Neuropathy is an exceptionally broad term - this group of disorders includes both dysfunctions related to a single nerve, as well as to several or even many of them. The same is true of the causes of neuropathy, which are also extremely distinguished: disorders of the peripheral nervous system can be caused by diabetes, but also various infections or various metabolic disorders. What are the symptoms that a patient may have neuropathy? How is neuropathy treated?

Neuropathyis a fairly general concept and it can be seen after analyzing the words from which this term is derived. Well, it was created from the combination of two Greek words:neuro , meaning the nervous system andpathos , translated directly as suffering, and in a broader sense as disease.

The group of neuropathies includes various pathologies of the peripheral nervous system. As you can easily guess, there are many such units, so it is not surprising that neuropathies are one of the most common neurological diseases.

According to statistics around the world, even more than 2% of the population may suffer from neuropathy. It is also worth noting that the frequency of these diseases increases with age - among patients over 55 years old, even almost 10% of them may struggle with neuropathy.

Neuropathy: symptoms

The ailments of patients with neuropathy vary in nature - it all depends on the type of nerve fibers involved in the pathological process. Symptoms of sensory neuropathies are various sensory disturbances - some sensory stimuli are not experienced by patients at all, while others may be felt much more strongly than before. In the case of these problems, patients may complain, inter alia, to:

  • numbness and tingling
  • pain sensation disorders (patients may not feel the pain associated with the appearance of various wounds, e.g. on the feet, but they may also experience hyperaesthesia and even exceptional severe pains, referred to as neuropathic pains)
  • stinging sensation
  • burning sensation
  • proprioceptive sensation disorders (they can result in both clumsy movement and even falls)

Another type of neuropathy is motor neuropathy. In her case, the pathology concerns the nerve fibers that control the activity of various muscle cells and the symptoms of this type of neuropathy include:

  • muscle aches and cramps
  • uncontrolled movements of individual muscles
  • muscle weakness
  • abolition of tendon reflexes
  • muscle atrophy

Yet another type of diseases in question are autonomic neuropathies, in which the fibers of the autonomic (vegetative) nervous system are damaged. In this case, the symptoms of neuropathy are definitely different from those presented above and may be:

  • urination disorders (including both urinary incontinence and problems with starting voiding)
  • sweating disorders (in the form of either a significant reduction in sweating or excessive sweating)
  • dry mouth, eyeball dryness
  • visual disturbance (related to abnormal pupil reactions)
  • sexual dysfunction: male erectile dysfunction, female vaginal dryness
  • difficulty swallowing food
  • bowel movements disorder: patients with autonomic neuropathy can have both diarrhea and constipation
  • orthostatic hypotension (significant drops in blood pressure, e.g. related to a change in body position from lying down to standing)
  • heart rhythm disturbance
  • so-called hypoglycemia unawareness (in he althy people with low blood glucose various symptoms appear, such as hunger, hand tremors or sweating - in patients with this type of autonomic neuropathy, warning symptoms may simply not occur)

Neuropathy: causes

Neuropathies can be both congenital and acquired. The first of these cases, i.e. the condition where the patient is born with neuropathy, is less frequent. Various diseases are included here, primarily caused by genetic mutations that can lead to dysfunction of the peripheral nerves. Examples of such entities include Charcot-Marie-Tooth disease and Friedreich's ataxia.

There are many more factors that are the causes of acquired neuropathies - here we should mention, first of all, such problems as:

    Diabetes atblood glucose levels are high)
  • deficiencies of various vitamins and nutrients, especially vitamin B12, vitamin B1, folic acid and vitamin E
  • nerve damage related to alcohol abuse or alcoholism (alcohol itself can damage the structures of the peripheral nervous system, but its abuse can also promote neuropathy, as in this case patients often struggle with deficiencies in essential nutrients )
  • injuries leading to nerve damage (such as a fall, traffic accident, or nerve damage during some surgery)
  • nerve compression (neuropathy associated with such a phenomenon is, for example, carpal tunnel syndrome, however, nerve fibers can also be compressed by other types of mass, e.g. by neoplastic tumors developing in their vicinity)
  • nerve damage occurring as a side effect of medications taken by the patient (in this case, neuropathy may occur in people after chemotherapy, but also in patients taking various antiviral, anticonvulsant drugs or even after treatment with certain antibiotics)
  • poisoning (e.g. lead, mercury or arsenic poisoning)
  • metabolic disorders (occurring in the course of either renal or hepatic failure)
  • various infections (neuropathy can occur both in the case of HIV orHerpesviruses, but also in the course of syphilis, Lyme disease and various parasitic infections)
  • various autoimmune diseases (such as systemic lupus erythematosus, Guillain-Barre syndrome or rheumatoid arthritis)
  • hematological diseases (here, mainly monoclonal gammapathies are mentioned)
  • hormonal disorders (such as hyperthyroidism or acromegaly)

Analyzing the above, it is clearly visible that there are many reasons for neuropathy. Interestingly, however, in a fairly large percentage of patients - even in 20% of all patients - it is not possible to find the cause of the disorders, and then their neuropathy is defined as idiopathic.

