Neuropathy of lower extremities

Neuropathy of the lower extremities is a collective concept, which means having problems with the peripheral nervous system in the legs. Gathering because the term reflects not one disease, but the essence of the problem as a whole. The reasons for neuropathy of the lower limbs are many, the symptoms are sensitive, motor and vegetative-trophic disorders. Diagnosis of neuropathy of the lower limbs is not so difficult. Treatment is especially effective when started at an early stage of the disease. Then almost always there is a 100% result in the form of recovery. If the disease is started, even multiple courses of treatment can be useless, and it is impossible to completely eliminate the symptoms. What is meant by the concept of "neuropathy of the lower extremities what are its causes, signs, methods of diagnosis and treatment, you will learn by reading this article.

So, neuropathy is the result of the defeat of the peripheral nervous system, one or more nerves. Under the defeat is meant a disturbance in the supply of nerve fibers, the development in them and in their shells of degenerative processes. The consequence of this is a dysfunction of the nerves, a poor transfer of momentum to the innervated tissues. There are such changes as a result of many reasons. What can serve as a source of development of neuropathy of the lower extremities? Let's see.

Causes of lower extremity neuropathy

Abuse of alcohol can lead to the development of neuropathy of the lower extremities.

The most common causes of neuropathy of the lower limbs are:

• long-term exposure to toxic substances (eg, alcohol, drugs, lead, acetone, arsenic, mercury and the like);
• metabolic disorders (diabetes mellitus, chronic renal failure, increased or decreased thyroid function);
• injuries;
• prolonged lack of vitamins in food;
• taking certain medications (for example, Amiodarone for the treatment of heart rhythm disorders, isoniazid for tuberculosis, antitumor drugs for oncological diseases, etc.);
• infectious diseases (eg, HIV infection, mumps, chicken pox, diphtheria);
• autoimmune diseases (when cells of the peripheral nervous system are perceived as a foreign agent and attacked by the immune system);
• burdened heredity (genetic diseases, one of whose manifestations is polyneuropathy of the lower extremities, in particular, amyotrophy of Charcot-Marie-Toot).

Any of the above listed causes can become a source of damage to the peripheral nervous system. Since the nerves of the lower limbs are the longest in the human body, they are the first to react in response to the influence of the harmful factor.

It is generally accepted that the neuropathy of the lower limbs can be of several types:

• sensitive;
• motor;
• vegetative;
• mixed.

This classification is based on direct damage to certain fibers in the nerve. And the symptoms can be corresponding to this division sensitive, motor, vegetative and mixed. Most often, the neuropathy of the lower limbs is mixed, that is, involving all types of fibers.

It is also common to distinguish between axonopathy and myelinopathy. When axonopathy is "sick" itself rod of nerve fiber, and with myelinopathy suffers its shell. Myelinopathies are somewhat easier to treat, recovery is faster than with axonopathy. However, this is a general trend, which should not be taken literally. After all, if myelinopathy is not treated for a long time, irreversible processes will develop. In this case, there is no need to talk about recovery.

Symptoms

The manifestations of neuropathy of the lower limbs can be very different. In many respects this is determined by the direct cause of the ailment. This means that with different diseases the symptoms of neuropathy will be slightly different. So, for example, neuropathies with diabetes are characterized by some symptoms, and neuropathies with lead poisoning are somewhat different. Also, one should consider the vastness of the involvement of certain legs nerves in the process. After all, for example, a trauma can damage one nerve, and maybe several, and diabetes mellitus "eats" all the nerves of both lower limbs.

Nevertheless, if in general to consider the symptoms of neuropathy of the lower extremities, then they can be as follows:

• sensitive disorders;
• motor disorders;
• vegetative-trophic changes.

Let us dwell on each group in more detail.

