Peripheral Neuropathy Neuropathy or peripheral neuropathy is a medical condition due to damage to the peripheral nerve, which carry information
to and from the brain and spinal cord. On a grossly observable level, peripheral nerve damage manifests as the body's inability to communicate and control its muscles, skin, joints or other internal organs. The severity of the symptoms depend on how extensive the nerve damage. Symptoms can range from numbness, pain, inability to control muscles to loss of sensation, abnormalities in heart rate and blood pressure. It may result from traumatic injuries, infections, metabolic problems, exposure to toxins and diabetes. Let's talk about Nerves... Generally, the human nervous system is divided into the central nervous system (CNS), composed of the brain and spinal cord, and the peripheral nervous system (PNS), composed of your cranial nerves from the brain, spinal nerves from the spinal cord and its associated ganglia. The PNS is further subdivided according to its function, namely, the sensory (afferent) component which transmits signals towards the CNS for processing, and the motor (efferent) component which transmits signals integrated in the CNS to effector organs throughout the body to perform a specific action. Also under the motor component of the PNS are the somatic and autonomic nervous systems (ANS). Your somatic nervous system provides motor impulses to the skeletal muscles (i.e. most of the muscles which you can control voluntarily like your quadriceps, biceps etc) while your autonomic nervous system sends motor impulses to smooth muscles of your viscera (internal organs like your stomach, intestines etc), muscles of your heart and secretory cells of glands. On a cellular level, your nervous tissue (e.g. brain, spinal cord, peripheral nerves) are made up of neurons and neuroglial cells. Neurons are your cells responsible for receiving, integrating, and transmitting information (i.e. nerve impulses) to and from the central nervous system (i.e. brain and spinal cord). While your neuroglial cells protect and support the neurons. Your neurons are composed of the cell body or soma containing most of the cell organelles, dendrites and axons. Nerve impulses are received by the dendrites which are then transmitted to the soma and eventually to the axon which conducts the impulses away from the cell body and towards other neurons, or to effector cells such as muscles, or glands. The axons of peripheral nerves may or may not be covered by myelin sheath produced by some of the neuroglial cells. The myelin sheath serves to increase the conduction velocity of the nerve impulse thus increasing the transmission of information by several folds. Knowing the basic functional unit therefore of your nervous system, one can understand that any damage to any part of your nerve i.e. the axon, cell body, myelin sheath, or dendrites, will result to peripheral nerve dysfunction. Thus if motor nerves are damaged, this often leads to weakness, cramps, spasms, and paralysis. Whereas if sensory nerves are damaged, abnormal sensations may be felt (e.g. tingling, pain) or sensation may be lost (e.g. numbness). Also, if there is autonomic nerve damage, abnormalities in the organ or tissue function innervated by the involved nerve may be
observed e.g. abnormal blood pressure and heart rate, digestion problems etc. Peripheral neuropathy may involve damage to only a single nerve or nerve group i.e. neuropathy or it may involve multiple nerves i.e. polyneuropathy. What causes peripheral neuropathies? Numerous factors have been identified which cause peripheral neuropathy, which include: - Hereditary disorders including Charcot-Marie-Tooth disease, amyloid polyneuropathy, and Friedreich's ataxia - Systemic or metabolic disorders like diabetes (diabetic neuropathy), dietary deficiencies (e.g. Vitamin B12), excessive alcohol use (alcoholic neuropathy), uremia and cancer - Infections or inflammations like AIDS, hepatitis, diphtheria, Guillian-Barre syndrome, leprosy, lyme disease, rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, syphilis, amyloidosis etc - Exposure to toxic materials like heavy metals (e.g. lead, arsenic, mercury, etc), industrial agents, organophosphate pesticides, nitrous oxide and other toxic compounds - Neuropathy due to drugs - Trauma or pressure on the nerve like carpal tunnel syndrome, or compression due to tumore or abnormal growths - and other conditions like ischemia which a decrease in oxygen and blow flow, and prolonged exposure to cold temperatures Risk factors and Incidence of peripheral neuropathy Risk factors