Polyneuropathy

A slight tingling in the legs or temporary numbness are usually the first signs of a polyneuropathy. Due to the disease, the transmission of impulses by the nerves is disturbed, which causes a variety of different symptoms and makes life more difficult for those affected. However, in many cases the disease is not a final fate, but can be cured causally.

What is polyneuropathy?

Polyneuropathy is a Disease of the peripheral nervous system, in which several different nerves can be affected. The word polyneuropathy comes from the Greek language and means “Many-Nerve Disease” (poly=much; neuro=nerve; pathie=disease).

The peripheral nervous system is responsible for sensitive perceptions such as pain sensation, the feeling of heat and cold, as well as touch. It also controls the motor nerve movements of the muscles. The autonomic nervous system, which regulates the function of organs and vessels, also belongs to the peripheral nervous system and can be affected by the disorder.

Due to the disease of the nerves, it comes to Sensory disturbances up to pain and paralysis, which occur especially in the legs and feet. However, due to the multifaceted tasks of the peripheral nervous system, other very different symptoms can be triggered. In Germany, 5 to 8 percent of the population suffers from the disease, which often develops as a result of diabetes mellitus or severe alcohol abuse. Depending on the form of the disease and its severity, patients in the final stages of the disease may be dependent on a wheelchair or walker.

What are the causes of polyneuropathy??

There are over 300 different possible causes for the development of a polyneuropathy. In up to 50 percent of cases, the Nerve damage, however, as a result of the metabolic disease diabetes mellitus or a long lasting Alcohol abuse. Also various viral (Lyme disease, diphtheria, mononucleosis, shingles, herpes simplex infections or HIV) and bacterial infections as well as certain autoimmune mechanisms (z.B. acute Guillain-Barre syndrome) can damage the nerves through inflammation.

Furthermore, medications or drugs (e.g.B. cancer drugs after chemotherapy or statins), toxins and heavy metal contamination (z.B. mercury or arsenic) and vitamin deficiencies (vitamin B1 and B12) a possible cause. Polyneuropathy often develops as a consequence of a so-called primary disease of the kidneys, liver, gout or thyroid dysfunction (hypofunction and hyperfunction or Hashimoto’s disease). In addition, a polyneuropathy can be a first sign of a cancerous disease.

From the multitude of possible disease-causing factors, it is important to find out individually what exactly is responsible for the development of the disease. However, in one out of five people with the disease, the cause is not clearly identified, in which case the doctor speaks of a idiopathic polyneuropathy.

Polyneuropathy as a result of a gene mutation:

New research from the Department of Orthopedics at MedUni Vienna indicates that a gene mutation which could be the trigger of the disease. As a result of this mutation, there is a Deficiency of the enzyme “neprilysin, which is supposed to trigger the polyneuropathy.

What are the symptoms of polyneuropathy?

The Symptoms can be varied and differ depending on which nerves are damaged. Typical symptoms include paraesthesia in the limbs such as tingling, stinging, numbness or “formication. However, there may also be Swelling and paralysis as well as dysfunctions of organs or a malposition of the foot.

If motor nerve fibers are affected muscle spasms and twitching (fasciculations) and/or muscle atrophy may occur. If nerves in the brain are affected, sufferers experience visual disturbances or paralysis in the facial muscles, which can also lead to speech and swallowing problems.

If the nerves of the autonomic nervous system are damaged, this can be seen, among other things, in the following symptoms bluish-red discoloration and swelling of the skin, Bone softening, cardiac arrhythmia, circulatory disorders, digestive disorders, urinary disorders or impotence as symptoms noticeable.

How does the doctor recognize polyneuropathy?

In anamnesis interview If the doctor inquires about the symptoms, records any existing underlying diseases (e.g.B. diabetes or a thyroid dysfunction) and inquires about possible substance abuse (such as drug or alcohol addiction). This is followed by an neurological examination. Reflexes and muscle strength are tested as well as the perception of touch, vibration and temperature.

Due to a Blood test the doctor recognizes existing vitamin deficiencies (vitamin B 12) or a diabetes that was unknown until then. Furthermore a malposition of the foot (claw toes, hollow foot) or other Deformities of the skeleton (such as scoliosis), a hereditary polyneuropathy can be detected.

The speed with which nerves transmit an excitation is measured by the electroneurography (ENG). The electromyography (EMG) in turn records the activities of a muscle – both at rest and under tension. A Electrocardiography (ECG) can provide information about whether the autonomic nerve fibers of the heart are damaged.

