Polyneuropathy () is damage or disease affecting peripheral nerves (peripheral neuropathy) in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain.
Classification
Polyneuropathies may be classified in different ways, such as by
cause,
[ by presentation,][ or by classes of polyneuropathy, in terms of which part of the nerve cell is affected mainly: the axon, the myelin sheath, or the cell body.]
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Distal axonopathy, is the result of interrupted function of the peripheral nerves.
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Myelinopathy, is due to a loss of myelin or of the Schwann cells.
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Neuronopathy is the result of issues in the peripheral nervous system (PNS) neurons. They may be caused by motor neurone diseases, sensory neuronopathies, toxins, or autonomic dysfunction. Neurotoxicity such as chemotherapy agents may cause neuronopathies.
Signs and symptoms
Among the signs and symptoms of polyneuropathy, which can be divided (into sensory and hereditary) and are consistent with the following, are:[
]
Causes
The causes of polyneuropathy can be divided into hereditary and acquired and are therefore as follows:
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Inherited – hereditary motor neuropathies, Charcot–Marie–Tooth disease, and hereditary neuropathy with liability to pressure palsy
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Acquired – diabetes mellitus, Blood vessel neuropathy, alcohol use disorder, vitamin E deficiency, and vitamin B12 deficiency
Pathophysiology
The pathophysiology of polyneuropathy depends on the type. Chronic inflammatory demyelinating polyneuropathy, for instance, is an autoimmune disease: T cells involvement has been demonstrated, antibodies alone are not capable of demyelination.
Diagnosis
The diagnosis of polyneuropathy begins with a history (anamnesis) and physical examination to ascertain the pattern of the disease process (such as arms, legs, distal, proximal), if they fluctuate, and what deficits and pain are involved. If pain is a factor, determining where and how long it has been present is important; one also needs to know what disorders are present within the family and what diseases the person may have. Although diseases often are suggested by the physical examination and history alone, tests that may be employed include electrodiagnostic testing, serum protein electrophoresis, nerve conduction studies, urinalysis, serum creatine kinase (CK) and antibody testing; nerve biopsy is done sometimes.
Other tests may be used, especially tests for specific disorders associated with polyneuropathies; quality measures have been developed to diagnose patients with distal symmetrical polyneuropathy (DSP).
Differential diagnosis
In terms of the differential diagnosis for polyneuropathy, the following must be considered:
Treatment
In the treatment of polyneuropathies one must ascertain and manage the cause, among management activities are: weight decrease, use of a walking aid, and occupational therapist assistance. Additionally, BP control in those with diabetes is helpful, while intravenous immunoglobulin is used for multifocal motor neuropathy.[
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According to Lopate, et al., methylprednisolone is a viable treatment for chronic inflammatory demyelinative polyneuropathy (which can also be treated with intravenous immunoglobulin). The authors also indicate that prednisone has greater adverse effects in such treatment, as opposed to intermittent (high-doses) of the aforementioned medication.
According to Wu, et al., in critical illness polyneuropathy supportive and preventive therapy are important for the affected individual, as well as, avoiding (or limiting) corticosteroids.
See also
Further reading
External links
