Peripheral Neuropathy

Peripheral neuropathy is a manifestation of peripheral nerve damage. It is not a separate disease within the medicine, but a complex of symptoms that reflects a certain pathological process in the longest nerve processes of the body. There is a peripheral neuropathy in a variety of conditions. Most often the symptoms appear gradually and without appropriate treatment gradually increase, like a snowball.

Among the signs of peripheral neuropathy, the most common are pain, sensitivity disorders and muscle weakness. Diagnosing peripheral neuropathy is not so difficult, but to find the true cause of this condition is already more difficult. But without this, full treatment is impossible. Therefore, in addition to establishing the fact of neuropathy itself, physicians make every effort to find the source of the problem. When the diagnosis is clear, the therapeutic measures become more precise and allow the symptoms of the disease to be eliminated. This article is devoted to everything related to peripheral neuropathy.

At the heart of peripheral neuropathy is the defeat of peripheral nerves. "Peripheral" in this case means located outside the brain and spinal cord (that is, the central divisions). Most often, the most remote nerve fibers are exposed to the disease, because they are the longest in the entire body, and therefore the most vulnerable. This is the nerves of the lower limbs. They carry information from the very bottom (periphery), so to speak, to the central departments of the nervous system and transfer the commands back. That is, they form the sensitivity of the legs, control the muscles, provide trophic support (a certain condition of the skin, hair, nails). Therefore, quite often the symptoms of a disease or pathological condition manifest themselves first of all by neuropathy of the lower extremities. If the process is not stopped at this stage, the neuropathy will manifest itself in both hands and on the trunk, and it will reach the cranial nerves. But there are also such varieties of peripheral neuropathy, which from the first day of the disease affects not lower limbs, but, for example, a person (facial nerve neuropathy) or virtually all peripheral nerves of the body (Guillain-Barre syndrome).

The basis of peripheral neuropathy is a degenerative-dystrophic process. This means the destruction of nerve fibers against the background of deterioration in their nutrition, attack by harmful substances (including free radicals). Both nerve shells and their rods (axons) can be destroyed.

Causes

What can lead to the appearance of peripheral neuropathy? There are quite a few reasons for this condition. To be more precise, more than 200 are described.

But the most frequent of them can be:

• metabolic disorders (diabetes mellitus, chronic renal failure, problems in the functioning of the thyroid gland);
• toxic effects on the nervous system (prolonged industrial contact with lead, arsenic, mercury, acetone, alcohol abuse and surrogacy, drug use);
• injuries;
• Infectious diseases and their consequences (including HIV);
• oncological diseases;
• deficiency of vitamins in food (especially vitamins of group B);
• autoimmune processes (when peripheral nerves are destroyed by their own antibodies);
• hereditary diseases.

Depending on the cause of neuropathy, the patient develops certain symptoms of the disease that have special signs. So, for example, in diabetes, most often at the same time there is a lesion of the nerves of both lower extremities with a predominant pain syndrome at the beginning. Alcoholic neuropathy is characterized by motor and trophic disorders. Traumatic lesions can touch one nerve, respectively, they are one-sided, but all nerve functions (motor, sensitive and vegetative) can be violated. From this point of view, it may seem that peripheral neuropathy has a huge number of symptoms. However, if you try to systematize all of its manifestations, then it turns out that this is not so. Let's try to figure it out.

Symptoms

Such patients may be concerned with burning, numbness, or pain in the feet.

All the symptoms of peripheral neuropathy can be divided into only three groups: motor (or muscle), sensitive and vegetative (or trophic). From a combination of these symptoms, a clinical picture of a particular neuropathy appears. And it depends on what fibers will be involved in the process. If the composition of the peripheral nerve includes all three types of fibers (motor, sensitive and vegetative), then there will be many symptoms. If, on the other hand, the nerve is, for example, extremely sensitive, then only sensory disturbances will appear when it is affected.

If motor fibers are affected, the patient may experience:

• varying degrees of muscle weakness. This may apply to individual movements (for example, with a lesion of the peroneal nerve it is impossible to stand on the heels, that is, muscles that raise the front part of the foot) or cause a general weakness in all the limbs, rapid fatigue and poor physical tolerance. With neglected cases, the degree of muscle weakness can reach immobility, when it is impossible to move one or another part of the body at all;
• violations of muscle tone. The muscles become flabby; when they feel, there is no elasticity;
• trembling in the muscles. Especially characteristic is the appearance of jitter when performing physical work. This refers to the appearance of a jitter in response to a slight muscle strain (for example, descended the stairs to one span), and not as a reaction to excessive load. That is, if a person walked down from the 15th floor down the stairs or without training, ran 10 km, then the appearance of a slight tremor in the legs is not a symptom of peripheral neuropathy;
• night or evening muscle cramps.