Sensitive disorders

Such disorders develop when the sensory (sensitive) nerve fibers are damaged. Clinically, this makes itself felt by the appearance of:

• pain aching, twisting, occasionally shooting character. The pain is localized according to the projection of the affected nerve. That is, each nerve has its own zone of innervation, in which pain occurs when it is damaged;
• just unpleasant sensations that can not be characterized by the word "pain." These symptoms include the feeling of crawling, the presence of a foreign body under the skin, the running of insects and the like. These feelings are quite stable, disturb the patient both at rest and walking, sometimes hard to bear, because they do not allow you to fall asleep at night. Sometimes even patients claim that it would be better if they just experienced pain, so unpleasant sensations can be so painful;
• disorder of certain types of sensitivity. In particular, it can be a violation of recognition of cold and hot, a violation of sensation of touch in general, an increase or decrease in the threshold of pain. It is also possible to disturb the sensation of the surface under the feet. Figuratively speaking, we can say that in this case the earth goes away from the patient from under the feet. The plantar surface of the legs loses its recognition of individual characteristics of the surface, because of what patients stumble and even fall, and stepping on a small pebble, immediately lose equilibrium. In order to move normally, patients have to look at their feet all the time, controlling the movement with the help of vision. In such patients, it is especially problematic to walk in the dark, when the ground under your feet is simply not visible.

Movement disorders

These disorders occur when motor (motor) fibers are damaged in the nerves of the lower limbs. Clinically, this manifests itself by the following changes:

• decrease in reflexes (mainly Achilles and knee). This does not manifest itself in ordinary life, but only when examined by a neurologist. But such changes are the most initial stage of motor disorders, which means a great recovery potential for treatment. When the process progresses, the reflexes fade completely and are not called at all;
• muscular spasms and cramps in the affected muscles;
• muscle weakness. This symptom appears somewhat later than the decrease in reflexes. Weakness manifests itself in the muscles innervated by the affected nerve (or nerves). Initially, the weakness can be temporary, appearing with a significant load on the muscle, and then intensifies and finds itself even at rest. In neglected cases, muscle weakness can be so pronounced that movement is generally not performed (this is especially true for traumatic lesions with rupture of nerve fibers). Muscular weakness leads to walking disorders, sometimes the patient has to move with an additional support (cane);
• thinning (losing weight) muscles with the development of their atrophy. This process develops rather slowly, for several months or even years (which largely depends on the cause of neuropathy).

Vegetative-trophic changes

They arise when the vegetative fibers that make up the nerve are affected. This is manifested by thinning and dry skin, hair loss, the appearance of pigmented spots on the skin, a violation of sweating, poor healing of small cuts and abrasions, their suppuration. Foot swelling is possible. In advanced cases, trophic disorders are so pronounced that they can lead to gangrene.

As we can see, the symptoms of the neuropathy of the lower limbs are quite numerous. Each patient will have his own list of symptoms, not all of the above. So, for example, with the neuropathy of the peroneal nerve, the patient will be disturbed by a violation of sensitivity along the anterior-lateral surface shin and on the back of the foot, there may be pain in the same zone, weakness of the extensor muscles of the foot and fingers, difficulty in trying to become on heels. With the neuropathy of the external cutaneous nerve of the thigh, the patient will experience pain and external surface of the thigh without any signs of muscle weakness, changes in reflexes and trophic changes.

Diagnostics

Thanks to modern methods of research, neuropathy of the lower extremities has become an easily diagnosed condition. A neurologist may be suspected of a neuropathy during a primary examination, revealing changes in the reflex area, impaired sensitivity, revealing trophic problems. To confirm the diagnosis, the patient is referred for electroneuromyography. This is an electrophysiological technique by which the defeat of various parts of the nervous system is established: from the central level to the peripheral. Electroneuromyography makes it possible to determine what the patient's problems are related to: muscle damage, nerve fibers or bodies of neurons of different parts of the nervous system (for example, the head or spinal cord brain). With neuropathy of the lower limbs, the source of the disease is detected at the level of the peripheral nerves of the legs. When the diagnosis is confirmed, then for the correct and successful treatment it is still necessary to establish the root cause, that is, to determine what exactly became the source of nerve damage. This is needed to determine the tactics of treating neuropathy. To search for the true cause of the disturbances, a wide variety of research methods (and biochemical analysis of blood, ultrasound of internal organs, and spinal puncture, and much more) may be necessary. A full list of examinations will be established by the doctor based on the results of existing studies.

