Peripheral Neuropathy : type, causes and symptoms, risk factors, prevention and treatment of peripheral neuropathy

Peripheral Neuropathy

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Peripheral neuropathy : type,causes,symptoms and Treatment of peripheral neuropathy, diabetes complication
Peripheral Neuropathy in Bangladesh

Type of peripheral nerve diseases:

The site of pathology maybe:

  1. Nerve root – reduculopathy
  2. Nerve plexus – plexopathy
  3. Nerves – Neuropathy

These maybe axonal or demyelinating

Types of peripheral neuropathy:

According to nerves damages peripheral neuropathy 3 types.

1. Mononeuropathy (Mononeuropathy occurs when only single nerve is damaged)

2. Multiple mononeuropathies (or mononeuritis multiplex)

3. Polyneuropathy (polyneuropathy occurs when multiple nerve are damaged)

More than 100 different types of peripheral neuropathy present. Each type has unique features and unique treatment Plan.

The three kinds of peripheral nerves are:-

  1. sensory nerves, that connect to skin
  2. motor nerves that connect to muscles
  3. autonomic nerves, that connect to internal organs

Peripheral neuropathy can affect one nerve or multiple or all three kinds of nerves

Symptoms of peripheral neuropathy :

  • tingling sensation in the hands or feet
  • a feeling like wearing a tight glove or sock
  • sharp or stabbing pains
  • numbness in the hands or feet
  • heavy and week feeling  in the arms and legs.
  • dropping something from hands regularly
  • shocking sensation
  • thinning of the skin
  • drop in blood pressure
  • sexual dysfunction or premature ejaculation especially in men
  • Gastrointestinal abnormality
  • excessive sweating

Causes of peripheral neuropathy :

    • Systemic disease :diabetes mellitus (According to the University of Chicago’s Center for Peripheral Neuropathy : about Sixty percent of people with diabetes have nerve damage due to high blood sugar levels),Renal failure,Sarcoidosis
    • kidney disease in which high amount of toxic substance produce in the body and damage the nerve tissue
    • Genetic disease :
  1. Charcot-Marie-Tooth disease
  2. Hereditary neuropathy with liability to pressure palsies
  3. Familial amyloid polyneuropathy
  4. Refsum’s disease  etc
    • hypothyroidism lead to fluid retention and pressure surrounding the nerve tissues
    • Deficiencies of vitamins B1, Vitamin B6,  vitamin B12 and Vitamin E which are essential to nerve health and functioning but excess Vitamin B6 also cause of neuropathy. 
    • Trauma or injury is the common cause of damaged to the nerves. This can include car falls, fructures and road traffic accidents. Inactivity, or holding still too long time in single position, can cause neuropathy. Increased pressure on the median nerve that supply movement to the hand, causes carpal tunnel syndrome. This is a common type of peripheral neuropathy of hand
    • Alcohol:Alcohol might cause a toxic effect on nervous  tissue, putting people with severe alcoholism at a greate  risk of peripheral neuropathy.
    • Exposure to toxic chemicals like glue, solvents, or insecticides etc can cause nerve damage. Additionally, exposure to heavy metals like as arsenic, mercury and lead can also cause nerves damaged.
    • Infections :Some microorganisms attack to the nervous tissue directly.
  1. herpes simplex
  2. varicella-zoster virus
  3. Epstein-Barr virus
  4. Human immunodeficiency virus (HIV)
  5. Lyme disease
  6. Diphtheria
    • Autoimmune diseases and Inflammatory condition:
  1. Acute inflammatory demyelinating neuropathy(Guillain-Barre-Syndrome)
  2. Chronic inflammatory demyelinating neuropathy(CIDP)
  3. Vasculitis(polyarteritis nodosa,granulomatosis with polyangitis)
  4. Rheumatoid arthritis
  5. Systemic Lupus eraythematous
    • Medications may also cause nerve damage. These include:
  1. anticonvulsants
  2. Anti-bacterial medication such as dapsone,isoniazid, metronidazole
  3. Amiodarone
  4. Phenoytin
  5. Antiretrovirals(stavudine,dideoxycitabine)
  6. Nitrous oxide for recreational use
  7. cancer medication: cisplatin,vincristine,thalidomide.
  8. Statin Increase the risk of neuropathy (source: the Journal of family practice)
  • Malignant conditions: malignant infiltration
  • Others: amyloidosis and Paraprotienaemia

