Polyneuropathy – causes, symptoms, treatment. Hereditary and acquired polyneuropathies

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Numbness in the hands, tingling in the extremities, decreased sensation? These are one of the many symptoms of polyneuropathy. It is a disease that can appear at any age. What tests should be performed to diagnose polyneuropathy? And what are the causes of the disease?

Polyneuropathy – causes

Polyneuropathy is a peripheral neuropathy, which is characterized by generalized multifocal damage to the peripheral neuron manifested by defective motor and sensory syndromes.

Polyneuropathy can occur at virtually any age. The causes of the disease are genetic or acquired. Some types of polyneuropathy, especially those predominantly genetically determined, exist in specific age groups.

Polyneuropathy can be classified according to the type of nerve fiber damage:

1. axonal,
2. demyelinating,
3. mixed axonal-demyelinating.

In most cases, polyneuropathy, especially demyelinating polyneuropathy, causes motor and sensory deficit syndromes, mainly of the feet and hands.

Polyneuropathy, which manifests itself mainly with movement problems, may occur because of:

1. Lyme disease,
2. lead and hexane poisoning,
3. porphyria (a rare inherited disease with symptoms such as photophobia).

Polyneuropathy with predominant sensory symptoms may be caused by, for example:

1. vitamin B6 deficiency,
2. thallium poisoning,
3. amyliodosis (also known as amyloidosis – a disease in which a biologically inactive protein (amyloid) is deposited in the cells of various organs),
4. diabetes,
5. tumors.

See also: Characteristics of pain in peripheral neuropathy

Polyneuropathy – symptoms

The symptoms of polyneuropathy differ due to: the cause, the severity of disease processes, and the type of nerve fiber damage.

The most common symptoms of polyneuropathy are:

1. numbness,
2. tingle,
3. paresthesia (also known as misguided feeling),
4. reduced muscle strength,
5. reduced feeling
6. limb pain.

Less common symptoms associated with polyneuropathy include:

1. stinging,
2. baking,
3. a squeezing or burning feeling
4. pain perception disorders.

If the autonomic system is involved during polyneuropathy, the following may also appear:

1. pressure drops,
2. disturbance of sweat secretion,
3. vasomotor disorders,
4. constriction of the pupils.

Polyneuropathy is divided into two types – hereditary and acquired polyneuropathy.

Hereditary polyneuropathy

The field of neuropathy is referred to as sensorimotor polyneuropathy – HMSN, CMT. The types of the disease differ in terms of age, degree of inheritance, types of damage to the nerve fiber, as well as its degree of advancement.

Read: When the legs fail. Check what the disease of shop windows looks like

Acquired polyneuropathy

The most common type of acquired neuropathy is Guillain-Barré syndrome. It occurs in 1 to 2 cases out of 100000 people a year.

It is an acute demyelinating inflammation accompanied by axonal motor polyneuropathy. Nerve damage is caused by autoimmune processes. GBS can occur at virtually any age, but is less common in children.

GBS may occur as a result of complications following a digestive system infection, such as Campylobacter, Zika virus infection, HIV-acquired immunodeficiency, hepatitis B, cytomegalovirus, and even herpes zoster, smallpox or influenza.

GBS is most often manifested by:

1. root pains,
2. autonomic disorders (e.g. arrhythmia, impaired sweat secretion),
3. respiratory failure,
4. paresthesia,
5. foot pain
6. limb paresis,
7. paresis of facial muscles,
8. weakness.

Chronic inflammatory demyelinating polyneuropathy

Another very common type of acquired polyneuropathy is chronic inflammatory demyelinating polyneuropathy (CIDP). This type of polyneuropathy is characterized by the involvement of the spinal roots and peripheral nerves, which results in flaccid paresis with the abolition of deep reflexes and sensory disturbances. It occurs in 1 in 100000 people of all ages.

What is very important, this polyneuropathy may occur for no apparent reason or be preceded by an infection. It happens that it occurs in pregnant women (especially in the third trimester or in the puerperium). As for the symptoms, they take at least 2 months to develop.

Yet another variation of this polyneuropathy is Lewis-Samner Syndrome (MADSAM). This variety, in turn, is characterized by a subacute course, asymmetry, mainly affecting the upper limbs (it also happens that the lower limbs and cranial nerves are affected). Treatment is based on reducing the neurological deficits and preventing relapse. The treatment uses immunoglobulins, steroids or plasmapheresis, and sometimes also immunosuppressants. In this case, pharmacological and rehabilitation treatment are very important.

Multifocal motor polyneuropathy with conduction block

In addition, we should mention multifocal motor polyneuropathy with conduction block (MMN). This type of polyneuropathy is characterized by a slow course without remission, complete persistent or partial block of conduction in motor fibers, and asymmetric involvement of the limbs (especially the upper limbs).

It occurs in 1 to 2 cases in 100000 people. The most vulnerable patients are those in the 20-50 age group (especially men). Symptoms include distal muscle atrophy and asymmetric paresis. Often you can also observe myokimias, fasciculations and increased muscle contractions. The treatment uses immunoglobulins, and if there is no improvement, immunosuppressants (e.g. azathioprine, rituximab or cyclophosphamide).

