Neuropathy

Peripheral neuropathy is a problem with the nerves that carry information to and from the brain and spinal cord. This can produce pain, loss of sensation, and an inability to control muscles.

  • “Peripheral” means nerves further out from the center of the body, distant from the brain and spinal cord.
  • ” Neuro” means nerves.
  • “Pathy” means abnormal.

nervous system

Symptoms

The symptoms depend on which type of nerve is affected. The three main types of nerves are:

  • Those that carry sensations (sensory)
  • Those that control muscles (motor)
  • Those that carry information to organs and glands (autonomic)

Neuropathy can affect any one or a combination of all three types of nerves. Symptoms also depend on whether the condition affects the whole body or just one nerve (as from an injury).

Longer nerves are more easily injured than shorter ones, so it is common for you to have worst symptoms in the legs and feet than in the hands and arms.

central-nervous-system-diagram

SENSATION CHANGES

Damage to sensory fibers results in changes in sensation, burning sensations,Nerve paintingling,numbness or an inability to determine joint position, which causes incoordination.

For many neuropathies, sensation changes often begin in the feet and progress toward the center of the body with involvement of other areas as the condition worsens. Diabetes is a common cause for sensory neuropathy.

MOVEMENT DIFFICULTIES

Damage to the motor fibers interferes with muscle control and can cause weakness, loss of muscle bulk, and loss of dexterity. Sometimes, cramps are a sign of motor nerve involvement.

Other muscle-related symptoms include:

  • Difficulty breathing or swallowing
  • Difficulty or inability to move a part of the body (Paralysis
  • Falling (from legs buckling or tripping over toes)
  • Lack of dexterity (such as being unable to button a shirt)
  • Lack of muscle control
  • Loss of muscle tissue
  • Muscle twitching or cramping

peripheral nervous system

AUTONOMIC SYMPTOMS

The autonomic nerves control involuntary or semi-voluntary functions, such as control of internal organs and blood pressure. Damage to autonomic nerves can cause:

  • Abdominal bloating
  • Constipation
  • Diarrhea
  • Difficulty beginning to urinate
  • Dizzinessthat occurs when standing up or fainting associated with a fall in blood pressure
  • Feeling of incomplete bladder emptying
  • Male impotance
  • Nausea or vomiting after meals
  • Unintentional weight loss (more than 5% of body weight)
  • Urinary incontience

Exams and Tests

A detailed history will be needed to determine the cause of the neuropathy. A neurological exam may reveal problems with movement, sensation, or organ function. Changes in reflexes and muscle bulk may also be present.

Blood tests may be done to screen for medical conditions such as diabetes and vitamin deficiencies.

Tests that reveal neuropathy may include:

  • EMG (a recording of electrical activity in muscles)
  • Nerve Conduction Tests
  • Nerve Biopsy

Tests for neuropathy are guided by the suspected cause of the disorder, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, scans, or other tests and procedures

Treatment

Treatmet involves:

  • Identifying and treating any underlying medical problem (such as diabetes) or removing the cause (such as alcohol)
  • Controlling symptoms
  • Curing the disorder, if possible
  • Helping the patient gain maximum independence and self-care ability

Physical therapy, occupational therapy, and orthopedic interventions may be recommended. For example, exercises and retraining may be used to increase muscle strength and control. Wheelchairs, braces, and splints may improve mobility or the ability to use an affected arm or leg.

Safety is an important consideration for people with neuropathy. Lack of muscle control and reduced sensation increase the risk of falls and other injuries. The person may not notice a potential source of injury because he or she can’t feel it. For example, one may not notice if water in a bathtub is too hot. For this reason, people with decreased sensation should check their feet or other affected areas frequently for bruises, open skin areas, or other injuries, which may go unnoticed and become severely infected. Often, a podiatrist can determine if special orthotic devices are needed.

Safety measures for people experiencing difficulty with movement may include:

  • Installing railings
  • Removing obstacles on floors such as loose rugs

Safety measures for people having difficulty with sensation include:

  • Adequate lighting (including night lights)
  • Testing water temperature before bathing
  • Use of protective shoes (no open toes, no high heels)

Shoes should be checked often for grit or rough spots that may cause injury to the feet.

Persons with neuropaties are prone to new nerve injury at pressure points such as knees and elbows. They should avoid prolonged pressure on these areas from leaning on the elbows, crossing the knees, or assuming similar positions.

Prescription pain medications may be needed to control nerve pain. Anticonvulsants (phenytoin, carbamazepine, gabapentin, and pregabalin), tricyclic antidepressants (duloxetine), or other medications may be used to reduce the stabbing pains. Use the lowest dose possible to avoid side effects.

Adjusting position, using frames to keep bedclothes off tender body parts, or other measures may also be helpful to reduce pain.

The symptoms of autonomic changes may be difficult to treat or respond poorly to treatment.

  • Use of elastic stockings and sleeping with the head elevated may help treat low blood pressure that occurs when standing up (postural hypotension). Fludrocortisone or similar medications may also be helpful.
  • Medications that increase gastric motility (such as metoclopramide), eating small frequent meals, sleeping with the head elevated, or other measures may help.
  • Manual expression of urine (pressing over the bladder with the hands), intermittent catheterization, or medications such as bethanechol may be necessary for those with bladder dysfunction.
  • Impotence, diarrhea, constipation or other symptoms are treated as appropriate.
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