Polyneuropathy and it’s Associated Features

Overview

Neuropathy refers to any problem associated with nerves. Polyneuropathy is a condition in which multiple peripheral nerves are damaged. This condition is interchangeably called peripheral neuropathy.  

Nerves present outside the brain and spinal cord are called peripheral nerves. They maintain a connection between the central nervous system (CNS) and other parts of the body. In polyneuropathy, different nerves of the body are affected simultaneously, and the affected nerves can include: 

  • Sensory neuropathy – nerves responsible for sensation or feeling  
  • Motor neuropathy – nerves that transmit the signals to the muscles for movement of the body  
  • Sensorimotor neuropathy – involving both sensory and motor nerves 

Polyneuropathy is seen in around 1% of the general population and 7% of the older population, with western countries being more affected. Hints are also there showing that females are more commonly affected than males.  

In this article, we will review some clinical features of polyneuropathy, its causes, treatments, and preventions.  

Nephron, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons

Types

Peripheral neuropathies are present in many different forms for example neuropathy associated with diabetes (high blood sugar levels) is called diabetic neuropathy. There are some general classifications for polyneuropathy: 

  • Chronic symmetrical peripheral neuropathy – neuropathies that develop over many months or years. They develop slowly and comprise most of the polyneuropathy cases.  
  • Multiple mononeuropathies – damage to at least two separate nerve areas 
  • Acute symmetrical peripheral neuropathy – sudden onset and damage to the nerves. It is a rare condition and the most commonly determined cause is the Guillain-Barre syndrome. It can precipitate to be fatal if not treated.  

Symptoms

Polyneuropathy can present in a variety of ways with a wide range of symptoms. Symptoms depend on the nerves that are damaged or affected alongside the area that these nerves are supplying. Sensory or motor neuropathies can present as: 

  • Paraesthesia – burning or tingling along with the feeling of needles or pins  
  • Numbness  
  • Difficulty in moving arms, legs, or feet 
  • Insomnia due to night-time pain  
  • Inability to feel pain, sense temperature change, etc.  
  • Leg and foot ulcers – commonly associated with diabetes mellitus  
  • Recurrent infections  
  • Muscle spasms or twitching  

Symptoms associated with the neuropathy of autonomic nerves (part of the autonomic nervous system) are: 

  • Unusual sweating  
  • Flushing of skin and heat intolerance  
  • Digestive issues  
  • Dizziness  
  • Abnormal blood pressure or pulse problems  
  • Difficulty in breathing, or swallowing  

Causes and Risk Factors

Polyneuropathy is caused by damage to the neuronal cell body or the axon. A neuron is a term that refers to one nerve cell. Axon is the long tail that carries information and is attached to the cell body. Abnormal changes in the cell body e.g., excess sugar, physical trauma to the cell body or the axon, etc. are the common causes. Some diseases and risk factors associated with polyneuropathy are: 

  • Diabetes – the most common  cause of neuropathy is diabetes. The associated nerve damage is oftentimes called diabetic neuropathy. It is caused by uncontrolled blood sugar levels. This excess sugar can go into nerve cells and get trapped there causing damage to the cell and inducing neuropathy 
  • Alcohol abuse – excessive alcohol use causes several nutritional deficiencies like vitamin deficiencies. This can cause nerve tissue damage eventually damaging several nerves of the body 
  • Bacterial or viral infections – certain bacteria or viruses attack and even live in the neurons of the body, eventually causing damage or cell death. These include bugs causing Lyme disease, Shingles, Herpes, hepatitis B or C, HIV, or Campylobacter 
  • Autoimmune conditions – people who have autoimmune disorders like Sjogren’s syndrome, Guillain-Barre syndrome (associated with Campylobacter), rheumatoid arthritis, and lupus can have an increased risk of developing neuropathies. In autoimmune disease, your immune system gets overactive and attacks its healthy cells 
  • Hypothyroidism – low levels of thyroid hormones 
  • Poor nutrition – deficiencies like vitamins B1, B6, and B12 deficiencies may lead you to polyneuropathy 
  • Physical trauma or injury – injuries like accidents, etc. can cause polyneuropathy  
  • Occupational trauma – repetitive motion of limbs e.g., typing, drilling can also damage your nerves by overworking them 

Some people experience nerve damages in their body without any cause or risk factors. These cases are called  idiopathic polyneuropathy. 