Neuropathy: division and types

Not only the causes of neuropathy are mentioned a lot, so is the division of these disorders. Well, neuropathy can be divided due to:

  • duration of symptoms: list here acute, subacute, chronic andrecurrent
  • etiology of the problem: in this case, the division takes into account, inter alia, Congenital neuropathies, infectious neuropathies, drug-induced neuropathies or entrapment neuropathies
  • number of nerves involved: in the case of dysfunction of one nerve, the condition is called mononeuropathy, when several nerves are involved, it is referred to as multifocal mononeuropathy, and when the patient becomes pathologic to many different nerves, then it is possible to diagnose polyneuropathy

The above divisions are undoubtedly important, but the division based on the exact types of nerves involved in the disease seems to be much more important.

In this approach, three main types of neuropathy are distinguished: sensory, motor and autonomic (there is also the possibility of mixed forms of disorders, e.g. sensorimotor neuropathy).

This division is important mainly due to the fact that in the case of the various types of neuropathies mentioned above, patients struggle with various types of ailments.

Neuropathy: diagnosis

The diagnostic process in a patient with neuropathy is often quite complicated. First of all, it is necessary to conduct a very thorough neurological examination - recognizing what type of neuropathy is present in a given patient narrows down the group of potential causes of this ailment.

In the diagnosis of neuropathy, laboratory tests are very important, and patients are often ordered in large amounts - in a patient with this disease, it is necessary to determine the cause of its occurrence.

A variety of studies are relevant here, such as blood count, blood glucose measurements, electrolyte levels, hormone and urine tests.

Patients may also have immunoglobulin tests, proteinograms or the determination of the concentration of various vitamins (e.g. B12) in the body.

Testing for potential infection may also be performed, in this case patients may be ordered e.g. to test for HIV infection.

It is also possible that a patient with neuropathy will undergo a lumbar puncture and the resulting cerebrospinal fluid will be sent for laboratory analysis.

The scope of tests performed in patients with neuropathy is extremely large - the choice of specific analyzes depends on the cause of neuropathy the doctor suspects.

In addition to the studies already mentioned, other analyzes are also important. Here we must mention the researchelectrophysiological tests (in which the activity of specific nerve fibers is assessed and which allow the final determination of neuropathy), as well as nerve biopsy (this test is rarely performed, although it may be ordered, for example, if there is a suspicion that sarcoidosis is responsible for neuropathy) .

Neuropathy: treatment

Nerve fiber function can be improved with electrostimulation of nerve fibers, although this type of neuropathy treatment is rarely used today.

Treatment of neuropathy is based primarily on managing the underlying disease.

In patients with diabetes, it may be necessary to intensify treatment - even though glycemic control will not lead to the recovery of already existing damage, it will prevent the appearance of new ones.

In patients with vitamin deficiencies - e.g. with vitamin B12 deficiency - supplementation of this vitamin may be necessary.

In patients who develop neuropathy due to alcohol abuse, it is recommended that they maintain complete abstinence and, if necessary, also supplement their vitamin deficiencies.

In still other cases of neuropathy, mainly resulting from pressure - as is the case in the case of carpal tunnel syndrome - patients can be relieved by having a surgery.

Sources:

  1. Neurology, scientific eds. W. Kozubski, P. Liberski, ed. PZWL, Warsaw 2014
  2. Neuropathy Action Foundation resources, on-line access: http://www.neuropathyaction.org/downloads/naf_what_is_neuropathy_brochure(final).pdf
  3. University of Colorado Denver Materials, on-line access: http://www.ucdenver.edu/academics/colleges/medicalschool/centers/BarbaraDavis/Documents/ATDC%202014%20Slides/7.83 % 20Bessesen% 20ATDC% 20Neuropathy% 202014.pdf
  4. Lanford J., Evaluation and Treatment of Peripheral Neuropathy, online access: http://he althcare-professionals.sw.org/resources/docs/division-of-education/events/ foot-care-symposium / 0730_Eval% 20and% 20Rx% 20of% 20Neuropathy_Lanford.pdf
About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Neurology