Neuropathy is the term used to describe quite a few disorders of the peripheral nervous system. However, disorders of the central nervous system, such as autonomic dysfunction, also fall under this term. Sometimes neuropathy is a consequence of other diseases such as diabetes or the consequence of consumption of neurotoxic substances such as alcohol or drugs.
What is neuropathy?
Regarding the etiology of primary neuropathies, primary neuropathies originating from the nerves themselves are usually inherited. Primary neuropathies include hereditary motor-sensory neuropathies (affecting motor function), hereditary sensory neuropathies, hereditary sensory autonomic neuropathies (disorders of the sense of pain and temperature), hereditary motor neuropathies, and the hereditary neuropathies with a tendency to pressure lesions. On the etiology of secondary neuropathies: these include inflammatory diseases, autoimmunologic diseases, e.g., Guillain-Barré syndrome (there is an attack of the immune system on the body, especially on the nerves), metabolic diseases (metabolic disorders of the nervous system), and the consequences of ingestion of neurotoxic substances (such as benzene, phenol, drugs, alcohol, or chemotherapeutic agents).
Causes
About the causes: The nervous system is divided into the central nervous system (brain as well as spinal cord) and the peripheral nervous system ( these are the nerves from the spinal cord to the corresponding organs that need to be supplied). The main task of the nerves is to transmit motor impulses sent by the brain – e.g. as movement of a muscle or to transmit information and sensations to the brain. Nerve damage, as in neuropathy, leads to disturbances of these functions. The causes are manifold and range from circulatory disorders, inflammations, poisonings to diseased genetic material or metabolic disorders. Diabetes can also trigger neuropathy: Due to higher blood glucose levels, the walls of the veins that supply blood to the peripheral nerves in the arms and legs become thicker – thus resulting in circulatory disorders of the nerve fibers. Other causes of neuropathies include hyperthyroidism and hypothyroidism, liver disease, acromegaly, neuritis, and malnutrition.
Symptoms, complaints, and signs
The symptoms neuropathies cause depend on the underlying disease and the nerves affected. Symptoms often change in type, intensity, and frequency. Peripheral neuropathies primarily cause nerve damage in the arms, legs, hands, and feet. Nerve pain is very distressing for those affected. It is described as stabbing, burning, tingling, shooting in or radiating. It tends to occur spontaneously at rest and often subsides with activity. Sensory disturbances are experienced as bothersome. The skin feels furry to numb. Recognition of touch and temperature and the sense of touch may be impaired. Some patients report muscle weakness or cramps. Sometimes paralysis occurs, leading to unsteady gait and balance problems. Autonomic neuropathies cause symptoms in body functions that cannot be consciously controlled. Circulatory and cardiac rhythm changes may occur. The functions of the entire digestive system may be disturbed. Disorders of the urinary and genital organs are also possible. Heavy perspiration promotes excessively dry, cracked skin in the area of the feet and lower legs. Sometimes water retention occurs. Primary neuropathies are congenital and inherited. They are rare and appear before the age of twenty. Possible signs are disturbances of movement or sensation and pain. Internal organ dysfunction and absence of pain sensation are less common.
Diagnosis and course
Diagnosis and Course: Following the history, a clinical examination is performed by the neurologist. A patient’s neurologic status is obtained. This is followed by a detailed history. Reflexes, coordination, motor function and sensibility are tested. Electromyography, which involves an examination of the muscles, can provide more information about peripheral paralysis. Through this method, one can differentiate between muscle atrophy caused by nerves and muscle diseases of their own. Electroneurography can also be informative. The course of the disease as well as its duration are different and difficult to predict.
Complications
Like the causes of neuropathy, its effects can vary. Often, it is enough to correct the underlying cause to restore nerve function. However, this is not always successful. This is the case when the nerve cells have already been irrevocably destroyed. In these cases, insensitivity and numbness remain. Since neuropathy can affect any organ, the type of complications often depends on the affected organ. Thus, in addition to cardiac arrhythmias, fecal or urinary incontinence, among other complications, may occur. A well-known complication of neuropathy is the so-called diabetic foot. In the case of the diabetic foot, the diabetic polyneuropathy is in the foreground. It impairs the supply of the foot, so that the slightest injury there results in massive wound healing problems. Initially, the polyneuropathy leads to muscle paralysis in the foot musculature, which causes poor posture of the foot. Due to the incorrect stresses, the bony foundation of the metatarsus constantly sinks. Initially, larger corneal layers develop, which over time lead to tears in the skin. However, these wounds are often not noticed by the affected person because they do not feel any pain due to the restricted nerve functions. Unnoticed, poorly healing wounds can then result, sometimes even leading to necrosis of the foot in the long term. In extreme cases, even amputation of the affected foot is necessary.
When should you go to the doctor?
