Polyneuropathy in somatic diseases: the role of a neurologist in diagnosis and treatment

Polyneuropathy, or peripheral neuropathy, occurs as a result of damage to the peripheral nerves and often results in symptoms such as weakness, numbness and pain, usually in the arms and legs. But polyneuropathy can also affect other areas of the body. Peripheral neuropathy may develop in one nerve (mononeuropathy), two or more nerves in different areas, or may involve many nerves (polyneuropathy).

The peripheral nervous system transmits information from the brain and spinal cord (central nervous system) to the rest of the body. Peripheral neuropathy can result from traumatic injuries, infections, metabolic disorders, hereditary causes, and exposure to toxins. One of the most common causes of polyneuropathy is diabetes mellitus.

Patients with peripheral neuropathy typically describe pain as a tingling or burning sensation. In many cases, symptoms decrease if compensation occurs for the underlying disease.

Each nerve in the peripheral nervous system has a specific function, so symptoms depend on the type of nerve that is damaged. Nerves are divided into:

• Sensory nerves that receive sensations from the skin, such as temperature, pain, vibration, or pressure
• Motor (motor) nerves that control muscle movement
• Autonomic nerves that control functions such as blood pressure, heart rate, digestion, and bladder function

Information about polyneuropathy

The word "polyneuropathy" is translated from Greek as "damage to many nerves." This term very accurately describes the essence of the pathology. All structures of the body are entangled in a network of thin nerve fibers, which are divided into three groups:

• motor: responsible for motor functions;
• sensory: provide tissue sensitivity;
• Autonomous (vegetative): necessary for the unconscious regulation of the activity of certain structures, for example, blood vessels or internal organs.

Damage to certain fibers inevitably leads to disruption of their functions. The most common is mixed polyneuropathy of the lower extremities, in which symptoms of dysfunction of the sensory and motor nerves appear.

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Causes

Damage to peripheral nerves can occur due to the following conditions:

• diabetes mellitus: the most common cause of polyneuropathy, resulting from metabolic disorders in the myelin sheath of nerve fibers; mainly the lower extremities are affected;
• severe and prolonged deficiency of B vitamins necessary for the full functioning of the nervous system;
• infectious diseases: HIV, tick-borne borelliosis, leprosy;
• renal failure;
• alcohol abuse;
• acute and chronic intoxication, including drugs;
• autoimmune diseases: damage occurs against the background of a malfunction of the immune system; the most common are chronic and acute inflammatory polyneuropathy (Guillain-Barré syndrome);
• long stay in intensive care, for example, with extensive injuries or serious illness;
• exposure to ionizing radiation;
• pregnancy: carrying a child can cause vitamin deficiency and autoimmune lesions.

In addition, there are hereditary forms of the disease, transmitted from relatives, as well as idiopathic polyneuropathy, the cause of which cannot be determined.

To exclude paraneoplastic syndromes, oncological screening is performed:

• carefully examine the mammary glands (ultrasound and mammography);
• lungs (CT);
• gastrointestinal tract (endoscopic examinations are performed); Ultrasound of the abdominal cavity, pelvis, genital organs;
• if necessary, PET-CT.

It is necessary to understand that drawing up an examination plan is individual for each patient. The polyetiology and different mechanisms of development of the disease, the diversity of the clinical picture require a detailed and comprehensive examination, but despite this, it is still not always possible to identify the cause of the disease. In this case, the diagnosis of idiopathic polyneuropathy is established.

Kinds

Polyneuropathy is divided into several types depending on the type of fibers affected:

• sensory: the nerves that provide sensitivity are affected;
• motor: disturbances in the functioning of motor nerves are detected;
• motor-sensory: mixed form, in which motor disorders predominate;
• sensory-motor: mixed neuropathy, in which sensitivity disturbances are more pronounced;
• vegetative: first place comes to disturbances in the functioning of internal organs, changes in vascular tone and associated trophic disorders.

Significant differences in symptoms are noticeable only in the initial stages of the disease. Subsequently, all nerve fibers are involved in the pathological process, and the manifestations become mixed.

There are other types of classification of the disease:

• depending on the cause: alcoholic, diabetic, idiopathic, etc.;
• depending on the location of the lesion: polyneuropathy of the upper or lower extremities;
• depending on the type of course: acute, subacute, chronic;
• depending on the mechanism of occurrence: demyelinating (the sheath covering the nerve fibers is destroyed), axonal (formed by the death of nerve processes - axons), axonal-demyelinating.

