Polyneuropathy

Polyneuropathy is a neurological condition in which damage may occur to : axon, myelin sheath , cell body , supporting connective tissue and nutrient blood supply to multiple peripheral nerves .

What are the causes of Polyneuropathy?

1. Infection

Infection is caused by bacteria such as Mycobacterium leprae (Cause leprosy ) or viruses such as HIV, varicella- Zoster, mumps, cytomegalovirus, etc.

2. Diabetes

A study done by (identified as per the WHO criteria) over 1401 persons with type 2 diabetes observed that every fifth person in the study population was more likely to have diabetic polyneuropathy.

3. Alcohol

Alcohol is more likely to lead to nutritional deficiencies in the body which leads to polyneuropathy. Many of the time it damages the neurons of the body.

4. Hypothyroidism

Decreased levels of thyroid in the body can lead to polyneuropathy though it is very uncommon nowadays.

5. Drug induce

A wide range of drugs since neuropathies including

Antibiotic: Metronicdazole; ethambutol; isoniazid; nitrofurantoin; dapsone

Oncology drugs : Adriamycin; cisplatin; taxanes; vincristine

HIVdrugs: Didanosine; stavudine; zalcitabine

Others : Amiodarone; gold; phenytoin

6. Nutritional deficiencies

Alcoholic polyneuropathy involves deficiencies of vitamin B1 (thiamine), B12 deficiency, etc.

7. Inherited polyneuropathy

The most common Hereditary polyneuropathy is Charcot-Marie-Tooth disease and Refsum’s disease.

9 . Kidney diseases

Uremia is the most common kidney disease that leads to axonal degeneration in neurons causing polyneuropathy

8 . Toxin

Toxin induced such as Heavy metals; lead; arsenic; thallium.

9. NO Cause found

In about 20% of patients with chronic neuropathy, no cause is identified . Follow-up of cohorts of such patients has found that while their symptoms slowly progress they do not develop significant disability.

What are the sign& symptom of polyneuropathy ?

In polyneuropathy, sensory loss is symmetrical and follows a characteristic stocking and glove distribution.
Romberg test is positive
Neuropathic burns/ulcer or joint may be present .
Tropic change such as cold blue extremities , hair loss, Brittle finger , toe nails
Local oedema
Symmetrical muscle weakness in lower limb and spreading to upper limb in a similar manner before ascending into proximal towards their nerve cell .
In Guillain -Barre, Chronic inflammatory demyelinating polyneuropathy, may affect proximal muscle group first .
In sever neuropathies , Truncal and respiratory muscle involvement occurs . Respiratory muscle weakness may result in death .
The tendon reflex are lost ( Distal reflexes are generally loss before proximal ones .

Treatment

Pharmacological treatment

NSAIDS for neuropathic pain , Half of all polyneuropathy(50%cases ) are associated pain .
Gabapentin, pregabalin, duloxetine, and tricyclika are the drugs of first choice.

Topical therapies

lidocaine or capsaicin patches can be helpful in the areas of pain

Physiotherapy

Physiotherapy in polyneurotherapy patient includes exercises that improve stability during standing and walking and which train balance, coordination, and proprioception .It help to increase muscle strength and function and to maintain or restore muscular balance in order to prevent deformities and contractures.

Physical and balneological therapy methods

Balneotherapy is defined as the use of baths containing thermal mineral waters from natural springs for the treatment of polyneurotherapy patient .

Resistance training

Three times a week has a positive effect on fitness and muscle strength in CIDP(Chronic inflammatory demyelinating polyradiculoneuropathy).

Reference

Polyneuropathies. 2018 Feb 9;115(6):83-90. doi: 10.3238/arztebl.2018.083.PubMed

Polyneuropathies. Published online 2018 Feb 9. doi: 10.3238/arztebl.2018.083.PubMed

Book- Neurology and neurosurgery illustrated by Kenneth W Lindsay