If there is pain in the limbs and muscles, cramps in the calves, or insensitivity, there may be an underlying neuropathy. Medical advice is needed if these symptoms persist over a long period of time or rapidly become more severe. If no clear cause can be assigned to the symptoms, a doctor must be consulted. Twitching or sensory disturbances indicate an advanced neuropathy and should be clarified quickly. If in doubt, the sufferer must be taken to a hospital, where a physical examination is performed and the condition diagnosed and treated. Risk groups include people with chronic infections, kidney damage or a long-term nutrient deficiency. Diabetes-mellitus patients as well as people suffering from a tumor or who have come into contact with a nerve toxin must also definitely speak to the responsible physician in the case of the aforementioned complaints. In addition to the family doctor, neuropathy is treated by various internists as well as dermatologists, nephrologists and other specialists. Severe diseases require in any case an inpatient therapy in a specialized clinic.
Treatment and therapy
For the therapy of neuropathies: depending on the pattern of affection, a distinction is made between mononeuropathy, polyneuropathy, autonomic neuropathy, mononeuritis multiplex, and radical neuropathies. And according to the pattern of affection, the basic disease, the therapy depends. In congenital neuropathies, only symptomatic therapy is possible. If a bacterial infection is the cause, antibiotic therapy is given. In the case of toxic poisons, a cure can be achieved by omitting them. Natural remedies, homeopathic and alternative medical methods such as magnetic field therapies or acupuncture can also help. If the neuropathy is metabolic, such as due to diabetes, adjusting blood sugar levels with medication can help. Advanced neuropathies usually cannot be completely reversed, but can be well suppressed with painkillers, which are also effective against depression or epilepsy. Smoking and alcohol should be avoided at all costs. If paralysis occurs with muscle atrophy, physiotherapy with light strength training is a treatment method. Misalignments of the joints should be avoided. Careful massage and respiratory training can also do a lot. In advanced stages of the disease, patients have to consult with the doctor about which aids should be used, such as orthopedic shoes, rollator or wheelchair. In severe cases, patients may become bedridden. In that case, a nursing service should be engaged.
Outlook and prognosis
The prognosis of neuropathy depends on the present causes of the health disorder. In the case of a congenital disease, there is no prospect of cure. In a medical care, the individual pronounced symptoms are treated as best as possible.If therapy is started as early as possible, the best long-term successes are given. Nevertheless, relapse occurs as soon as the initiated medical measures are discontinued. If the cause of the neuropathy is bacterial, the pathogens are prevented from spreading and killed by administering medication. Subsequently, the organism can remove and eliminate the germs on its own. There is a gradual improvement in the health situation until freedom from symptoms can be documented. With many patients a relief of the complaints can be observed likewise by the recourse to alternative welfare methods. In the field of natural healing methods, there are various approaches that have proven successful in the past. However, this must be evaluated based on the overall situation at hand. If the causes of the disorder are due to an irregularity of the metabolism, drug treatment can lead to a significant improvement in health. In addition, the lifestyle should be optimized so that complaints are reduced. If a severe neuropathy is present, the affected person requires daily care and support in managing everyday life.
Prevention
Prophylaxis: What works preventively are moderate exercise, a healthy diet, and adjustment of blood glucose if needed due to a pathological change. Especially if a family disposition is recognizable, one should be careful with nerve toxins such as alcohol and medications. Diabetes patients need to be especially careful and check their blood glucose levels promptly.
Follow-up
In most cases, there are very few and usually very limited aftercare measures available to the affected person with neuropathy. For this reason, the affected person should see a physician at an early stage to prevent and also limit the occurrence of other complications. The earlier a doctor is contacted, the better the further course of the disease usually is. Therefore, a doctor should be consulted already at the first symptoms and signs of this disease. Most patients with this disease are dependent on taking various medications to permanently alleviate the symptoms. Patients should always make sure that they take their medication regularly and that they take the prescribed dosage. In case of side effects or uncertainties, a doctor should be consulted first. Physiotherapy measures are also often necessary to alleviate the symptoms. Here, many of the exercises can also be performed at home, which could accelerate the treatment. The affected person should avoid alcohol and smoking as much as possible. Possibly, the life expectancy is also limited due to the neuropathy.
What you can do yourself
In the case of nerve damage, the causes are extremely varied. The most effective way of self-help here is a mindful, healthy lifestyle. Everything that literally “gets on your nerves” should be avoided. This includes, in particular, smoking and excessive consumption of alcohol. There are alternatives to medicinal pain therapy. For example, impressive results have been achieved with electrical, transcutaneous stimulation of the nerves (TENS). Blood sugar and blood pressure values should be checked regularly, as an optimal setting is extremely important in polyneuropathy. It may also be possible to lower them naturally through diet. Diabetics are advised to have regular professional foot care – and to examine their feet themselves daily with a small mirror. Those suffering from “multi-nerve disease” should wear shoes that are safe to walk in, have a good footbed, and protect against injury. Sports that put a strain on the foot, such as running, jogging or playing tennis, are not recommended. Better suited sports for all patients with neuropathy are cycling or swimming. Due to the prevalence of neuropathy, there are many support groups where patients can find advice and support.
