested by a violation of sensitivity in the lower extremities, symmetrical weakness, loss of reflexes. If bulbar muscle is involved in the process, then there are difficulties with chewing and swallowing. The prognosis of this disease is relatively favorable: as a rule, 95% of patients are restored, however, the rehabilitation period can last up to 2 years.

Forms

Peripheral neuropathy includes a number of disease states, which, although they have common characteristics, can be quite diverse. This allows us to distinguish various types of peripheral neuropathies, which depends, both on the localization of the lesion, and on the mechanism of the development of pathology.

• Peripheral neuropathy of the lower extremities is most common among other species of the disease. Lower limbs suffer from the predominant defeat of long nerves, so the first signs usually affect the furthest leg segments - the ankles. Over time, the disease rises higher, the calves, knees are involved in the process: muscle function and sensitivity deteriorate, blood flow becomes more difficult.
• Diabetic peripheral neuropathy is a common complication that occurs in patients with diabetes mellitus. As a rule, such a diagnosis is put to patients with obvious symptoms of peripheral nerve damage. Diabetic neuropathy is characterized by impaired sensitivity, autonomic nervous system disorders, urinary disorders, etc. In practice, this is manifested by numbness of the legs and / or hands, problems from the heart, vessels, digestive organs.
• Peripheral neuropathy of the facial nerve is manifested by one-sided paralysis of facial muscles, caused by damage to the facial nerve. The facial nerve branches out in two, but only one of the branches is affected. That is why signs of neuropathy with lesions of the facial nerve arise on one side of the face. The affected area of the face acquires a "masklike" appearance: wrinkles are smoothed, facial expressions completely disappear, can cause pain and numbness, including in the ear zone on the side of the lesion. Often there is lacrimation, salivation, change in taste sensations.
• Peripheral neuropathy of the upper extremities can be manifested by the defeat of one of the three main nerve bands: the radial nerve, the median nerve or the ulnar nerve. Accordingly, the clinical picture will depend on which nerve is affected. The most frequent symptoms that are present in any type of upper limb injury are severe pain, numbness of the fingers or the entire arm. Additional signs are common manifestations of neuropathies: spasmodic twitching of the muscles, a sense of running "creepy", a deterioration of sensitivity and motor coordination.

The classification also extends to the predominant nerve damage. As you know, nerves are of three kinds, and they are responsible for sensitivity, motor activity and vegetative function. Accordingly, peripheral neuropathy can be of several types:

• Peripheral sensory neuropathy is diagnosed with damage to sensitive nerve fibers. The pathology is characterized by acute pain, tingling sensation, a change in sensitivity upward (a decrease also happens, but much less often).
• Peripheral motor neuropathy proceeds with lesion of motor nerve fibers. Such a pathology is manifested by the weakness of the musculature, which diverges from the lower parts to the upper ones, which can cause a complete loss of motor ability. Violation of motor function is accompanied by frequent convulsions.
• Peripheral sensorimotor neuropathy has a mixed character of the lesion and is manifested by all the listed clinical signs.
• Peripheral autonomic neuropathy is a defeat of the nerves of the autonomic nervous system. The clinical picture is characterized by increased sweating, a violation of potency, difficulty with urination.

There is also a clinical classification of peripheral neuropathy, according to which the following stages of pathology are distinguished:

1. Subclinical stage of initial manifestations.
2. The clinical stage of neuropathy is a stage of a bright clinical picture, which is divided into the following categories:

• chronic painful stage;
• acute painful stage;
• Stage without pain on the background of a decrease or total loss of sensitivity.

1. Stage of late consequences and complications.

[24], [25], [26]

Complications and consequences

Peripheral neuropathy is capable of significantly "knocking down" human health. So, the possibility of development of negative consequences and complications is not ruled out. In the first place, with peripheral neuropathy, the sensory function suffers, which threatens with such complications as:

• strong "shooting" pain in the zone of nervous innervation;
• sensation of foreign matter under the skin;
• loss of thermal sensitivity, which, in turn, can cause burns, cryotrials, etc.

However, there may be more serious complications that occur in the defeat of the autonomic nervous system:

• deterioration of the skin;
• loss of hair at the site of innervation;
• hyperpigmentation of the skin;
• violation of sweating;
• violation of skin trophism, the formation of erosions, ulcers, up to the gangrene of the limb.

If the nerves responsible for motor activity suffer, then knee and other reflexes can be smoothed out. Often there are spasmodic convulsions, muscle weakness, muscle atrophy. In such cases, the disease often ends with a disability.

[27], [28], [29], [30], [31], [32], [33]

Diagnostics of the peripheral neuropathy

Diagnosis is sometimes difficult, because of the variety of symptoms of peripheral neuropathy. Most patients have to undergo a full course of neurological diagnosis for the correct diagnosis.

