PERIPHERAL NEUROPATHY - NERVOUS-SYSTEM-HEALTH

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Peripheral Neuropathy

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The causes of peripheral neuropathy are numerous; diabetes is the main trigger, at least as far as industrialized countries such as Italy or the United Kingdom are concerned.
Symptoms vary depending on whether sensory, motor or autonomic nerves are involved.
To plan an "adequate therapy," a very careful diagnostic investigation is required: the identification of the causes and the subsequent treatment are of fundamental importance.

Brief reminder of the nervous system

The nervous system is a set of organs, tissues and nerve cells (neurons), capable of receiving, analyzing and processing stimuli coming from inside and outside the body.
At the end of the processing, the nervous system generates responses suited to the situation, which favor the survival of the organism to which it belongs.
The vertebrate nervous system consists of two components:

The central nervous system (CNS): it is the most important part of the nervous system, a real data processing and control center. In fact, it analyzes the information arriving from the external and internal environment of the organism, then formulates the answers most appropriate to the above information.
It is made up of the brain and spinal cord.
The peripheral nervous system (PNS): is the "arm" of the central nervous system. In fact, his job consists in transmitting to the CNS all the information collected inside and outside the organism and in spreading all the elaborations originating in the CNS to the periphery.
Without the PNS, the central nervous system could not function properly.

, or the extensions of neurons that spread the nerve signal.
Thanks to its nerves, the SNP communicates with the arms, hands, feet, legs, internal organs (this was previously referred to as "the information data captured inside the" organism "), the mouth and the face.
The cranial nerves and the spinal nerves are part of the PNS, which originate respectively in the brain and spinal cord.
These nerves are of type:

Psychic. A sensory nerve is a nerve that carries sensory information, captured in the periphery. Pain, tactile perception and proprioceptive sensitivity are just some examples of sensory information.
Motor. Motor nerves are the nerves that control skeletal muscles. They are triggered by a signal that originates in the central nervous system.
Autonomous. The autonomic nerves are the nerves that regulate the automatic functions of the body, such as blood pressure, digestion, or the bladder filling / emptying process.

, as, in the so-called countries of the Western World (therefore also in Italy), it is most likely one of the main triggers.

DIABETES

Diabetes mellitus is a metabolic disease, caused by a defect in the secretion and / or action of insulin, a hormone essential for the passage of glucose from the blood to the cells.
As a result of the lack of secretion and / or malfunction of insulin, the levels of glucose in the blood (blood sugar) rise and a very dangerous condition for the body, known as hyperglycemia, develops.
Peripheral neuropathy that arises due to diabetes mellitus is also called diabetic neuropathy.
According to the most recent and reliable theories, hyperglycemia is the cause of diabetic neuropathy. In fact, the high levels of glucose in the blood damage the blood vessels that supply the peripheral nerves (ie the nerves of the peripheral nervous system) with oxygen and nutrients. .
Without oxygen and nutrients, any nerve, tissue or organ in the body undergoes a process of death, more properly referred to as necrosis.
Various conditions contribute to increasing the risk of peripheral neuropathy in a patient with diabetes mellitus, including:

Hypertension
Overweight and obesity
Be over 40 years old
Consume large quantities of alcoholic beverages
To smoke

OTHER CAUSES OF PERIPHERAL NEUROPATHY

A form of peripheral neuropathy can also arise due to or as a result of:

