PolyneuropathyDoctors refer to polyneuropathies as systemically caused Damage to multiple peripheral nerves, leading to insensations, sensory disturbances and pain in the supply areas of the affected nerves.
Anatomical background of polyneuropathy
The peripheral nervous system (PNS) includes, from an anatomical point of view, that part of the nerves that does not belong to the central nervous system (CNS) – i.e., that part of the brain that does not belong to the central nervous system (CNS) Not located within the skull or the vertebral canal. The nerves of the PNS are, however, functionally connected with the central nervous system. They transmit impulses from the brain and spinal cord to the organs and ties to be supplied, thus ensuring a physiological response at the target organs.
The peripheral nervous system consists of two distinct parts: The somatic (voluntary) nervous system is responsible for planning and controlling voluntary movements and reflexes. The autonomic (vegetative, involuntary) nervous system (ANS), on the other hand, controls vital functions such as respiration, metabolism and digestion.
In most polyneuropathies nerves of the voluntary nervous system affected. Sensory disturbances occur, especially in the extremities, and sensitivity is impaired.
In a later stage affected persons often have difficulties in controlling certain voluntary muscle groups: muscle twitching, cramps, restlessness and often also pain in the area of the damaged nerves.
In the International Classification of Diseases (ICD) of the World Health Organization, polyneuropathy has the ICD code G62.
Causes and risk factors for polyneuropathy
Two particularly common triggers are known for polyneuropathy: Diabetes mellitus (diabetes) and chronic alcohol abuse.
Much less common are hormonal, injury-related, infectious, and those caused by nutrient deficiencies, toxic substances, or internal diseases Nerve damage as the cause of a neuropathy.
Tumor diseases also sometimes cause peripheral nerves to become damaged. In total, more than 200 triggers for neuropathic disorders are known. However, in many patients it is not possible to determine a specific cause for their disease.
What are the different forms of polyneuropathy??
Polyneuropathies can basically be differentiated according to whether they were acquired in the course of life or were already congenital.
The acquired polyneuropathy is by far the more common form of the disease – it develops as a consequence of another disease or due to an external trigger.
diabetic are particularly at risk of developing acquired polyneuropathy. This is due to the fact that longstanding and/or poorly controlled diabetes leads to damage of the smallest vessels that supply the peripheral nerves. These so-called microangiopathies subsequently lead to an deficiency of the nerve tie with nutrients, metabolic end products are deposited, causing loss of function.
This so-called diabetic polyneuropathy often begins in the toes and feet and is characterized by and decreased sensation of pain and temperature. In contrast to most other forms of polyneuropathy, the autonomic nervous system is often affected in people with diabetes autonomic neuropathy.
The second common form of acquired polyneuropathy is the alcoholic polyneuropathy or alcohol-related neuropathy. The neurotoxic (nerve-damaging) effects of chronic alcohol consumption lead to functional impairment of the peripheral nerves. Alcoholic polyneuropathy is characterized by an increased sensation of pain: Affected persons perceive even the smallest stimuli as painful, and they feel actual pain stimuli much more strongly than healthy persons.
Congenital polyneuropathies are relatively rare. They have hereditary diseases such as enzyme defects, altered proteins or restricted nerve conduction velocity.
For this reason, they usually differ from acquired polyneuropathies in their symptomatology. In some diseases, polyneuropathy also occurs as a concomitant of the actual clinical picture, for example in acute intermittent porphyria.
What are the symptoms of polyneuropathy and how does it progress??
At the onset of the disease, patients experience a loss of sensation in the fingers, hands, toes and feet tingling or numbness true. Often these symptoms are accompanied by pain or cramps. In some sufferers, muscle strength and function are also affected – for example, objects fall out of the hand or an involuntary pattern of leg movement develops (restless legs syndrome).
In the course of the disease without treatment to aggravation of symptoms, especially the sensation of pain. Other disorders that frequently occur are:
– muscle weakness and muscle degeneration – reduced temperature sensation in the extremities – reduced sensitivity in the extremities (mainly hands and feet) – painless sores on the feet and soles (mainly in diabetic neuropathy) – burning sensation of pain in the skin (mainly in alcoholic neuropathy) – prere pain in the area supplied by the damaged nerves (mainly in the lower legs)
If the autonomic nervous system is also affected, the following additional symptoms may occur:
– Dizziness and/or nausea due to blood prere regulation problems – Gastrointestinal complaints, constipation, diarrhea – Bladder emptying problems – Impotence
How is the diagnosis made? What tests are performed?
The diagnosis of the disease requires some experience. Therefore, if you suspect a polyneuropathy, it is best to consult an Specialist in neurology or to a neurological outpatient clinic.
The attending physician will first ask you about your medical history and the intensity and duration of the symptoms to find clues to possible causes. Following this anamnesis interview find Special tests take place, which provide clues to the presence of the disease:
– the Electromyography measures electrical voltages in the muscle, from which the neurologist can draw conclusions about a conduction disturbance of the supplying nerve, – the electroneurography measures the nerve conduction velocity of a specific peripheral nerve, – in the case of a Lumbar puncture fluid (CSF) is taken from the subarachnoid space of the spinal cord and then examined for antibodies, tumor cells or an inflammatory process, – an Biopsy of peripheral nerves Can also be performed to assess existing nerve damage.
If necessary, the neurologist will also investigate whether a severe Kidney disease which is also a possible cause of polyneuropathy. Nutrient deficiencies, especially deficiencies of vitamins B12 and B1, B3, B6, folic acid, and vitamin E, can be detected by specialized laboratory medical testing procedures.
How is a polyneuropathy treated?
The therapy of polyneuropathy depends on the identified cause and on the symptoms. Against the pain symptoms are opioids the first remedy of choice, as a supplement the transcutaneous electrical nerve stimulation (TENS)), in which the use of electrical impulses of different frequencies leads to a reduction in the sensation of pain.
Drugs used to treat seizure disorders (anticonvulsants) or depression (antidepressants) are another option for pain therapy.
For the treatment of diabetic polyneuropathy The administration of alpha-lipoic acid and vitamin B1 is particularly suitable for the treatment of allergic patients; alcoholic polyneuropathies also respond well to vitamin B1 substitution.
As Possibility of self-help healthy, balanced nutrition, sports and physiotherapeutic exercises have proven successful for many affected persons.
The question of whether a cure for polyneuropathy is possible can unfortunately not be answered unequivocally. It depends, among other things, on the time of diagnosis, the underlying disease, and the extent of pre-existing nerve damage.
Even if a complete cure is not possible, with the appropriate medication, a Largely symptom-free life accessible for most patients.
Rehab after treatment
If previous treatments have not led to the desired freedom from symptoms, a stay in rehab is a useful therapeutic supplement. Physiotherapeutic and physical measures are most effective as long-term treatments. In the context of a rehabilitation stay, it is therefore easier to compensate for gait and balance disorders, to reduce pain and to treat the causes of the disease.