Mechanism of occurrence

The exact mechanism of damage to nerve cells is unknown; it is assumed that the drug penetrates from the blood into the intercellular fluid, from there it diffuses into the cell, where it damages the protein tubulin and other proteins.

Each drug has its own “point of application” to tubulin: taxanes break up its microtubules, platinum derivatives denature it, vinca alkaloids are disassembled into components.

The process of protein damage by cytostatics in all cells is the same, its consequences are varied:

• degeneration of nerve processes - axonopathy;
• degenerative changes in neuron cell bodies—neuronopathy;
• destruction of the myelin sheath of the nerves - myelinopathy throughout or partially.

Symptoms

Symptoms of polyneuropathy depend on its cause and the characteristics of the damage to the fibers. The most common signs of pathology include:

• decreased sensitivity of the feet and palms, leading to the subjective sensation of wearing socks or gloves;
• pain in the affected limbs (sharp or dull, short-term or nagging, usually worse at rest and at night);
• spasms and twitching of muscle fibers;
• pain when touching the skin or pressing on the affected limb;
• decreased reflexes;
• increased sweating of the extremities;
• trophic disorders: swelling, changes in skin color and dryness, trophic ulcers;
• weakness of the muscles of the arms and legs, slight tremors;
• paresthesia: pathological sensations of crawling, burning, coldness;
• muscle atrophy;
• restless legs syndrome.

Alcoholic polyneuropathy

This form of the disease most often affects the lower extremities. It develops with prolonged uncontrolled consumption of alcoholic beverages and manifests itself primarily as a burning sensation and tingling sensation in the legs. With the further development of the pathology, the patient begins to feel numbness and muscle cramps, which develop due to the concomitant lack of B vitamins.

Diabetic polyneuropathy

Elevated sugar levels cause damage to the nerves of the feet (distal version) and the upper legs (proximal version). In the first case, a person experiences a characteristic set of symptoms:

• numbness and decreased pain sensitivity;
• periodic burning pain;
• muscle weakness;
• decreased reflexes;
• impaired coordination of movements, manifested by unsteadiness of gait.

The combination of polyneuropathy with damage to small vessels leads to the appearance of trophic ulcers in the lower part of the leg. The proximal version of the lesion is characterized by sharp pain in the buttock and upper thigh, as well as gradual muscle atrophy in this area.

Content:

1. Alcoholic polyneuropathy - what is it?
2. Why does the disease develop?
3. Stages of alcoholic polyneuropathy
4. Signs of the disease
5. Survey
6. Treatment of alcoholic polyneuropathy

By alcoholic polyneuropathy, doctors mean multiple damage to peripheral nerves.
The disease is caused by long-term intake of high doses of alcohol. It is characterized by weak muscles and decreased sensitivity of the limbs. The addict develops severe motor disorders, due to which he cannot normally control his own body and move around. Therapy for the disease is long-term - usually takes several months. Treatment must be in a hospital. It is impossible to get rid of the disease on your own.

Diagnostics

Diagnosis of polyneuropathy requires a comprehensive examination, which includes:

• survey: identifying patient complaints, clarifying the time and circumstances of the occurrence of each symptom;
• taking an anamnesis: recording all past diseases, injuries, intoxications, chronic pathologies, hereditary risk factors, etc.;
• neurological examination: assessment of skin and proprioceptive (spatial) sensitivity, motor function, muscle strength, quality of reflexes;
• consultations with specialized specialists: endocrinologist, narcologist, toxicologist, nephrologist, etc.;
• general urine test, general blood test, blood biochemistry (determination of glucose levels, lipid spectrum, vitamins and microelements, kidney function indicators and other parameters);
• blood test for HIV and other infections;
• genetic and immunological studies according to indications;
• Electroneuromyography allows you to identify lesions of nerve fibers and exclude other diseases with similar symptoms;
• biopsy of nerve and muscle tissue;
• lumbar puncture (examination of cerebrospinal fluid) to exclude neuroinfections;
• Doppler ultrasound of the vessels of the lower extremities.

The list of examinations can be adjusted depending on the form of polyneuropathy and concomitant pathology.

Treatment of polyneuropathy of the extremities

Treatment is aimed at eliminating the main cause of damage to nerve fibers, restoring their normal functioning, as well as eliminating symptoms that are unpleasant for the patient.

Depending on the cause of the disease, the following may be prescribed:

• drugs to correct blood sugar levels;
• antihistamines;
• immunoglobulins and glucocorticosteroids to eliminate inflammation and autoimmune damage;
• plasmapheresis and detoxification drugs;
• antibiotics for infections.