Diagnosis

Your physician will confirm a diagnosis based on your medical history, medical examination, and neurological evaluation. Some simple tests to check the sensorimotor peripheral nervous system are the reflex tests, sensations test, etc. Reflex tests may include knee jerk reflex, bicep or triceps reflex, etc. other posture and gait test may also be assessed to see you if you have stability in coordination in your movements without having an adverse effect like pain, etc. 

Other tests that may be used to confirm the diagnosis of polyneuropathy are: 

  • Electromyography and nerve conduction tests – these tests include sending of impulses in your muscles or nerves and measure the response to check the integrity of your nerves and muscles. These tests can also confirm the severity of the neuropathy that you have.  
  • Nerve biopsies – biopsy refers to taking a live tissue as a sample and assessing it with different tests. These biopsies are taken to check if the cells are working properly. 
  • MRI or CT scan – these are imaging techniques through which the presence of underlying cause of neuropathy can be figured out. These causes can include tumours and herniated discs, etc.  
  • Blood tests and urine samples – the presence of abnormal blood components can hint towards some cause of polyneuropathy. For instance, high blood or urine sugar levels can indicate diabetic polyneuropathy, and the presence of auto-antibodies (antibodies against your own body) can be found in blood tests.  
Dr. Jana, CC BY 4.0 https://creativecommons.org/licenses/by/4.0, via Wikimedia Commons

Treatment

Treatment of polyneuropathy depends on the symptoms you’re having and the severity of your symptoms. In patients who have an underlying disease-causing polyneuropathy e.g., diabetic patients, the underlying disease is treated with symptomatic medication for the associated problems. For idiopathic (due to an unknown reason) polyneuropathies, the usual treatment is to take care of the symptoms. Some of the available options are: 

  • Medications – medicines can help cure the underlying disease which is causing polyneuropathy. Insulin can be used to treat hyperglycaemia (high blood sugar levels) and thyroid hormones can be used to reverse polyneuropathy caused by hypothyroidism. Moreover, over-the-counter pain killers can be used to alleviate the pain caused by polyneuropathy 
  • Transcutaneous electrical nerve stimulation – a gentle current is sent to the muscles or nerves by placing electrodes on the skin. This can help with the pain and extreme sensitivity 
  • Immunoglobulin therapy and plasma exchange – these therapies aim to decrease the number of circulating autoantibodies in the body. This can reduce the destruction of nerve cells by your immune system. These therapies can be used to reduce the severity of polyneuropathy 
  • Physical therapy – as with a lot of other musculoskeletal and nerve anomalies, physical therapy like massages, light active stretching, and exercises can help reduce pain, increase the mobility and overall strength of your muscles.  
  • Surgery – Surgery is opted for cases of severe nerve compressions i.e., by a herniated disc or tumour 

Complications

Some complications associated with polyneuropathy are: 

  • Ulcers or gangrene – occur especially in the feet and leg as a result of diabetic neuropathy. Infections in the lower limb can go unnoticed due to diminished sensations, causing ulcers and gangrene (tissue death). This can lead to amputation (cutting) of the limb. This condition is often referred to as diabetic foot/feet 
  • Falls and injury – polyneuropathy can cause loss of fine control and you might become unstable leading to fall and injury 
  • Burns and skin damage – inability to feel pain due to lack of sensation and lack of sensing temperature change can cause accidental burns 

Prevention

Prevention of polyneuropathy includes addressing the risk factors that can cause this condition. You can choose to: 

  • Avoid alcohol  
  • Avoid tobacco and cigarette smoke 
  • Avoid physical trauma by limiting repetitive tasks  
  • Eating a healthy and balanced diet  
  • Having a good night sleep 

The content shared in the Health Literacy Hub website is provided for informational purposes only and it is not intended to replace advice, diagnosis, or treatment offered by qualified medical professionals in your State or Country. Readers are encouraged to confirm the information provided with other sources, and to seek the advice of a qualified medical practitioner with any question they may have regarding their health. The Health Literacy Hub is not liable for any direct or indirect consequence arising from the application of the material provided.

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