Analyzes are carried out with the purpose of detection of a diabetes, an avitaminosis, disturbances from the vascular and urinary systems. This is especially important if the innervation of individual organs is affected, or when peripheral neuropathy is caused by endocrine or other disorders.

Diagnostic testing of muscle strength helps to detect convulsive activity and damage to motor nerve cells.

Instrumental diagnostics is appointed selectively and can include such procedures:

• Computer tomography, magnetic resonance imaging - can find the cause of nerve compression (eg, vertebral hernia, tumor process).
• Electromyography - helps to trace the transmission of nerve impulses to the musculature.
• The study of nerve conduction - is a diagnosis of the transmission of nerve impulses by placing electrodes on the skin.

[34], [35], [36], [37], [38], [39]

Differential diagnosis

Differential diagnosis of peripheral neuropathy is carried out with such violations:

• hypothyroidism, uremia;
• sarcoidosis, nodular periarteritis;
• insufficient adrenal function;
• syringomyelia, tumors of the nervous system, multiple sclerosis.

[40], [41], [42],

Treatment of the peripheral neuropathy

Treatment is based on the elimination of the underlying pathology, which caused the development of peripheral neuropathy. For example, if the development factor of the disease is diabetes, then it is necessary to first establish control over the sugar content in the blood. If peripheral neuropathy was provoked by avitaminosis B, then it is important to establish additional intake of multivitamins, as well as adjust the patient's diet.

Often, timely medical intervention not only facilitates the patient's condition, but also allows to stop further progression of peripheral neuropathy. However, it is better to use a combination of different treatment methods.

Patients with peripheral neuropathy can be prescribed such drugs:

• Analgesics - for example, Paracetamol, non-steroidal anti-inflammatory drugs (Ibuprofen, Orthofen).
• Means, whose action is aimed at improving blood circulation (Actovegin, Pentoxifylline).
• B-group vitamins (Undevit, Neurorubin).
• Anticholinesterase drugs (Aksamon, Proserin).

If the peripheral neuropathy is heavy, the doctor may additionally prescribe anticonvulsants (for example, Sibazon), antidepressants (preparations of St. John's wort).

With severe pain, prescription analgesics (Tramadol) are used.

With peripheral neuropathy of autoimmune origin plasmapheresis is connected, intravenous immunoglobulin - this allows you to suppress the activity of your own immunity and stop the attack on nerve fibers.

	Dosing and Administration	Side effects	Special instructions
Orthophenia	The daily dose is 100-150 mg, taken for 2-3 doses.	Depression, headache, pain in the stomach, trembling in the fingers, irritability.	If the drug is supposed to be taken for a long time, it is necessary to provide additional protection for the digestive system in advance.
Aktovegin	Introduce intravenously, 20-30 ml with 200 ml of the basic solution, daily for a month.	There is a possibility of allergies, up to the development of anaphylaxis.	Before the start of treatment, a trial injection is mandatory to exclude allergies - inject 2 ml intramuscularly.
Neyrorubin	Enter intramuscularly one ampoule per day, until the acute clinical signs are eliminated.	Feeling of anxiety, tachycardia, digestive disorders.	Long-term use of the drug (more than half a year) can cause the development of reverse peripheral sensory neuropathy, so the question of long-term treatment is discussed with the doctor individually.
Photographs	Enter intramuscularly for 5-15 mg to 2 times a day, for 10-15 days, sometimes - up to a month.	Tachycardia, nausea, increased salivation and sweating.	Aksamon strengthens the sedative effect of many drugs, so you need to be careful when driving a car and when working with different mechanisms.
Tramadol	They are prescribed only by a doctor with severe pain, 50 mg per reception. The daily limit of the drug is 400 mg.	Tachycardia, nausea, dizziness, increased sweating, impaired vision and taste.	During the period of treatment, alcohol consumption is prohibited in any form.

Physiotherapeutic treatment

Physiotherapy with peripheral neuropathy is used quite often. Regular and properly selected procedures help restore the musculature lost functionality and restore blood supply to tissues. However, the methods of physical therapy can be used only after the end of the acute period of the disease, as well as in the implementation of rehabilitation measures.

Successfully used electrophoresis with drugs that improve metabolism and vascular circulation. Myoelektrostimulyatsii procedures help neurons restore sensory and motor ability. However, it is better if the listed methods are applied in a complex.

Massage, including water massage, has a mechanical effect, which accelerates blood circulation and metabolic processes in the diseased hands or feet.

Mandatory exercises are assigned to exercise therapy, allowing to maintain muscle tone.

