Neuropathy

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Weakness, numbness, and pain from nerve damage, usually in the hands and feet. More than 3 million US cases per year

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What is Peripheral Neuropathy?

The term 'neuropathy' covers a wide area and many nerves, but the problem it causes depends on the type of nerves that are affected:

  1. Sensory nerves (the nerves that control sensation) causing cause tingling, pain, numbness, or weakness in the feet and hands
  2. Motor nerves (the nerves that allow power and movement) causing weakness in the feet and hands
  3. Autonomic nerves (the nerves that control the systems of the body eg gut, bladder) causing changes in the heart rate and blood pressure or sweating

Neuropathy has many causes, and any number of the three nerve types can be affected at any one time.

  • Mononeuropathy refers to a single nerve being affected
  • Polyneuropathy means several nerves are affected
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Causes of Peripheral Neuropathy

Approximately 30% of neuropathies are 'idiopathic', or of an unknown cause.

Many different conditions can lead to peripheral neuropathy:

  • Diabetes - the commonest cause of chronic peripheral neuropathy. High blood sugar levels in people with poorly controlled diabetes damage nerves.
  • B12 or folate vitamin deficiencies can cause nerve damage and peripheral neuropathy.
  • Drugs - such as some chemotherapy medication and medicines used to treat HIV can cause damage to peripheral nerves.
  • Poisons (toxins) - insecticides and solvents can cause peripheral nerve damage.
  • Cancers - peripheral neuropathy can occur in people with some cancer E.G: lymphoma and multiple myeloma.
  • Alcohol excess - high alcohol levels in the body cause nerve damage.
  • Chronic kidney disease - if the kidneys are not functioning normally, an imbalance of salts and chemicals can cause peripheral neuropathy.
  • Chronic liver disease.
  • Injuries - broken bones and tight plastercasts can put pressure directly on the nerves.
  • Infections - damage can be caused to peripheral nerves by some infections including shingles, HIV infection and Lyme disease.
  • Guillain-Barré syndrome is the name given to a specific type of peripheral neuropathy triggered by infection.
  • Connective tissue diseases - rheumatoid arthritis, Sjögren's syndrome and systemic lupus erythematosus.
  • Certain inflammatory conditions - conditions including sarcoidosis and coeliac disease can also cause peripheral neuropathy.
  • Hereditary diseases - Charcot-Marie-Tooth syndrome and Friedreich's ataxia.
  • Idiopathic - in a few people, no specific cause is found for their peripheral neuropathy. This is known as idiopathic peripheral neuropathy.

Peripheral Neuropathy

  • Peripheral neuropathy is common.
  • It is estimated that upwards of 20 million Americans suffer from this illness.
  • It can occur at any age, but is more common among older adults.
  • A 1999 survey found that 8-9% of Medicare recipients have peripheral neuropathy as their primary or secondary diagnosis.
  • The annual cost to Medicare exceeds $3.5 billion.

Diabetic Neuropathy

The commonest cause of peripheral neuropathy is diabetes.

High blood sugar levels causes damage to the walls of the tiny blood vessels that supply oxygen and nutrients to the nerves in the ends of the hands and feet, and the essential organs in the body (eyes, kidneys, heart).

As a result, skin becomes damaged and the loss of sensation only makes the skin of the feet more prone to damage.

In the US, diabetic neuropathy is the primary cause of diabetic foot problems and ulcers. Specific estimates vary, but overall about half of people with diabetes have diabetic neuropathy.

Symptoms of Peripheral Neuropathy

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Sensory Neuropathy

  • Tingling and numbness.
  • Pins and needles and hypersensitivity.
  • Increased pain or the loss of ability to feel pain.
  • Loss of ability to detect changes in heat and cold.
  • Loss of co-ordination and proprioception.
  • Burning, stabbing, lancing, boring or shooting pains - which may be worse at night.
  • Skin, hair or nail changes.
  • Foot and leg ulcers, infection and gangrene.

Motor Neuropathy

  • Muscle weakness - causing unsteadiness and difficulty performing small movements such as buttoning the shirt.
  • Muscle wasting.
  • Muscle twitching and cramps.
  • Muscle paralysis.

Autonomic Neuropathy

  • Dizziness and fainting (because of sudden changes in blood pressure).
  • Racing heart.
  • Reduction in sweating.
  • Inability to tolerate heat.
  • Loss of control over the bladder function leading to incontinence or retention of urine.
  • Bloating, constipation or diarrhea.
  • Difficulties in achieving or maintaining an erection (impotence).

Examples of Mononeuropathies

  • Postherpetic neuralgia - following shingles. Sensory neuropathy can last for many months after the rash disappears.
  • Ulnar nerve palsy - following an injury to the elbow.
  • Carpel tunnel syndrome - caused by compression of the nerves in the sheath of the wrist.
  • Peroneal nerve palsy - caused by compression of a nerve in the leg that runs by the neck of the fibular (the calf bone, between the knee and ankle).
  • Radial nerve palsy - caused by draping an arm over the back of a chair for a long time during deep sleep.
  • Bell's palsy is a single-nerve neuropathy that affects the face.