that predispose one to the development of peripheral neuropathy include diabetes, alcohol abuse, vitamin deficiencies, immunosuppression, autoimmune diseases (e.g. rheumatoid arthritis and lupus), and individuals with kidney, liver or thyroid disorders. The incidence of peripheral neuropathy is not determined precisely since the there are several types and causes of neuropathy and scientists have not arrived at a unified definition of neuropathy. However, peripheral neuropathy is a very common condition affecting approximately 1-4% of the population. Also, some individuals may have a hereditary predisposition to the development of peripheral neuropathy. Symptoms to look out for Symptoms vary greatly according to the type of nerve affected (i.e. motor, sensory, autonomic) and the severity of the nerve damage (i.e. mononeuropathy affecting a small segment of the body or polyneuropathy affecting a larger area of the body). Often, symptoms are greatest at night. Sensory nerve damage often present as changes in sensation (e.g. extreme sensitivity to touch), burning sensations, nerve pain, tingling or numbness, or incoordination due to inability to determine joint position. Often changes in sensation are progressive and usually start at the feet towards the center of the body as the condition worsens.
If there is motor nerve damage, it usually presents as muscle weakness, loss or lack of muscle control, bulk and dexterity, cramps, paralysis, muscle atrophy, muscle twitching and difficulty in breathing or swallowing. Lastly, autonomic nerve damage can cause blurred vision, decreased ability to sweat, dizziness or fainting associated to fall in blood pressure, decreased ability to regulate body temperature, nausea or vomiting after meals, abdominal bloating or distention, early satiety, diarrhea, constipation, unintentional weight loss of more than 5% of body weight, urinary incontinence, male impotence, urinary hesitancy, and feeling of incomplete bladder emptying. When should I seek medical advice? Early diagnosis and treatment is the best way in controlling your symptoms and preventing further progression of peripheral nerve damage. Do not hesitate to seek medical attention once you notice abnormalities in sensation and your motor and autonomic nerve functions (e.g. weakness, pain, numbness etc). Your physician will be able to suggest treatments that will help alleviate and cure your symptoms if they are detected early. What to expect from your physician... Since peripheral neuropathy is a symptom to many potential causes, your physician will have to take a complete medical history and perform a physical and neurologic examination to pinpoint the suspected cause of the disorder. He/she will check any abnormalities in your movement, sensation, or organ function by checking your tendon reflexes, muscle strength and tone, posture and coordination, and your ability to feel certain sensations. Blood tests, urinalysis, thyroid function tests, electromyography (to measure electrical discharges produced in your muscles and the velocity at which they carry electrical signals), and nerve biopsy to examine nerve abnormalities, may be requested by your physician to help narrow down the cause of your condition. Treatment Treatment is directed at identifying and treating the underlying medical problem and removing the cause. If the cause is corrected, the condition often improves on its own. Medications to relieve painful symptoms such as pain relievers, anti-seizure medications (e.g. gabapentin, topiramate, pregabalin, carbamazepine, pheynytoin), lidocaine patch ---a topical anesthetic---, and antidepressants (e.g. amitriptyline, nortriptyline, duloxetine) may be prescribed by your physician. Also, physical therapy, occupational therapy, and orthopedic interventions to retrain and increase muscle strength and control may be recommended. Complications to watch out for If left untreated, peripheral neuropathy may cause permanent loss of nerve function, tissue damage, and muscle atrophy. Pressure points with decreased sensation should be taken cared of since they are potential sources of injury and may lead to severe infections and structural damage if left untreated. Also, chronic pain may cause sleeplessness and a decrease in quality of life. They are also prone to developing depression.
Prevention Eating a balanced diet, drinking alcohol in moderation, control of diabetes by controlling blood sugar level, careful management of other medical conditions, and avoiding repetitive motions, cramped positions and toxic chemicals may help prevent from development of nerve damage.