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Polyneuropathy

polyneuropathy, polyneuropathy symptoms
Polyneuropathy poly- + neuro- + -pathy 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 pain1 It usually begins in the hands and feet and may progress to the arms and legs; and sometimes to other parts of the body where it may affect the autonomic nervous system It may be acute or chronic A number of different disorders may cause polyneuropathy, including diabetes and some types of Guillain–Barré syndrome234

Contents

  • 1 Classification
  • 2 Signs and symptoms
  • 3 Causes
  • 4 Pathophysiology
  • 5 Diagnosis
    • 51 Differential diagnosis
  • 6 Treatment
  • 7 See also
  • 8 References
  • 9 Further reading

Classificationedit

Polyneuropathies may be classified in different ways, such as by cause,5 by presentation,1 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 body67

Action potential propagation in myelinated neurons is faster than in unmyelinated neuronsleft
  • Distal axonopathy, is the result of interrupted function of the peripheral nerves8 It is the most common response of neurons to metabolic or toxic disturbances, and may be caused by metabolic diseases such as diabetes, kidney failure, connective tissue disease, deficiency syndromes such as malnutrition and alcoholism, or the effects of toxins or drugs such as chemotherapy They may be divided according to the type of axon affected large-fiber, small-fiber, or both, the most distal portions of axons are usually the first to degenerate, and axonal atrophy advances slowly toward the nerve's cell body, however if the cause is removed, regeneration is possible, although the prognosis depends on the duration and severity of the stimulusmedical citation needed People with distal axonopathies usually present with sensorimotor disturbances such as amyotrophic lateral sclerosis9
  • Myelinopathy, is due to a loss of myelin or of the Schwann cells10 This demyelination slows down or completely blocks the conduction of action potentials through the axon of the nerve cellneuraplaxia11 The most common cause is acute inflammatory demyelinating polyneuropathy AIDP, the most common form of Guillain–Barré syndrome12although other causes include chronic inflammatory demyelinating polyneuropathy 13
  • 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 Neurotoxins such as chemotherapy agents may cause neuronopathies14

Signs and symptomsedit

Among the signs/symptoms of polyneuropathy, which can be divided into sensory and hereditary and are consistent with the following:1

  • Sensory polyneuropathy - ataxia, numbness, muscle wasting and paraesthesiae
  • Hereditary polyneuropathy - scoliosis and hammer toes

Causesedit

The causes of polyneuropathy can be divided into hereditary and acquired and are therefore as follows:5

  • Inherited -are hereditary motor neuropathies, Charcot–Marie–Tooth disease, and hereditary neuropathy with liability to pressure palsy
  • Acquired -are diabetes mellitus, vascular neuropathy, alcohol abuse and B12 deficiency

Pathophysiologyedit

Human T Cell

In regards to the pathophysiology of polyneuropathy, of course, the former depends on which polyneuropathy For instance in the case of chronic inflammatory demyelinating polyneuropathy, one finds that it is a autoimmune disease Here, T cells involvement has been demonstrated, while in terms of demyelination, antibodies alone are not capable15

Diagnosisedit

Micrograph of a muscle biopsy

The diagnosis of polyneuropathies begins with a history 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 the pain 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 sometimes done116

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 DSP17

Differential diagnosisedit

In terms of the differential diagnosis for polyneuropathy one must look at the following:

  • Vitamin deficiency18
  • Diabetes mellitus18
  • Toxins18
  • Guillain–Barré syndrome18
  • Lyme disease18
  • Hepatitis C18
  • Amyloidosis18
  • Acromegaly18
  • Kidney failure19

Treatmentedit

Methylprednisolone

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 neuropathy1

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 medication120

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 21

See alsoedit

  • Neuropathy
  • Mononeuropathy
  • Polyradiculoneuropathy
  • Neuritis
  • Neuromuscular disease
  • Neuromuscular medicine
  • Hereditary neuropathy with liability to pressure palsy
  • Radial neuropathy