Questions When a Loved One Has Peripheral Neuropathy

What is Peripheral Neuropathy? +

Peripheral neuropathy is not a single disease. It is a general term for a series of disorders that result from damage to the body’s peripheral nervous system. The peripheral nervous system sends messages from the brain and spinal cord (central nervous system) to the rest of the body: the arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin. Peripheral nerves also relay information back to the spinal cord and brain from the skin, joints, and other organs. The symptoms of peripheral neuropathy occur when peripheral nerves are damaged or destroyed. Peripheral neuropathy’s course is variable; it can come and go, slowly progressing over many years, or it can become severe and debilitating. However, if diagnosed early, peripheral neuropathy can often be controlled. This is why we need increased research to find better treatments.

What causes peripheral neuropathy? +

Peripheral neuropathy is not a single disease. It is a general term for a series of disorders that result from damage to the body's peripheral nervous system. The peripheral nervous system sends messages from the brain and spinal cord (central nervous system) to the rest of the body: the arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin. Peripheral nerves also relay information back to the spinal cord and brain from the skin, joints, and other organs. Peripheral neuropathy occurs when these nerves are damaged or destroyed, resulting in loss of sensation, pain, or inability to control muscles.

There are many causes of peripheral neuropathy, including diabetes, hereditary disorders, inflammation, infections or autoimmune diseases, protein abnormalities, compression or physical trauma, exposure to toxic chemicals, poor nutrition, kidney failure, chronic alcoholism, and certain medications - especially those used to treat cancer and HIV/AIDS. In some cases, however, even with extensive evaluation, the cause of a person's peripheral neuropathy remains unknown - this is called idiopathic neuropathy.

My 92-year-old mother began developing symptoms of peripheral neuropathy in her late 60s; my symptoms began in my mid-40s. I was told this could be an inherited disease. Is this correct? +

Peripheral neuropathy is a general term for disorders of the peripheral nerves (the nerves connecting the brain and spinal cord to the rest of the body) - it is not a single disease. Some forms of peripheral neuropathy, e.g., Charcot-Marie-Tooth disease, are considered inherited diseases, that is, passed from parent to child. For many other peripheral nerve disorders, people may have a 'genetic predisposition' that makes them more likely to develop symptoms - similar to being at risk for heart disease or high blood pressure.

What is the difference between polyneuropathy and mononeuropathy? +

Peripheral neuropathy can affect multiple nerves (polyneuropathy) or only one nerve or nerve group (mononeuropathy) at a time.

Mononeuropathy is usually the result of damage to a single nerve or nerve group by trauma, injury, local compression, prolonged pressure, or inflammation. Examples include:

  • Carpal tunnel syndrome (a painful wrist and hand disorder often associated with repetitive tasks on a computer keyboard)
  • Bell's palsy (a facial nerve disorder)

The majority of people, however, suffer from polyneuropathy, an umbrella term for damage involving many nerves at the same time.

What is pre-diabetes? Can that cause peripheral neuropathy? +

It is well-known that diabetic patients frequently develop peripheral neuropathy. Today, doctors are exploring a link between peripheral neuropathy and pre-diabetes (also known as impaired glucose tolerance or IGT). An estimated 20 million people in the US have what is being called "pre-diabetes" or "borderline diabetes" — a condition where the body has higher than normal blood sugar levels, but not high enough to be diagnosed as true diabetes. If left untreated, people with pre-diabetes are at risk of developing type 2 diabetes, heart disease, and nerve damage (which could result in peripheral neuropathy.)

People with pre-diabetes often have no symptoms. People who actually have diabetes-and who therefore are at greater risk of developing peripheral neuropathy-often don't realize it because the symptoms of diabetes (frequent urination, constant thirst, blurred vision, fatigue, cuts and bruises that heal slowly, and tingling or numbness in the hands or feet) come on so gradually. You might want to consider being screened for pre-diabetes if you are over the age of 45, overweight and not physically active, have a family history of diabetes, and belong to an 'at-risk' ethnic or minority group.

The good news is that studies show that with modest weight loss (5 - 10% of total body weight) and increased moderate physical activity, such as walking 30 minutes a day, five days a week, you can reduce your risk of developing type 2 diabetes by 58%.

What role does celiac disease (gluten sensitivity) play in peripheral neuropathy? +

Celiac disease, a digestive disease that damages the small intestine and interferes with absorption of nutrients from food, can be associated with peripheral neuropathy, along with other disorders. People with celiac disease cannot tolerate a protein called gluten, which is found in wheat, rye and barley. It is an inherited condition that is believed to be significantly under-diagnosed in the United States.

For people who are genetically susceptible to celiac disease, gluten can trigger an autoimmune reaction in the intestines, which causes a variety of gastrointestinal symptoms and prevents the proper absorption of food and nutrients. A recent study found that some people with celiac disease had neuropathic symptoms before the gastrointestinal symptoms of celiac disease appeared.

I was diagnosed with peripheral neuropathy last year. I am not diabetic. Although I have seen several doctors, so far they have not found a cause. Can you reverse the effects of peripheral neuropathy or, at least, stop it from getting worse? +

Peripheral neuropathy is a general term for disorders of the peripheral nerves (the nerves connecting the brain and spinal cord to the rest of the body) - it is not a single disease. Peripheral neuropathy frequently is a complication of another condition such as diabetes, inflammation, infections or autoimmune diseases, hereditary disorders, poor nutrition, kidney failure, chronic alcoholism, or as a side effect of certain medications - especially those used to treat cancer and HIV/AIDS. In these cases, doctors start by treating the underyling condition that may be contributing to the problem.

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