Polyneuropathy – Causes, Symptoms, Treatment

Polyneuropathy is a most common type of disorder in the peripheral nervous system in where multiple nervous systems are damage resulting from pain, paresthesia, itching, numbness, itching due to nerve root compression, demyelination, nerve entrapment, diabetes mellitus, diabetic neuropathy, mononeuropathy, and traumatic injury in the brain and spinal. cord. In this case, the major nerves can not send the signal to the brain and the spinal cord due to damage of nerve cells, skin, and muscle partially or totally. Sometimes the polyneuropathy can affect sensory function, heat, cold sensation, movement, motor neuropathy, and sensory neuropathy

Types of  Polyneuropathy

  • Acute Polyneuropathy – Acute neuropathy means the damage of the peripheral nerve by a sudden road traffic accident, gunshot wound, blunt trauma,. It is usually caused without knowing and patients can not control this condition. In this case, emergency medical treatment is best as early as possible.
  • Chronic Polyneuropathy – It basically occurs in elderly people due to aging, nutritional deficiency, hormonal imbalance, poor diet, muscle fatigue, muscle wasting are also relater to this condition. This kind of polyneuropathy developed in a prolonged time.
  • Symmetrical peripheral polyneuropathy – In can developed in your body congenitally and chromosomal abnormality, birth defect, Guillain-BarrĂ© syndrome, interpregnancy, during the time of pregnancy, and drugs abuses of father and mother.
  • Multiple Polyneuropathy – In here the total peripheral nervous system is damaged due to sudden road traffic accidents, gunshot wounds, blunt trauma, myasthenia gravies, dutchmen muscular distrophy, etc.

Causes of Polyneuropathy

The most important cause polyneuropathy in hand and leg muscle are described bellow

  • Diabetic Mellitus may type 1 or types 2
  • Over uses and addictions to alcohol may cause sensory neuropathy
  • Chronic alcoholism in the late stage of life may lead in sensory neuropathy
  • The nutritional deficiencies that are B1, B6, B12, vitamin E or nor take the food contain vitamin B12
  • Inflammatory conditions such as vasculitis, cellulitis
  • Hypothyroidism or abnormal endocrine system may result in sensory neuropathy
  • Abnormal liver disease, Cholecystitis, colon cancer
  • An autoimmune disease that falls into Sjogren syndrome, lupus erythematosus, rheumatoid arthritis
  • Infections (Epstein-Barr virus, Lyme disease, chronic hepatitis
  • The Guillain-Barre syndrome, dutchmen muscular dystrophy, myasthenia gravis is one of the most leading causes of sensory neuropathy
  • Toxins induce disease (heavy metals, chemicals) basically in an industrial area.
  • Prolong chemotherapy of cancer patients and its related therapy
  • Overuse of antibacterial drugs and some cardiovascular medications
  • Tumors it may be  secondary to compression or the paraneoplastic syndromes
  • Inherited conditions are familial amyloidosis Charcot-Marie-Tooth disease
  • Trauma/injury in the specific organ of your body may hamper the nerve damage or cause in sensory neuropathy
  • Multiple myeloma and its treatments
  • Adverse effects of drug or prolong exposer of heavy metal
  • Monoclonal gammopathy of undetermined significance (MGUS) systemic lupus erythematosus,
  • celiac disease
  • hyperlipidemia
  • Chemotherapy, drug-induced, alcohol
  • Hereditary and genetic conditions
  • Hemochromatosis,
  • Fabry disease,
  • Ehlers-Danlos syndrome

Symptoms of Polyneuropathy

The symptoms of polyneuropathy in Hand Leg are described bellow

  • The first symptoms are loss of feeling, itching, smell
  • Bowel and bladders control may be a loss due to sensory neuropathy
  • Many patients in severe condition  may feel the burning sensation in the whole body
  • The patient may found muscle wasting, spasm muscle wasting
  • Pain that may be prolonged or acute onset in a long time standing, and sitting
  • Pain paresthesia may be an increase during working, running
  • Pain and paresthesia also increase during traveling on a motorbike for long-distance.
  • Muscle fatigue or loss of muscle tone may be an increase in working or driving
  • Feeling soreness frequently in sensory neuropathy
  • Muscle spasm and wasting may be found frequently in sensory neuropathy
  • The electrolyte imbalance  in your body may found
  • Feeling tiredness may be found in small working in sensory neuropathy
  • Blood pressure may be increase and gait and posture become abnormal in sensory neuropathy
  • Tingling, numbness, pins, and needles
  • Difficulty using the arms, legs, hands, or feet
  • The pain may be an increase in such a common condition such as shooting pains, stabbing, freezing and burning sensation
  • Sleep problems due to night-time pain
  • iInability to feel pain
  • Extreme sensitivity to touch
  • Inability to sense temperature changes
  • Lack of coordination
  • Increased episodes of falling
  • changes to the skin, hair, or nails
  • Foot and leg ulcers
  • Skin and nail infections
  • Muscle weakness
  • Muscle twitching