Shot glass with alcohol next to beer glass

Alcohol should be avoided in the case of polyneuropathy. (c) Rainer Fuhrmann / Fotolia

Special diagnostic procedures:

If the doctor cannot find a cause for the polyneuropathy symptoms using the methods described above, the doctor must use more specialized procedures. In this way, the physician can identify polyneuropathy as a result of inflammation by examining the nerve fluid (cerebrospinal fluid examination) How to recognize a polyneuropathy caused by inflammation. If a genetic polyneuropathy is suspected genetic analysis is also possible.

By means of Ultrasound examination of the urinary bladder The doctor can determine whether bladder emptying is disturbed, which is often the case with autonomic polyneuropathy.

In particularly severe cases of illness, a so-called nerve biopsy for which a tiny sample of the nerve tissue is taken from a small incision in the patient’s skin. Under the microscope, the doctor can detect a polyneuropathy. This examination is particularly necessary for diabetics, in whom only nerves on one side of the body are damaged. In technical jargon this means asymmetric diabetic polyneuropathy. If there is evidence of leprosy as the cause of the nerve damage, the doctor will also perform a nerve biopsy.

How is polyneuropathy treated?

The polyneuropathy itself is not treatable, rather, the cause of the nerve damage must be identified and cured. If there is an underlying disease, the first step is to treat it and thus stop the progression of the disease.

Treat the cause:

For diabetics this means consistent adjustment of blood sugar, regular medical checks and a balanced diet with sufficient exercise. In addition, high-dose alpha lipoic acid infusions help stabilize sugar metabolism and relieve nerve pain.

Is high Alcohol consumption the cause of the polyneuropathy, the patient must refrain from alcoholic beverages. At Vitamin deficiency it is necessary to balance them and thus prevent the progression of the disease. It should be noted, however, that in some cases the deficiency is caused by a resorption disorder of the body. In these cases oral supplementation is of no use. Instead, the physician should administer the appropriate vital substances (especially frequently B vitamins) intravenously.

In cases of poisoning, for example by lead or arsenic, binders such as Penicillamine help toxins out of the system. Re-exposure should be avoided urgently. If the polyneuropathy was caused by bacteria In many cases, antibiotics can be used to kill off the bacteria that have caused the pain. In the case of viral infections, the treatment is highly dependent on the type of pathogen.

treat symptoms:

As symptomatic therapy the doctor uses medication against the pain. These are based on the respective symptoms and are individually adapted to the patient. Through the administration of painkillers the unpleasant sensations of irritation can be damped down. For this, the doctor usually prescribes acetylsalicylic acid or paracetamol, also opioids are administered in rare cases against severe pain. Anticonvulsants (antiepileptics) and antidepressants help patients to tolerate the discomfort more easily.

Stimulation therapy:

For transcutaneous electrical nerve stimulation (TENS), the doctor places electrodes on the painful regions, which send electrical impulses to the skin area and thus reduce the pain. However, the effectiveness of this therapy is still scientifically unconfirmed.

Exercise therapy and physical applications:

In order to ensure the mobility of those affected for as long as possible, exercise therapy is very helpful. In this way, the possibly disturbed motor function is trained and circulatory disturbances are prevented. Physiotherapy, alternating baths, exercise baths, heat applications, acupuncture and massages are also frequently used as supportive measures in the treatment of polyneuropathy.

How to prevent polyneuropathy?

There is no real protection against polyneuropathy, but through a appropriate lifestyle, the risk of disease can be minimized. Especially a low-sugar, balanced diet with plenty of fiber and regular exercise prevents the development of many diseases of civilization.

For diabetics, it is also important to have their blood values checked regularly and to be on possible changes of the feet to pay attention – especially to injuries or wounds that are not felt.

Since regular alcohol consumption increases the likelihood of polyneuropathy, it is recommended to, alcohol should be consumed only occasionally or completely dispensed with. Drugs and environmental toxins should be avoided, and in the event of a viral or bacterial infection, a doctor should be consulted immediately.

What are the chances of cure for polyneuropathy?

If the cause of the disease is recognized and eliminated in time, the polyneuropathy decreases in most cases a good course.

However, if the triggers are not found, it can lead to permanent damage to the nerves come. Therefore, already at the first symptoms a doctor should be consulted absolutely. This is especially true if one of the primary disease is known to be present.

Due to the many manifestations, the course of the disease differs from patient to patient. Like this some forms of polyneuropathy originally curable, others must be treated symptomatically for a long time.

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