To restore nerve fibers, the following are used:

• B vitamins (milgamma, neuromultivit);
• drugs that improve blood circulation, metabolism and tissue regeneration: actovigin, cerebrolysin, berlition (especially effective for diabetes mellitus);
• angioprotectors: trental, pentoxifylline;
• means to enhance the conduction of nerve impulses to muscles: neuromidin.

Symptomatic therapy includes:

• non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, ketorolac), glucocorticosteroids (hydrocortisone, dexamethasone), analgesics (analgin, lidocaine) in the form of tablets, injections or local forms to relieve pain;
• anticonvulsants: tebantin, catena;
• antidepressants for chronic pain;
• sleeping pills according to indications.

Non-drug therapy is of great importance in the treatment of polyneuropathy. It includes:

• restorative and therapeutic massage to stimulate blood circulation in tissues, their nutrition and regeneration, as well as strengthen muscles;
• electrophoresis and phonophoresis with analgesics, B vitamins and other drugs (the use of electric current or ultrasonic waves facilitates the delivery of drugs to the affected area);
• electrical stimulation of muscles;
• magnetic therapy, UHF therapy, ultraviolet irradiation;
• darsonvalization: exposure to high frequency alternating current to improve metabolism and tissue regeneration;
• mud therapy: mud applications on the affected area;
• therapeutic baths with mineral waters or sea salt;
• physical therapy: dosed physical activity strengthens muscles and improves blood circulation in them; at an advanced stage of the disease, it is necessary to start with the easiest complex and gradually complicate it.
• classical acupuncture and electroacupuncture: stimulate the work of muscle tissue and nerve fibers;
• classes with an occupational therapist: necessary when it is not possible to fully restore the function of the limb; exercises are aimed at developing new movements adapted to the capabilities of the arm or leg.

For full treatment, a long-term complex effect on the affected area is required. Only if the patient thoroughly fulfills all the doctor’s instructions can success be achieved, but even in this case, full restoration of the functions of the nerve fibers is not guaranteed.

How to treat neuropathy

There is no point in looking for a cure for neuropathy on your own. This is a consequence, not a cause. The disease that caused it needs to be treated. In each specific case, its own therapy is prescribed. Therefore, you cannot do without the help of a doctor.

Vasoactive drugs and B vitamins will help maintain the condition, especially in cases of alcoholic or toxic damage. Means to improve blood circulation, restore fiber conductivity and light sedation will not be superfluous.

It’s a mistake to drown out sensations with painkillers. They only relieve discomfort, but do not cure. And the disease that has become the root cause of neuropathy remains unattended.

A healthy lifestyle is not an alternative to therapy. Changing your diet, quitting smoking and exercising are all helpful and will improve your overall well-being. But these measures are secondary and do not replace treatment.

Complex methods of treatment are used to treat polyneuropathy. In some cases, observation by a neurologist and several specialized specialists is necessary - for diabetes - an endocrinologist, for kidney pathology - a urologist, alcoholism - a narcologist.

Tricyclic antidepressants and anticonvulsants help reduce unpleasant painful sensations, convulsive contractions and a burning sensation. (Here we need a link not to Finlepsin, but to Gabapentin) With infectious causes of polyneuropathy, especially those caused by HIV infection, it is impossible to completely recover from the pathology, but with proper treatment of the underlying disease, its progression can be stopped.

Some patients with autoimmune, toxic or metabolic disorders are prescribed plasmapheresis. Blood purification allows you to get rid of substances that cause damage to nerve trunks. At the recovery stage, exercise therapy and physiotherapy are used: electrophoresis, magnetic therapy, laser therapy, acupuncture.

There is no need to put off visiting a neurologist. It is better to select adequate treatment as early as possible, get rid of unpleasant symptoms and prevent further negative effects on the body.

Complications

If you do not consult a doctor in time and do not eliminate the cause that caused the damage to the nerve fibers, neuropathy will steadily progress. Complications of the disease include:

• a significant decrease in muscle tone with subsequent muscle atrophy;
• loss of limb performance;
• development of extensive trophic ulcers requiring surgical intervention;
• loss of ability to move and self-care;
• chronic insomnia due to pain and the development of restless legs syndrome;
• depression and neuroses.

You can avoid complications if you consult a doctor for help in a timely manner and also follow preventive measures.

