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Peripheral Neuropathies

What is it?

Peripheral neuropathies are a group of disorders characterized by the degeneration of the nerves involved in the communication between the central nervous system (the brain and spinal cord) and the rest of the body. Peripheral nerves transmit sensory signals back to the central nervous system, and signals from the brain to the muscles. Neuropathies are caused by a wide variety of underlying disorders, and nerve function may be lost in a number of ways: the nerve fibers themselves (axons) may degenerate; the myelin sheaths that cover and protect the nerves may erode; and in some cases there is a loss of blood supply to a nerve. The mononeuropathies are conditions that affect a single nerve (see Bell's Palsy and Carpal Tunnel Syndrome for more information); polyneuropathies affect multiple nerves that may be distributed throughout the body. Symptoms vary according to which nerves are affected.Most often, symptoms develop gradually over months or years; however, in Guillain-Barré syndrome, an uncommon form of polyneuropathy, severe symptoms appear within days. (Recovery from Guillain-Barré may also be relatively rapid in many cases.) Peripheral neuropathies are most common in men between the ages of 30 and 50. Symptoms may arise from degeneration of the sensory neurons, the motor neurons, or both. Fortunately, because these disorders often leave the cell bodies of the nerves intact, the nerves can regenerate; thus, chances for recovery may be good. However, prognosis and specific treatment depend on the underlying disorder.

What Causes It?

  • Many disorders, including alcoholism, diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, amyloidosis, and uremia, may cause peripheral neuropathy.
  • Malnutrition, especially a vitamin deficiency, may lead to peripheral neuropathy.
  • A viral infection, rabies and flu vaccines, or surgery may sometimes be associated with Guillain-Barré syndrome.
  • A number of medications, especially isoniazid, pyridoxine, and vincristine, can cause peripheral neuropathy.
  • Exposure to toxic chemicals, including lead, mercury, arsenic, and the chemicals in pesticides and herbicides, may lead to peripheral neuropathy.
  • Nerve damage may be caused by injuries or by repeated jarring, such as that brought on by operating a jackhammer.
  • Exposure to cold temperatures can produce nerve damage (see Hypothermia for more information).
  • Some cancers, such as multiple myeloma, lung cancer, and leukemia, may cause peripheral neuropathy.
  • Some types of peripheral neuropathy are hereditary.
  • The cause is unknown in some cases.

Prevention

  • Consume no more than two alcoholic drinks a day. If you suspect that you may have a drinking problem, seek help from a doctor or support group immediately.
  • Eat a healthy, balanced diet.
  • Try to reduce or eliminate exposure to toxic chemicals at home and in the workplace.

Diagnosis

  • Patient history and physical examination are needed.
  • Electromyography may be performed. In this procedure, needle electrodes are inserted into various muscles to measure electrical activity associated with nerve function. Electrical shocks are given to the peripheral nerves in the arms and legs to assess the spread of electrical conduction down the nerves.
  • A variety of tests may be given to evaluate reflexes and nerve performance.
  • Lumbar puncture (spinal tap).
  • Blood tests.
  • Biopsies of nerve or muscle tissue.

How to Treat It

  • Strict control of diabetes through medication, diet, and exercise may allow diabetic neuropathy to subside either partially or completely, depending upon the extent of the nerve damage.
  • People with diabetes should practice good foot care and check their feet every day. Peripheral neuropathy reduces sensation in affected areas, so minor foot problems may go unnoticed and develop into major infections.
  • Alcohol-induced neuropathy requires complete abstinence from alcohol.
  • Multivitamin supplements may be recommended.
  • Exposure to toxic chemicals should be reduced or eliminated as much as possible.
  • Plasmapheresis (a procedure that involves partial removal of blood plasma while the blood cells are returned to circulation) may be performed to speed recovery from Guillain-Barré syndrome by filtering out irritating or dangerous antibodies from the bloodstream.
  • Hospitalization is recommended for treatment of Guillain-Barré syndrome because the condition may worsen unpredictably and be life-threatening before recovery begins. Breathing and swallowing difficulties are treated with supplemental oxygen and intravenous feeding.
  • Over-the-counter pain relievers may be taken to reduce pain.
  • Patients with severe, burning pain have neuropathic pain, a form of pain that occurs when the nerves or nerve pathways become damaged and malfunction. Neuropathic pain does not respond to usual painkillers. Physicians may prescribe a variety of other medications for neuropathic pain, including a tricyclic antidepressant (amitriptyline) or an anticonvulsant (gabapentin).
  • Physical therapy is advised to help regain muscle function. Canes, walkers, or wheelchairs may be temporarily useful, and rails near stairs and in the bathroom are recommended to prevent falls.

When to Call a Doctor

  • Call a doctor if you develop symptoms of peripheral neuropathy.
  • Call a doctor if, after being diagnosed with peripheral neuropathy, you develop sores or open wounds on the hands and feet.
  • EMERGENCY Call an ambulance if you or someone in your presence experiences breathing difficulty,widespread muscle tingling or numbness, or paralysis.