When the phenomena of neuropathy already exist for a while, but the patient does not seek medical help and is not treated, the motor disorders progress. In such cases, deep reflexes from the extremities decrease, and then completely disappear. If the muscle weakness exists for several months, then it is accompanied by a loss of muscle fibers (hypotrophy), which is expressed in a decrease the volume of forearms, shoulders, legs, hips, strengthening of the relief of the bones of the hands and feet (the bone base is better seen)

Sensitive disorders in peripheral neuropathy include:

• paresthesia, that is, unpleasant sensations in the form of crawling, tingling, numbness;
• pain. The pain syndrome in neuropathy can be of a very different nature. The intensity of pain is also very variable: for someone they have a level of discomfort, and someone is not allowed to sleep at night, completely exhausting. Most painful pain syndrome debuts with burning, and already with some experience of the disease the pain becomes more diverse in sensations (aching, piercing, stitching, etc.);
• change of different types of sensitivity. What is meant? The point is that the concept of sensitivity includes not only a sense of touch. Sensitivity is also the difference between warm and cold, this is the formation of the sensation of the body in space, the ability to distinguish two touches separately, the ability to precisely localize the irritation applied. With peripheral neuropathy, any kind of sensitivity can be disturbed, either alone or together. The sensitivity may vary in the direction of amplification (the so-called hyperesthesia) or decrease (hypoesthesia). The decrease in sensitivity can reach the level of its complete absence in some areas, which is fraught with increased injuries. The latter is typical for diabetic neuropathy, which is dangerous by the development of suppurative complications, because the received microtrauma is not noticed by the patients. So, for example, wearing uncomfortable shoes, but without feeling uncomfortable, a person with diabetic neuropathy can rub his legs to the blood without even noticing it. Sometimes, if the sensitivity is disturbed, the gait may change a second time. This occurs in cases where the nerves do not carry the impulses from the legs about their position in space, when the plantar surface of the feet is insensitive. Then the sick person does not feel the surface of the earth, stumbles on level ground. He needs constant eye control for normal movement.

The vegetative symptoms of neuropathy are the result of damage to the peripheral vegetative fibers that make up some nerves. These symptoms look like this:

• cold skin to the touch;
• thinning of hair or even their disappearance (not necessarily on the entire surface innervated by a certain nerve, sometimes only small islands);
• discoloration of the skin. Persistent pallor or cyanosis can be symptoms of neuropathy. There may be a variety of spots on the skin;
• thickening or stratification of the nails;
• increased or decreased sweating;
• increased dryness of the skin, peeling;
• in neglected cases, the appearance of wounds, ulcers, which do not heal for a long time.

Peripheral neuropathy can be either one-sided or two-sided. Symptoms on both sides most often mean the presence of a so-called polyneuropathy, when the nerve fibers of most nerves "get sick". In such cases, at first there are symptoms in the feet, which, in the absence of treatment, move higher to the legs and hips. If any one nerve is affected (most often it happens with trauma), then they say mono-neuropathy. In this case, the symptoms concern a single nerve (more often it is the radial nerve on the upper limb and the peroneal nerve on the lower extremity). Mononeuropathy in most cases occurs as a result of trauma, and polyneuropathy - in all other cases.

The described symptoms of peripheral neuropathy can occur in different combinations. Much in the clinical picture depends on the cause of neuropathy. So, for example, with the Guillain-Barre syndrome, there may be a violation of independent breathing, that is, weakness of the respiratory muscles, which is not the case with virtually any other neuropathy.

Diagnostics

The identification of peripheral neuropathy is not a difficult task. At the heart of the diagnosis is a thorough collection of complaints and an attentive neurological examination. The initial manifestations of neuropathy can not be detected with the help of a neurological examination, with the exception of some of its varieties. An example is the neuropathy of the facial nerve, when there is an asymmetry of the face from the first hours of the disease. Therefore, the initial stage of diagnosis is based solely on the patient's complaints. Among the additional diagnostic methods for confirming peripheral neuropathy is electroneuromyography (the method of recording electrical potentials from nerve fibers). But the identification of the true cause of neuropathy is already a more difficult task, for the implementation of which many methods of investigation may be needed. First of all, this is a general analysis of blood and urine, a biochemical blood test, the determination of blood glucose level, the study of the hormonal background. Depending on the results of these analyzes, certain additional methods of investigation are assigned. Sometimes, despite a comprehensive examination, the true cause of neuropathy can not be established.