State of severe alcoholism. Alcoholics do not properly absorb ingested foods and are often prone to episodes of diarrhea and vomiting. This determines a state of malnutrition, in some cases even very severe, which particularly affects vitamins.
Vitamins (in particular B12, B1, B6, niacin and E) are essential for the good health of the nervous system, therefore their deficiency involves, among the various consequences, also the deterioration of the nerves of the peripheral nervous system. .
Vitamin deficiencies due to causes other than alcoholism. If certain foods are, by choice (wrong) or lack of availability, excluded from the diet, it is likely that certain vitamins are not consumed in adequate quantities. This can negatively affect the structures nervous, exactly as in the case of alcoholism.
Chronic kidney disease. If the kidneys work poorly, there is a buildup of toxic substances in the body; toxic substances that damage the nervous system, including peripheral nerves.
Chronic liver disease. Similar to the kidneys, if the liver malfunctions, the blood accumulates toxic waste products and infectious agents; the latter, in the long run, cause damage to nerve cells, including those making up the peripheral nerves.
An "inflammation of the blood vessels (vasculitis).
State of hypothyroidism. Hypothyroidism is a morbid condition that arises due to an underactive thyroid. An underactive thyroid produces an insufficient amount of thyroid hormones to meet the needs of the body.
Infections, such as Lyme disease, diphtheria, botulism, shingles and AIDS. These morbid states arise from viruses or bacteria capable of invading and damaging nerve cells.
Autoimmune diseases, including Guillain-Barré syndrome, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome and chronic inflammatory demyelinating polyneuropathy. People with autoimmune disease have an improperly functioning immune system. , attacks, through its cells, healthy tissues and organs.
Amyloidosis. It is the medical term to identify a group of diseases characterized by the accumulation, often in the extracellular area, of the so-called amyloid fibrils. Insoluble, amyloid fibrils compromise the functionality of various tissues and organs of the body, including nervous structures.
Charcot-Marie-Tooth disease and the like. Charcot-Marie-Tooth disease, also known as hereditary sensory motor neuropathy, is an inherited neurological syndrome of the peripheral nervous system. Therefore, its onset determines a deterioration of the peripheral nerves, in particular those destined for the lower limbs.
A physical trauma that damages the peripheral nerves. The classic physical traumas that can cause damage to peripheral nerves are those following road accidents, falls (for example from a horse) or bone fractures.
Nerve compression syndromes. They are pathologies due to the crushing (or compression) of a nerve by the surrounding tissues or due to the presence of a tumor mass. The compressed nerve, therefore, becomes irritated, causes pain and loses its functions.
A classic example of peripheral neuropathy, due to the compression of a peripheral nerve, is carpal tunnel syndrome.
Cancers, such as lymphoma and multiple myeloma. A lymphoma is a malignant tumor of the glandular system that makes up the lymphatic system (lymph nodes).
Multiple myeloma is a malignant tumor that affects certain cells of the immune system. The latter, in fact, begins to produce an abnormal protein that causes kidney problems and damages other organs and tissues in the body.
Exposure to toxic substances, such as insecticides, arsenic, lead, mercury and heavy metals in general.
Monoclonal gammopathies of uncertain significance. They are pathologies characterized by the large presence, in the blood, of an abnormal protein of lymphoid origin. This protein is produced by plasma cells, which are the cells of the immune system that secrete antibodies.
Diseases of the connective tissue. If they affect the connective tissue surrounding the peripheral nerves, they can lead to a form of peripheral neuropathy.
Taking certain medications.Among the offending drugs, there are chemotherapy drugs for cancer, drugs for blood pressure, some antibiotics (metronidazole and nitrofurantoin) and anticonvulsants for the treatment of epilepsy (phenytoin).
Recently, statins for hypercholesterolemia have also been found to favor the onset of peripheral neuropathy.
Obviously, we are talking about long-term hires.

EPIDEMIOLOGY

Peripheral neuropathy is a fairly common morbid condition.
According to a British statistic, in the United Kingdom, it would affect one in every 50 of the general population and one in every 10 of the population over 55.
Hence, it is more common among middle-aged people.
Particularly interesting is the epidemiological aspect concerning the combination of diabetes and peripheral neuropathy. In fact, according to what is reported by the Center for Peripheral Neuropathy of the University of Chicago, about 60% of diabetics develop more or less serious damage at the level of the peripheral nerves.

sensory-motor).
The typical signs and symptoms in case of sensory neuropathy, motor neuropathy and autonomic neuropathy will be reported below.
In the presence of a polyneuropathy, the clinical manifestations obviously overlap.