Treatment

Given the similarity of clinical manifestations of various types of neuropathies, therapeutic tactics have common trends. All measures are aimed at restoring the nerve fiber, resuming normal nerve conduction along it, correcting circulatory disturbances in the zone of nerve endings. And at the same time, there are subtleties of the therapeutic process, for the sake of which, in fact, the true cause of neuropathy is established. So, for autoimmune diseases it will be hormonal or cytostatic therapy, with chronic renal failure, it may be carried out hemodialysis, with a toxic form - plasmapheresis and so Further. Without these "subtleties" of full recovery, there can be no question.

Let's dwell on the basic therapies of neuropathy of the lower extremities.

Since neuropathy inevitably disrupts nerve fiber nutrition processes, in order to improve this situation, the patient prescribe courses of vasoactive drugs (Pentoxifylline (Trental, Vazonite), Emoxipine, Instenon, Nicotinic acid and others). Also, as neurotrophic drugs, along with vasoactive drugs, can be used antioxidants (vitamin E, Mexidol, preparations of thioctic acid (Oktolipen, Berlition), Actovegin, Tsitochrom C and others).

Science proved that with the neuropathy of the lower limbs, it is necessary to prescribe vitamins of group B (B1, B6, B12). They improve the conductivity of nerve fibers, stimulate the healing of their membranes, have some analgesic effect.

Anticholinesterase drugs are prescribed to improve the speed of nerve impulse transmission. Earlier used Prozerin, but today more effective the appointment of Ipidacrine (Neurromidine, Amiridin). Very convenient is the fact that Epidacrine is compatible with vasoactive and antioxidant drugs, B vitamins. This allows you to simultaneously affect almost all sources of problems in neuropathy, which significantly increases the patient's chances of success. Ipidacrin helps restore sensitivity and minimize muscle weakness.

The problem of pain in neuropathy of the lower limbs can be quite acute, being almost the main for the patient. For the purpose of anesthesia, non-steroidal anti-inflammatory drugs (Ketoprofen, Xefokam, Meloxicam, Nimesulide and many others), and anticonvulsants and antidepressants.Of anticonvulsants, preference is given to Gabapentin (Neurontin) and Pregabalin (Lyrics), since these drugs have good tolerability. Of the antidepressants, selective serotonin and noradrenaline reuptake inhibitors (sertraline, duloxetine, venlafaxine and others) are more often used. More recently, the practice has included the application of the Cataladol - an anesthetic drug with a central mechanism of action that is not addictive. All these drugs are taken internally.

Locally for the purpose of anesthetizing patients can use various creams and ointments. They can include the same non-steroidal anti-inflammatory drugs (Ketoprofen gel, ointment with Diclofenac and so on), local anesthetics (lidocaine), irritants (Capsaicin, Capsicum, Finalgon).In order not to spoil clothes, pharmacists have come up with a method of applying, for example, local anesthetics and non-steroidal anti-inflammatory drugs in the form of a patch (Versatis, Voltaren). The patch is glued for 12 hours and ensures the penetration of the active substance into adjacent tissues without systemic exposure (and therefore without side effects). In advanced cases with severe pain syndrome with some types of lower extremity neuropathy (for example, diabetes), it is possible to use narcotic drugs for analgesia, when other means are powerless. These funds, of course, appoint a doctor (such drugs as Tramadol, Oxycodone).

When expressed muscle spasms are used muscle relaxants (Baclofen, Midokalm). However, you need to be very careful with them, as they increase muscle weakness.

Some medicinal effects for neuropathy of the lower extremities are not limited. Physiotherapy methods are actively used. This is electrophoresis, and magnetotherapy, and electroprocedures, and mud therapy. Massage and acupuncture are also very effective in neuropathy of the lower limbs. It is obligatory to use a complex of therapeutic physical training. In most cases, with a combination of drug and non-pharmacological treatments, the symptoms of lower-extremity neuropathy can be eliminated.

Thus, the neuropathy of the lower extremities is a multifaceted problem, because it can occur with a variety of diseases. It must be diagnosed in time so that you can get rid of the disease as soon as possible. For treatment, you may need both medications and physiotherapy techniques, as well as patience and perseverance of the patient.