Diabetic polyneuropathy

Diabetic polyneuropathy is also a very common acquired polyneuropathy. In the classic form of this disease, the symptoms are: numbness, burning, cold, tingling and pain in the distal parts of the limbs. However, when there are symptoms such as: pain, severe asymmetric muscle weakness and atrophy of the thigh adductors, hip-femoral and quadriceps muscles, it is a sign that we are dealing with the so-called diabetic amyotrophy. The condition is mainly seen in elderly people with advanced insulin-dependent diabetes. It may persist for 1 to 3 years.

Acquired polyneuropathies also include: hypothyroid neuropathy, uremic neuropathy, diphtheria neuropathy, drug-induced neuropathy, alcoholic neuropathy, neuropathy in celiac disease and liver diseases.

Polyneuropathy – diagnosis

Polyneuropathy can be diagnosed by performing an EMG test (i.e. electromyography – a test that allows the assessment of muscle function), an electrophysiological test, a genetic test, and a nerve biopsy. EMG is a test that allows you to find out which muscle fibers are damaged and which part of the nerve is damaged the most. In addition to determining the state of damage, this examination allows to determine the prognosis.

It should be added that when it comes to others tests in the case of polyneuropathy are selected individually for each patient. What tests will need to be carried out is closely related to the clinical picture and the EMG result. In addition to the aforementioned tests, it is also necessary to add: laboratory tests of blood and urine, lumbar puncture or examination of the cerebrospinal fluid. It should be mentioned that, unfortunately, sometimes despite the fact that many different tests have been carried out, the cause of polyneuropathy remains unknown.

Treatment of polyneuropathy is mainly based on physical rehabilitation of the limbs and pharmacotherapy.

In the treatment of polyneuropathy and other diseases of the peripheral nerves, drugs such as Neurovit, as well as Milgamma 100 or Bexon vitamin complexes are used.

Polyneuropathy – when we notice symptoms

If we notice any symptoms of polyneuropathy, we should contact a primary care physician, who (if necessary) will refer us to a neurologist. It should be remembered that in the case of polyneuropathy, it is mostly chronic, in which symptoms slowly increase. If you experience motor symptoms, such as weakness in the muscles of the arms or legs, see a doctor immediately.

Polyneuropathy – treatment

As far as the treatment of polyneuropathy is concerned, it includes it causal treatment or symptomatic treatment. The former, in the case of immune-mediated polyneuropathy, include the administration of immunoglobulins, glucocorticosteroids, immunosuppressants, and sometimes the performance of plasmapheresis, i.e. procedures for removing pathological proteins from the blood plasma. As for polyneuropathy associated with metabolic diseases such as diabetes and endocrine diseases, their treatment focuses mainly on treating the underlying disease.

Symptomatic treatment of polyneuropathy, in turn, consists in treating pain and physiotherapy, which includes: classic massage, whirlpool massage, exercises on sensorimotor pillows, exercises with various textures, strengthening and neuromobilizing exercises. In addition, it should be added that you should follow the recommendations regarding lifestyle, such as wearing cotton socks, non-compressive shoes, slippers with a soft pad, or taking moderate-intensity walks.

Polyneuropathy — physical therapy

Physical therapy in the treatment of polyneuropathy focuses on alleviating the existing ailments and on improving the comfort of patients in their daily functioning. In the case of this type of patients, physical therapy focuses on physical exercises and massage of the limbs (classic and whirlpool massage). It is not only a counteraction to the current paresis, but these treatments protect the patient by reducing the risk of possible muscle wasting.

In addition, physical therapy in the case of patients with polyneuropathy uses techniques such as anti-constriction postures, special mats are also used, and patients are taught to walk. Muscle training using the EMS method, i.e. muscle electrostimulation, gives very good results.

It should be added, however, that in physical therapy with patients with polyneuropathy, treatments based on thermal stimuli should not be used. This is due to the sensory disturbances, and lowering and raising the temperature may end up with permanent tissue damage due to impaired sensory senses.

Polyneuropathy – Can It Be Cured?

In most cases, polyneuropathy is chronic and the patient is forced to deal with it throughout his life. It should be added, however, that symptoms can often be alleviated or the disease progression can be inhibited. Additionally, with some types of this condition, symptoms may resolve completely and never recur. Among the types of polyneuropathy in which symptoms may disappear are, for example, toxic polyneuropathy associated with anti-cancer treatment. The same is true of the treatment of Guillain-Barré syndrome.

Polylineuropathy – profilaktyka

Prevention of polyneuropathy is about reducing risk factors and treating underlying diseases. A person with polyneuropathy may not be able to avoid all risk factors, but a proper healthy lifestyle can reduce these risks significantly. Belongs:

1. avoid alcohol,
2. avoid exposure to toxins, including cigarette smoke,
3. be aware of limiting factors that contribute to injury, such as repetitive activities and poor body postures
4. get enough sleep and spend time actively, which will have an impact on the immune functions of the body,
5. follow a balanced diet rich in vitamins and minerals,
6. for vegans and vegetarians, consider vitamin B12 supplementation.

People with diabetes and other conditions related to polyneuropathy should strictly follow the treatment plan developed by their doctor and attend all follow-up visits.

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