Referencesedit

  1. ^ a b c d e f "Polyneuropathies Medical information about polyneuropathy | Patient" Patient Retrieved 2016-07-17 
  2. ^ Richard A C Hughes 23 February 2002 "Clinical review: Peripheral neuropathy" British Medical Journal 324: 466–469 doi:101136/bmj3247335466 
  3. ^ Janet M Torpy; Jennifer L Kincaid; Richard M Glass 21 April 2010 "Patient page: Peripheral neuropathy" Journal of the American Medical Association 303 15: 1556 doi:101001/jama303151556 
  4. ^ "Peripheral neuropathy fact sheet" National Institute of Neurological Disorders and Stroke 19 September 2012 
  5. ^ a b MD, Dr Sara J Cuccurullo Physical Medicine and Rehabilitation Board Review, Third Edition Demos Medical Publishing p 434 ISBN 9781617052019 Retrieved 26 August 2016 
  6. ^ Rakel, David; Rakel, Robert E Textbook of Family Medicine Elsevier Health Sciences p 1026 ISBN 9780323313087 Retrieved 26 August 2016 
  7. ^ McCance, Kathryn L; Huether, Sue E Pathophysiology: The Biologic Basis for Disease in Adults and Children Elsevier Health Sciences p 635 ISBN 9780323316071 Retrieved 26 August 2016 
  8. ^ Perry, edited by Michael C 2007 The chemotherapy source book 4th ed Philadelphia, Pa: Lippincott Williams & Wilkins p 241 ISBN 9780781773287 Retrieved 26 August 2016 CS1 maint: Extra text: authors list link
  9. ^ Moloney, Elizabeth B; de Winter, Fred; Verhaagen, Joost 14 August 2014 "ALS as a distal axonopathy: molecular mechanisms affecting neuromuscular junction stability in the presymptomatic stages of the disease" Frontiers in Neuroscience 8 doi:103389/fnins201400252 Retrieved 26 August 2016 
  10. ^ Wardlaw, Graeme J Hankey, Joanna M; Wardlaw, Joanna M 2008 Clinical neurology London: Manson p 580 ISBN 9781840765182 Retrieved 26 August 2016 
  11. ^ Goodman, Catherine C; Fuller, Kenda S Pathology: Implications for the Physical Therapist Elsevier Health Sciences p 1597 ISBN 9780323266468 Retrieved 26 August 2016 
  12. ^ RESERVED, INSERM US14 -- ALL RIGHTS "Orphanet: Acute inflammatory demyelinating polyradiculoneuropathy" wwworphanet Retrieved 2016-08-26 
  13. ^ "Chronic Inflammatory Demyelinating Polyneuropathy CIDP Information Page: National Institute of Neurological Disorders and Stroke NINDS" wwwnindsnihgov Retrieved 2016-07-30 
  14. ^ Barohn, Richard J; Amato, Anthony A May 2013 "Pattern-Recognition Approach to Neuropathy and Neuronopathy" Neurologic Clinics 31 2: 343–361 ISSN 0733-8619 PMC 3922643  PMID 23642713 doi:101016/jncl201302001 
  15. ^ Mahdi-Rogers, Mohamed; Rajabally, Yusuf A 1 January 2010 "Overview of the pathogenesis and treatment of chronic inflammatory demyelinating polyneuropathy with intravenous immunoglobulins" Biologics : Targets & Therapy 4: 45–49 ISSN 1177-5475 PMC 2846143  PMID 20376173 
  16. ^ Burns, Ted M; Mauermann, Michelle L 15 February 2011 "The Evaluation of Polyneuropathies" Neurology 76 7 Supplement 2: S6–S13 ISSN 0028-3878 doi:101212/WNL0b013e31820c3622 Retrieved 26 August 2016 
  17. ^ England, John D; Franklin, Gary; Gjorvad, Gina; Swain-Eng, Rebecca; Brannagan, Thomas H; David, William S; Dubinsky, Richard M; Smith, Benn E 13 May 2014 "Quality improvement in neurology" Neurology 82 19: 1745–1748 ISSN 0028-3878 PMC 4032209  PMID 24696504 doi:101212/WNL0000000000000397 
  18. ^ a b c d e f g h "Polyneuropathy/differential diagnosis" BMJcom BMJ Best Practices Retrieved 26 August 2016 
  19. ^ Chronic renal failure, Medline Plus
  20. ^ Lopate, Glenn; Pestronk, Alan; Al-Lozi, Muhammad 1 February 2005 "Treatment of Chronic Inflammatory Demyelinating Polyneuropathy With High-Dose Intermittent Intravenous Methylprednisolone" Archives of Neurology 62 2: 249–54 ISSN 0003-9942 PMID 15710853 doi:101001/archneur622249 Retrieved 26 August 2016 
  21. ^ Zhou, Chunkui; Wu, Limin; Ni, Fengming; Ji, Wei; Wu, Jiang; Zhang, Hongliang 1 January 2014 "Critical illness polyneuropathy and myopathy: a systematic review" Neural Regeneration Research 9 1: 101–110 ISSN 1673-5374 PMC 4146320  PMID 25206749 doi:104103/1673-5374125337 

Further readingedit

  • Dimachkie, Mazen M; Barohn, Richard J 7 April 2013 "Chronic Inflammatory Demyelinating Polyneuropathy" Current Treatment Options in Neurology 15 3: 350–366 ISSN 1092-8480 PMC 3987657  PMID 23564314 doi:101007/s11940-013-0229-6 
  • Katirji, Bashar; Kaminski, Henry J; Ruff, Robert L Neuromuscular Disorders in Clinical Practice Springer Science & Business Media ISBN 9781461465676 Retrieved 26 August 2016 
  • Said, Professor Gérard 2014 Peripheral Neuropathy & Neuropathic Pain: Into The Light tfm Publishing Limited p 17 ISBN 9781910079027 Retrieved 3 August 2016 

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Polyneuropathy


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    29.10.2014


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