SENSITIVE PERIPHERAL NEUROPATHY

The characteristic symptoms of peripheral sensory neuropathy include:

Tingling and pricking in areas where damaged peripheral nerves reside.
Feeling of numbness and reduced ability to feel pain and temperature changes, especially in the hands and feet.
Burning, stinging pain, especially in the lower limbs and feet.
Allodynia, or pain caused by a stimulus which, under normal conditions, would be completely harmless and without consequences.
Loss of balance and coordination ability.

The pain experienced during a peripheral neuropathy represents a form of neuropathic pain. To be even more precise, it is called peripheral neuropathic pain.
Neuropathic pain is a different sensation from what one feels after a physical insult; in fact, it originates directly in the structures making up the nervous system (nerves, in the case of the PNS, and brain and spinal cord, in the case of the CNS).

PERIPHERAL MOTOR NEUROPATHY

Typical symptoms and signs of motor neuropathy are:

Muscle spasms and cramps.
Muscle weakness and / or paralysis affecting one or more muscles.
Reduction of muscle mass, due to inactivity.
Foot drooping. It is a particular condition characterized by the inability to keep the front part of the foot raised; this leads to considerable walking problems.
Frequent falling from the hands of objects.

AUTONOMOUS PERIPHERAL NEUROPATHY

The clinical manifestations that characterize autonomic neuropathy consist of:

Constipation or diarrhea. The latter is frequent especially at night.
Sense of discomfort, abdominal bloating and vomiting.
Drop in blood pressure (orthostatic hypotension), which leads to fainting and / or dizziness.
Tachycardia, i.e. increased heart rate.
Excessive sweating or lack of sweating (anhidrosis).
Sexual disorders. In men, for example, erectile dysfunction is particularly common.
Difficulty completely emptying the bladder.
Bowel incontinence, due to the loss of control of the smooth muscle of the intestine.
Dysphagia.
Thinning of the skin.

MONONEUROPATHY

Peripheral mononeuropathy is defined as a peripheral neuropathy involving a single peripheral nerve. Consequently, it is a condition that causes symptoms localized in a specific area.
A classic example of peripheral mononeuropathy is the aforementioned carpal tunnel syndrome, in which there is compression of the median nerve at the level of the wrist.

WHEN TO SEE THE DOCTOR?

In general, the earlier a condition of peripheral neuropathy is identified, the greater the possibility of limiting the damage it causes.
Therefore, if you are an individual at risk of peripheral neuropathy, pay close attention to symptoms and signs, such as:

Tingling, numbness or numbness in the hands and especially the feet.
Loss of balance.
Cuts or wounds that don't heal, especially in the feet.
Bowel problems, such as diarrhea or constipation, and bladder dysfunction.
Fainting on standing up.

COMPLICATIONS

The possible complications of peripheral neuropathy are numerous and depend, in the first place, on the causes of deterioration of the peripheral nerves.
For the sake of brevity, the three main and probably most common complications are reported, namely:

The diabetic foot. It is one of the most feared consequences of diabetes. To find out more, we recommend that you consult the article here.
The risk of gangrene. With gangrene s "means the massive putrefaction of one or more tissues of the body. To cause such a process, it is the total lack of blood flow in that or those tissues involved. In case of gangrene it is necessary to remove the necrotic tissue (i.e. to necrosis). In the most serious cases, it is also necessary to resort to the amputation of a part of the body.
Autonomous cardiovascular neuropathy. It is a morbid condition that completely disrupts several autonomic nerve functions, including blood pressure, heart rate, bladder control, sweating etc.

, a neurological evaluation, imaging tests (CT and MRI), an "electromyography, a biopsy of one or more nerves and / or a skin biopsy.
An accurate diagnostic procedure allows us to establish not the characteristics of the peripheral neuropathy in progress, but also the cause that triggered it.
Knowledge of the triggering factor allows the planning of the most appropriate therapy.