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Signs of the disease

It is impossible not to notice the development of polyneuropathy. As a rule, paresthesia appears first. The person realizes that his sensitivity has decreased significantly. From time to time his fingers go numb, he gets goose bumps all over his body, and an unpleasant tingling feeling occurs. The addict notices that he often “sits his leg” or “tracks his hand” in his sleep.

In the first stages, negative symptoms develop only if the patient is forced to remain in an uncomfortable position for a long time. Because of this, patients do not attach due importance to painful symptoms and do not worry about reduced sensitivity.

Gradually, negative signs appear more and more often. The severity of paresthesia increases. Temperature and pain sensitivity also decreases. My hands go numb all the time. There is a feeling as if they are wearing thick gloves, which makes it uncomfortable to touch objects. While walking, the addict feels as if he is walking on a soft, springy mattress.

The dangerous symptoms of polyneuropathy in alcoholism progress rapidly or slowly (over a year or longer). But the result that the disease leads to is the same - the inability to control one’s own body and do the simplest work.

Very often, paresthesia in addicts is combined with severe muscle weakness. It spreads in an upward direction. Sometimes numbness fades into the background and the alcoholic complains precisely of weakness and lethargy.

With polyneuropathy, the nerve limbs are affected in almost all patients, the upper ones - in about half. Even the development of general paralysis cannot be ruled out.

Prevention

Polyneuropathy is a condition that can be effectively prevented long before the first symptoms appear. To do this you need:

• visit a doctor in a timely manner and undergo comprehensive diagnostics in order to promptly identify and eliminate diseases that can cause damage to peripheral nerve fibers;
• eliminate bad habits: smoking and drinking alcohol, prevent toxins from entering the body;
• eat well, include a sufficient amount of macro- and microelements, vitamins in the diet; For the proper functioning of nervous tissue, polyunsaturated fatty acids, which are found in vegetable oils, olives, nuts, and fatty sea fish, are especially important;
• control blood sugar and cholesterol levels;
• provide the body with regular physical activity without striving for records (walking, swimming, cycling, etc.).

Literature:

1. Guide to neurology according to Adams and Victor: textbook. manual for the postgraduate system. prof. physician education / Maurice Victor, Allan H. Ropper; scientific ed. V. A. Parfenov; lane from English edited by N. N. Yakhno. — 7th ed. — Moscow: Med. information agency, 2006. - 677 p.
2. Peripheral nervous system in normal and pathological conditions: [educational manual] / N. S. Subbotina; Federal Agency for Education, State. higher educational institution prof. Education Petrozavodsk State univ. - Petrozavodsk: PetrSU Publishing House, 2006. - 129 p.
3. Classical neurology: a guide to the peripheral nervous system and chronic pain syndromes / Silantiev Konstantin. - Volgograd: Panorama, 2006 (Volzhsky: Alliance Yugpoligraphkombinat, Volzhsky polygraphkombinat). — 399 s

Treatment at the Energy of Health clinic

Neurologists at the Energy of Health clinic will provide assistance with any form of polyneuropathy. Specialists will conduct a full diagnosis to accurately identify the extent and location of the lesion, and then prescribe treatment and rehabilitation in accordance with the individual characteristics of the body. We use comprehensive methods that include:

• drug therapy in accordance with indications and modern recommendations for the treatment of polyneuropathy, including courses of infusions;
• various types of physiotherapy: magnetic therapy, laser and ultrasound exposure, phonophoresis and electrophoresis;
• physical therapy under the supervision of an experienced instructor, training in exercises to restore limb function at home;
• massotherapy;
• sessions with a psychotherapist if you have depression, insomnia, or increased anxiety;
• organization of sanatorium-resort treatment for complete rehabilitation.

Advantages of our clinic

The multidisciplinary clinic “Energy of Health” has experienced staff and the most modern equipment for diagnosing and treating various diseases. We provide each client with high quality medical services, which include:

• detailed examination to accurately determine the cause of complaints;
• consultations with narrow specialists directly in the clinic, as well as communication with foreign doctors if necessary;
• comprehensive treatment, selected in accordance with the indications and individual characteristics of the body;
• minor surgical operations directly in the clinic;
• own day hospital for maximum convenience;
• drawing up rehabilitation programs;
• affordable prices and services within the framework of voluntary health insurance.

Polyneuropathy is a dangerous complication of many conditions and diseases. You should not hope that the symptoms are limited to a simple tingling sensation; over time, the condition will worsen. Don’t delay seeing a doctor; sign up for a consultation with neurologists at the Energy of Health clinic.