Risk factors of peripheral neuropathy :

  • Poorly control Diabetes mellitus
  • Drugs abuser
  • Alcoholics
  • Vitamin B deficiency
  • Infections
  • Lyme disease,
  • Herpes zoster
  • Epstein-Barr virus
  • hepatitis B
  •  Hepatitis C, and
  • Human immunodeficiency virus Autoimmune diseases(heumatoid arthritis and lupus)
  • liver,kidney, thyroid disorders
  • Exposure to toxic agents
  • Repetitive motion
  • First degree Family history of neuropathy

Causes of Axonal peripheral neuropathy

  • Diabetics mellitus (Read : Type 2 Diabetes Mellitus)
  • Alcoholo
  • Uremia
  • Cirrhosis
  • Amyloid
  • Hypothyroidism
  • Acromegaly
  • Para neoplastic
  • Medication
  • Toxic substance
  • Infection
  • Congenital
  • Idiopathic

Causes of Demyelinating neuropathy :

  • CIDP(chronic inflammatory demyelinating polyradiculopathyl
  • Multifocal Motor neuropathy
  • Paraprotein associated demyelinating neuropathy
  • Charcot marrie tooth disease

Causes of Mononeuritis Multiplex :

  • Diabetes mellitus
  • Leprosy
  • Vasculitis including chrug-strus syndrome
  • Neurofibromatosis
  • Amyloidosis
  • Multifocal motor neuropathy
  • Human immunodeficiency virus and Hepatitis c virus infection
  • Malignancy

Complications of peripheral neuropathy :

  • skin trauma and burn:  failure to feel temperature changes or pain on parts of the body that are numb. So check the temperature by the elbow.
  • Infection. lack of sensation can become injured without  knowing. Check these areas (speciallly   foot) regularly and treat minor injuries before they become infected, especially if you have diabetes mellitus.
  • Falls: loss of sensation may be associated with lack of balance that result is falling due to lack of balance.

Prevention of peripheral neuropathy :

First manage medical conditions that put at high risk for neuropathy, example: diabetes, alcoholism, rheumatoid arthritis etc.
1) Make healthy lifestyle That support your nerve health:
  • Eat a diet rich in vitamin  B such as  fruits, vegetables, whole grains and lean protein to make nerves healthy. Protect against vitamin B12 deficiency by eating meats, fish, eggs, less fat dairy products and fortified cereals. If you are vegetarian,  fortified cereals are a bestsource of vitamin B-12, but contact to your doctor about  vitamin B12 supplements.
2) Exercise regularly: at least 30 minutes to sixty  minutes  of exercise at least 3 times a week.
3) Avoid  risk factors that may cause nerve damage or destroye, including cramped position, repetitive motions, cramped positions that put pressure on  the nerves, avoid exposure to toxin,  smoking and overindulging in alcohol

Laboratory investigation of peripheral neuropathy:

  • Blood glucose level for diabetes
  • HbA1C
  • Complete blood Count(CBC)
  • ESR (Erythrocyte Sedimentation rate)
  • CRP(C-Reactive Protein)
  • Chest X-ray
  • Serum electrolyte with Anion gap
  • Serum urea level
  • Serum Vitamin B12 and Folic acid
  • ANA(antinuclear antibody)
  • ANCA( antineutrofil cytoplasmic antibody)    At last,
  • Nerve conduction studies
  • Genetic test

Treatment of peripheral neuropathy:

Treatment of peripheral neuropathy are done by registered doctor or genarel physician or neurologist (best neurologist in Dhaka )
1. Control Diabetes mellitus (Best Diabetes doctors in Dhaka)
2. Deficiency recover
3. Avoidance triggering factor( drugs)
4.Vitamin B1,B6,B12 combination
5.Vitamin E supplementation
6.Amitryptiline HCl or Nortryptiline HCl
7.Gabapentin or pregabaline
8.Doluxetine etc are helpful for reduce symptoms
9.Some suppliment such as alpha lipoic acid, acetyl L carnitine,L arginine, acetyle cysteine etc are very effective for preventing Neuropathy.
10. Immunoglobulin for demyelinating neuropasymptoms
Read more:
  • Recurrent Apthous Ulcer : Type, cause, prevention and Treatment
Author :
Dr. Md Noman Islam Nirob,
MBBS(Rangpur Medical College).
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