Treatment

Since the basis of the development of peripheral neuropathy is a degenerative-dystrophic process in nerve fibers, the main principle of treatment is restorative, healing therapy. Nerve fibers need to be given what they lack, through increased blood flow, increased delivery of nutrients. And, of course, to get rid of the provoking destruction of the factor. Therefore, it is so important to establish the true cause of peripheral neuropathy. Without treatment of the underlying disease, all other techniques will be ineffective.

So, first of all they struggle with the basic disease. The methods of struggle are radically different from each other, so we will not talk about them now. Secondly, it is necessary to prescribe drugs that improve blood flow (Pentoxifylline, Instenon, Emoxipin, Nicotinic acid and its derivatives).Third, to neutralize free radicals, which in themselves have a destructive effect, use antioxidant drugs (Thioctic acid, Mexidol, Actovegin, Cytoflavin and so on).

Treatment of any peripheral neuropathy is impossible without the use of vitamins. The leading role in this belongs to the vitamins of group B, because they are necessary for nerve fibers as the building material of shells. Complexes of B vitamins (Neuromultivit, Milgamma, Neurobeks and others) have an analgesic effect (when the pain is caused by the defeat of the peripheral nervous system). In addition to B vitamins, Ascorbic acid (vitamin C) and Alfa-tocopherol (vitamin E) will be useful.

To restore sensitivity, eliminate muscle weakness with the use of anticholinesterase drugs (Neuromidine, Aksamon, Amiridin, Proserin).

Some forms of peripheral neuropathy require the use of hormonal drugs (eg, facial nerve neuropathy).

Pain in peripheral neuropathy requires a thoughtful approach to treatment. In this matter, much depends on the true cause of the disease. For many types of neuropathy for anesthesia, there are enough non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen, Meloxicam, and so on), while others are completely insensitive to these drugs. In such cases resort to anticonvulsants (gabapentin, Pregabalin, carbamazepine), antidepressants (Amitriptyline, Duloxetine, Ludomil and others). And some forms of peripheral neuropathy may require even narcotic drugs (Tramadol).

An important role in the treatment of peripheral neuropathy is played by physiotherapy. The combination of physiotherapy techniques with drug treatment allows you to get rid of manifestations of neuropathy much quicker. Moreover, the spectrum of possible methods is quite wide:

• electrophoresis and ultraphonophoresis with various drugs;
• diadynamic currents;
• darsonvalization;
• magnetotherapy;
• mud and ozocerite applications;
• various baths (hydrogen sulphide, radon);
• shower-massage;
• electrostimulation.

In addition to these methods, with great success is used physical therapy and massage (especially in cases of motor disorders). You can also use acupuncture.

It should be clarified that the process of treating peripheral neuropathy can be quite long. Terms of treatment depend on the cause of neuropathy, the duration of its existence, the presence of concomitant pathology and the complexity of the therapy. The earlier treatment is started, the higher the probability of complete elimination of all symptoms and in a short time.

Prevention

To avoid the appearance of peripheral neuropathy, first of all it is necessary to lead a healthy lifestyle. Proper balanced nutrition, adequate sleep, outdoor exercise, moderate exercise, compliance with the regime labor and rest - all this allows the human body to be more resistant to all diseases, including neuropathy. Avoid traumatic situations as a risk factor for the development of neuropathy. It is necessary to pay attention to your condition and seek the medical help at the slightest symptoms of any illness in order to avoid complications.

Also, regular preventive medical examinations should be carried out with the help of which one can detect a "dormant" pathology.

Thus, peripheral neuropathy is a common pathology, the symptoms of which are very diverse. Many people do not even suspect about its existence at home, although for a long time they experience the corresponding symptoms. Peripheral neuropathy in most cases is not so terrible for a person, but it needs to be diagnosed and treated in time to avoid serious consequences. Be attentive to your feelings, do not ignore the symptoms, visit the doctor on time - and be healthy!

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