History

The course of a polyneuropathy can be just as varied as the symptoms. Usually the disease begins with sensations in both feet or lower legs. Affected persons typically report, for example, a nightly burning sensation on both soles of the feet or tingling in the area of both calves.

Depending on the cause, the onset can be gradual (e.g. diabetes polyneuropathy) or sudden (e.g. due to infection). In the course of the disease, the symptoms increase and even lead to numbness.

Surprisingly, in the case of concomitant sensations of discomfort, a significantly reduced pain sensation can be observed very often. As a result, shards, splinters or ingrown toenails are not noticed. If affected persons do not carry out careful and regular foot care, inflamed, poorly healing wounds can develop quickly.

Furthermore, many polyneuropathy patients also show disturbances of the motor nervous system during the course of the disease. An unsteady gait can be observed, frequent stumbling and “getting stuck” with the feet.Special forms of polyneuropathy (Guillain-Barré syndrome) can also begin with a loss of motor function. Polyneuropathies in infectious diseases: 5% of polyneuropathies occur in infectious diseases and are classified as polyneuritis.

The “inflammatory” polyneuropathies are caused by three mechanisms: Viral polyneuritis are caused by herpes zoster, influenza, measles, AIDS, etc. However, these are very rare. More common are bacterial forms, especially Lyme disease, diphtheria, botulism and leprosy.

Direct exposure to the pathogen
Damage by its poison
Damage caused by the reaction of the immune system
Lyme disease: asymmetrical sensitivity disorders, paralysis, involvement of the meninges and cranial nerves
Diphtheria: Paralysis of the soft palate and pharynx with nasal pronunciation and swallowing disorders due to paralysis of the responsible cranial nerves, later also paralysis of the respiratory muscles and sensory and motor paralysis of all four extremities
Botulism: dysphagia and abdominal discomfort after consumption of canned food, followed by paralysis of the eye muscles, but no sensitivity disorders
Leprosy: Tuberculoid leprosy causes asymmetrical sensory disturbances and paralysis, lepromatous leprosy causes cranial nerve symptoms. Dimorphic leprosy is a mixed form.

Usually, this type of polyneuropathy has a symmetrical distribution pattern with sensitive and motor deficits. Addictive substances and environmental toxins such as industrial poisons and pesticides are among the most common causes.

Alcoholic polyneuropathy: very common form. Besides the effect of the alcohol itself (ethanol) and its degradation product (acetaldehyde), malnutrition plays an important role in alcoholics. Defects in the enzymes that are responsible for the breakdown of alcohol can also be involved in the cause of the disease.
Symptoms include severe pain in the legs, often also muscle cramps and calf pressure pain. The sense of touch and vibration is diminished, as well as the muscle reflexes are weakened and ASR is absent. The motor nerve conduction speed is usually normal or only slightly reduced.

The critical limit of alcoholic polyneuropathy is 80-100g alcohol daily.
Vitamin deficiency polyneuropathy: Eye muscle paralysis and fluctuations in attention (vigilance) usually indicate vitamin B1 deficiency in chronic alcoholism. A vitamin B2 deficiency leads to a pellagra polyneuropathy with an inflammatory reaction of the skin (dermatitis), diarrhea (diarrhea) and dementia. Vitamin-B6 deficiency also leads to polyneuropathy.
Polyneuropathy due to triarylphosphate poisoning: Example of an acute toxic neuropathy.
Triaryl phosphate is contained in mineral oil residues and, if mistakenly used as cooking oil, leads to diarrhea and fever. After 10 to 38 days, paralysis of the feet occurs first, followed by paralysis of all four extremities; sensitivity is also impaired. In some cases, the nerve deficits do not or not completely disappear.

Asymmetrical: There are three different types:

In a mononeuropathy, only disorders in the supply area of a peripheral nerve can be detected.
In mononeuropathia (mononeuritis) multiplex (multiplex type), disturbances in the supply areas of several peripheral nerves can be recognized, but the adjacent nerves are hardly or not at all affected.
The focal neuropathy is a combination of mononeuropathy multiplex and a symmetrical polyneuropathy.

Besides alcoholic polyneuropathy, diabetic polyneuropathy is the most common polyneuropathy.

20-40% of diabetics show signs of polyneuropathy, most of them are between 60 and 70 years of age and have already had the disease for more than 5 to 10 years. In 10% of these patients, the clarification of the polyneuropathy has led to the diagnosis of diabetes in the first place. Both the direct effects of the metabolic disorder and the changes in the vessels caused by the diabetes (diabetic angiopathy) lead to polyneuropathy.

In this form, mainly axon degeneration, but sometimes also demyelination of the nerve fibers occurs (see diagnosis). The symptoms are initially symmetrical sensitive irritation symptoms with sensory disturbances and often burning and painful areas on the feet.Typical are the lack of Achilles tendon reflex and a reduction in the sense of touch, especially the sense of vibration. Later, 50% of patients experience a loss of motor function.

There are also asymmetrical disorders or failures of individual nerves (mononeuropathy multiplex), especially the eye muscle nerves, wider cranial nerves or the femoral nerve, a nerve in the thigh muscle region. In addition, in about half of the cases there are disorders of the organs (vegetative disorders): dry, reddened skin, bladder dysfunction, an accelerated pulse (tachycardia), difficulty swallowing, diarrhea and impotence in male diabetics. There is also the risk of a painless heart attack. As a therapy, the optimal adjustment of diabetes is the main focus.