Alternative treatment

The people know many ways to alleviate the condition of the patient with peripheral neuropathy. Nevertheless, we strongly advise that when using such alternative agents, it is necessary to consult your doctor in advance.

The following recipes in the people are considered the most effective.

• Cocktail with egg yolks and honey.

As ingredients, one fresh egg yolk, 4 tsp. Unrefined vegetable oil, 100 ml freshly squeezed carrot juice and 2 tsp. Honey. All ingredients should be mixed well in a blender. The received quantity of a medicine needs to be drunk daily for two times (in the morning and in the evening) before meal.

• Salt bath.

Pour hot water (approximately 55 ° C) into the bowl to half the capacity. Add 200 g of salt and 150 ml of table vinegar. Dip the affected limbs into the solution for 20 minutes. The procedure is carried out daily, for 4 weeks.

• Mask made of clay.

Diluted with water 120 g of cosmetic clay, to the consistency of sour cream. Mass is applied to the affected area, left to dry. The procedure is carried out daily, until the condition is permanently improved.

• Massage with camphor oil.

Camphor oil is rubbed into the affected area with light massaging movements, and then left to soak for a quarter of an hour. Further, the affected area is rubbed intensely with alcohol and wrapped in heat. The procedure is repeated every day, preferably at night, for 4 weeks.

[43], [44], [45], [46]

Herbal Treatment

Alternative treatment can be added and treatment of medicinal plants. The simplest and most effective way is: the leaves of spring nettles are laid out on the floor and walk on them with bare feet.

Improve the effect of the main drug treatment can and such methods:

• Prepare the infusion of laurel powder and fenugreek seed. To make infusion brew in 1 liter thermos 2 tsp. Laurel powder and 2 full tablespoons of fenugreek seed. Insist 2 hours, filter and drink a little throughout the day.
• Brewed 2 tbsp. L. Marigold in 200 ml of boiling water, insist half an hour. Take 100 ml per day, for a month.
• Prepare a tray with coniferous branches and red hot pepper. Half a kilogram of coniferous branches boil in 3 liters of water, add 2 tbsp. L. Ground pepper, poured into a basin. Dilute with water to make the solution not very hot. Soar your feet for about half an hour, at night.

Homeopathy

In addition to the main therapy, you can also consider the use of homeopathic remedies:

• Aconite - used for dry skin, tingling, tremors, convulsions.
• Alumen - used for intolerable itching, ulcer formation, paresthesia.
• Argentum nitrikum - suitable for the treatment of diabetic neuropathy.
• Carcinosinum - is indicated with delayed wound healing, with purulent processes on the neuropathy affected limbs.
• Colchicum - used for neuropathy, which is accompanied by joint damage.
• Grafitis - especially suitable for the treatment of diabetic foot syndrome.
• Mercurius solubilis - is indicated with skin itching, trophic disorders.
• Phosphorus - used in the complications of neuropathy.
• Secale cornutum - recommended for dry gangrene, paresthesia.

Dosages for these drugs are individual: they are prescribed by a homeopath physician after personal consultation.

Surgery

The surgeon's help may be needed in case peripheral neuropathy is associated with tumor processes that squeeze nerves. Also, surgical treatment is appropriate for vertebral hernias and mononeuropathies. Thus, the compression of the nerve can be eliminated by incising tendon or muscle fibers. This is how the carpal tunnel syndrome is treated.

Prevention

The best option for the prevention of peripheral neuropathy is proper nutrition of healthy food against the background of quitting smoking and drinking alcohol. The statistical data voiced by WHO indicate that about 80% of neuropathies are caused by metabolic disturbances and chronic intoxications.

Patients suffering from diabetes, should constantly keep under control the level of glucose in the blood. With an increased level of sugar, toxic effects of glucose on neurons occur.

People who spend a lot of time "on their feet" need to pay special attention to the quality of worn shoes. Shoes should be comfortable and quality.

As a preventive measure, regular walking tours are recommended, which activate the immune system and improve the state of the cardiovascular system. Promotes the recovery of nerves and a full night's rest, in a comfortable bed and a well-ventilated room.

[47], [48], [49]

Forecast

In the case of timely treatment for medical care, with the correct treatment of the disease, the prognosis of peripheral neuropathy can be considered favorable.

With a hereditary etiology of peripheral neuropathy, it is not possible to talk about a complete cure, but there is a possibility of inhibition of the further development of the disease. Typically, literate therapy and lifestyle changes can alleviate painful symptoms and prolong the patient's ability to work.

At a belated address to doctors, at development of complications the forecast can not be considered favorable: many patients with the diagnosis "peripheral neuropathy" subsequently become invalids.