Diagnosis of Polyneuropathy

Your doctor may advise you to test to investigate the polyneuropathy in hand leg

  • Complete blood count to investigate the macrocytic anemia, vitamin b12 deficiency, folate deficiency
  • Metabolic Panels disorders such as BMP or CMP along with renal failure, electrolyte imbalance as uremia can also lead to neuropathy and polyneuropathy in the hand and leg.
  • HbA1c is a kind of testing to diagnosis diabetes that is a common cause of neuropathy
  • Testing for vitamin and mineral deficiencies such as mainly copper, thiamine or vitamin B6, pyridoxine, folate or vitamin B9, vitamin B12, and vitamin E which play important roles in central and peripheral nervous system development and maintenance.
  • Heavy metal toxicities in the industrial area, such as mercury, lead, arsenic are known to cause peripheral nerve toxicities along with CNS disturbances.
  • Test for infectious material that falls into for Lyme disease, Epstein-Barr virus, hepatitis C, HIV, and syphilis 
  • Thyroid function testing.
  • Anti-body testing to investigate for specific autoimmune diseases known to cause peripheral neuropathies such as Sjogren syndrome, lupus, rheumatoid arthritis.
  • Nerve conduction velocity test and electromyography (EMG)
  • Nerve biopsy
  • Genetic testing for identifying the causes of inherited neuropathies or in sensory neuropathy
  • Urine Test to investigate the infection or infectious disease.

Imaging

  • Radiographs of the joint – Conventional x-ray and radiography is the most widely used imaging modality and allows for the detection of bone fractures, osteoporosis, and abnormal pathologies condition like fracture, osteoporosis, erosions, osteonecrosis, osteoarthritis, or a juxta-articular bone tumor, neoplasm that are causes sensory neuropathy. Characteristic features of neck rheumatoid arthritis, osteoarthritis include marginal osteophytes formation may cause sensory neuropathy in Leg and Hand, joint space gradually narrowing, subchondral sclerosis formation, and cysts.
  • CT Scan – CT scan to identify the nerve root compression or nerve-related disease. High contrast CT scan is more effective to diagnose the spinal cord, surrounding muscle, rheumatoid arthritis. Abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid are also found in this test. It also helps to identify the bone tumor, necrosis, spinal stenosis,  abnormal vertebrae condition, etc.
  • MRI – It is called magnetic radical imaging is also helpful to find the bone conditions, abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, soft tissue, etc. It is the final stage test to confirm that all joint abnormality.
  • Nerve conduction study- It is one of the most common instrumental tests to identified to normal nerve conduction study by using electrical methods. The system took 20 -30 minutes of neuropathology. In this test patient may feel uncomfortable but there have no specific side effects

Treatment of Polyneuropathy

  • Muscle relaxant – It is important for patients with chronic muscle spasms, wasting, and muscle cramping releasing drugs. The drugs are tolperisone HCL, eperisone, baclofen, dantrolene, etc. The drug increases the blood supply with oxygen and nutrition to the affected joint.
  • Nerve relaxant –  It is basically used to reduce neuropathic pain, inflammation, nerve root compression, myalgia, neuralgia, and fibromyalgia. Your doctor may prescribe gabapentin, pregabalin, vitamin B1, B6, B12, etc. Major side effects are abdominal pain, nausea- vomiting.
  • Calcium & vitamin D3 – to improve bone health and healing fractures and osteoporosis, osteonecrosis. Your doctor may prescribe to take calcium and vitamin D3 supplementation to prevent thinning of the bone and maintain bone health and muscle pain. In scientific study show that normal men and women needed calcium 1200milligram and vitamin D3 500 milligram. The major side effect is a chronic kidney disease, stone, and hypercalcemia
  • Anticonvulsant drugs – It has gained popularity for neuropathic pain, with gabapentin (Neurontin) and pregabalin (Lyrica) being the most commonly used preparations in spine-related pain, radiating pain, and post-operative PLID. Gabapentin has been shown to be superior to pain killers in alleviating back and leg pain after spinal surgery []. Pregabalin plays an important role in the prevention of pain before and after surgery[].
  • Amitryptiline – In some scientific may suggest that amitryptiline is most widely used in chronic pain, paresthesia, itching, and numbness. It has the common side effect of nausea– vomiting, dry mouth, constipation.
  • Duloxetine – It also works as an anti-depression drug, it has some scientific study work a chronic pain, paresthesia, and peripheral neuropathy. it works excellently. The common side effects nausea- vomiting, dry mouth, constipation, and vertigo.
  • Mecobalamin – It is also called cyanocobalamin and it plays a vital role in the treatment of paresthesia, itching, numbness, and pernicious anemia.

References

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