BLOOD ANALYSIS

Analyzes on a blood sample allow us to determine if the patient has diabetes, some vitamin deficiency or a thyroid dysfunction.

NEUROLOGICAL EVALUATION

During a neurological evaluation, the doctor analyzes tendon reflexes and tests for the presence or absence of neuromuscular and coordinative disorders.

CT AND NUCLEAR MAGNETIC RESONANCE (MRI)

CT and nuclear magnetic resonance (MRI) are very useful and provide discrete information when a tumor, physical trauma to the peripheral nerves or a compression syndrome is suspected.

ELECTROMYOGRAPHY

Electromyography involves the study of the conduction of nerve signals along the area showing symptoms and, subsequently, the evaluation of the electrical activity of the muscle or muscles, always located in the symptomatic area.
For more information on electromyography, we recommend reading the article here.

BIOPSY OF ONE OR MORE NERVES

The biopsy of a nerve consists in the sampling and subsequent laboratory analysis of some cells of a nerve, considered responsible for the symptoms in progress.
It can be useful for tracing the causes of nerve damage.

SKIN BIOPSY

The laboratory analysis of skin cells, previously taken from an area of suffering skin, can be used to study the sensory nerves and to understand their state of health.

, keeping blood pressure under control, regulating body weight etc.
Using another example, in the case of drug-induced peripheral neuropathies, the main therapeutic remedy (sometimes even a solution) is to stop taking the drug responsible for the deterioration of the peripheral nerves.

Currently, there is no cure or remedy that can regenerate damaged neurons during a peripheral neuropathy.

Other examples of treatments, which depend on the triggering causes:

Immunosuppressants, immunoglobulins and corticosteroids, in the case of autoimmune diseases or inflammatory diseases.
Vitamin supplements, for vitamin deficiencies.
Surgery, for tumors that compress peripheral nerves or for nerve compression syndromes.
Cancer treatments (chemotherapy and radiotherapy), in case of multiple myeloma or lymphoma.

TREATMENT OF NEUROPATHIC PAIN

Neuropathic pain very often requires pain relieving drugs other than those used in the presence of trauma-induced pain. Hence, paracetamol or ibuprofen are usually ineffective.
Medicines used for neuropathic pain include:

Antiepileptics, such as gabapentin and pregabalin. As side effects, they present drowsiness and dizziness.
Antidepressants, such as amitriptyline, doxepin, nortriptyline, duloxetine (a reuptake inhibitor of serotonin and noradrenaline) and venlafaxine.
Some side effects of these medications are dry mouth, nausea, sleepiness, dizziness, constipation and / or decreased appetite.
Opioid-type pain relievers, such as tramadol. It is a derivative of morphine, so its long administration is highly dangerous because it can be addictive.
Among the side effects, there are: feeling of malaise, vomiting, dizziness and / or constipation.
Capsaicin in cream. Capsaicin is a chemical compound found in hot pepper plants, which somehow manages to stop the pain signal sent by the nerves to the brain. The cream preparation should be spread 3 to 4 times a day on the affected area of the body.
As side effects, it presents irritation and / or burning in the skin.

For doctors, the main problem when prescribing these drugs is the indication of the most appropriate dose. Often, this is done by trial and error, as each patient responds differently, so it represents a case in itself.

SYMPTOMATIC THERAPY

For patients with weakness or reduced muscle mass, doctors recommend physiotherapy to keep the muscles strong.
For men suffering from erectile dysfunction, they prescribe adequate treatments, also taking into account the causes of the onset of peripheral neuropathy.
For those suffering from hyperhidrosis, they plan a botulinum toxin therapy.
For individuals with constipation, they recommend drug preparations and a diet to promote peristaltic movements.
Finally, to patients with bladder dysfunction, they indicate the use of bladder catheters.

Some important information relating to the lifestyle that is good to adopt in the presence of a peripheral neuropathy: