An Easy Guide To Neuropathy

As regular readers of the blog will know; every now and then a general post about neuropathy and its causes and treatments will appear. These are all different and represent world wide views on neuropathy as a disease. They are simply written and easy to understand and are meant for new patients, or people coming into contact with neuropathy for the first time. Today's post comes from mdhil.com (see link below) and is written by an Indian doctor. The information is universally accepted as being true of neuropathy in general and can be seen as a starting point for further research into the disease. Other general articles about neuropathy can be found by scrolling down the alphabetical list to the right of the blog.

 Neuropathy – Causes, classification and treatment
December 6, 2012 By Dr Nisreen Nakhoda

Neuropathy is the medical term given to nerve damage in all the nerves of the body. It could be reversible or irreversible and generally the pain hampers the person from living a normal life.

Causes of neuropathy

The causes of neuropathy are varied and range from mild to serious.
The most common cause of nerve affliction or neuropathy is diabetes mellitus. If the blood sugar level of a diabetic patient is uncontrolled, chances of him/her developing peripheral neuropathy are high.

Injury to the nerves or prolonged pressure on a group of nerves can cause neuropathy, so also damage can result due to less blood supply to the nerves.

Systemic conditions like amyloidosis (abnormal protein deposits seen in various tissues of the body), rheumatoid arthritis, systemic lupus erythematoses and kidney failure can result in nerve damage.
Toxins and poisons like lead, mercury, arsenic and pesticides are some of the poisons which can lead to peripheral neuropathy.

Genetic or inherited conditions like Friedreich’s ataxia can cause nerve problems.

Drugs like vincristine used in chemotherapy and antibiotics like metronidazole have also been implicated.

Tumours, whether benign or malignant can invade the nerves or put pressure on them leading to neuropathy.

Lastly, many cases of neuropathy are idiopathic, that means no cause can be identified.

Classification of neuropathy

Neuropathy can be classified as acute, sub-acute or chronic depending on the duration of the problem.

Another way is to classify them depending on the location of the nerves involved.

Cranial neuropathy – involves any of the twelve cranial nerves coming out from the brain.

Peripheral neuropathy – this term is used for nerve problems outside the brain and spinal cord. It refers to nerves in the shoulders, entire upper and lower limbs and also hips.

Autonomic neuropathy – the autonomic nerves are those around the heart, lungs, liver and other involuntary organs. When these nerves are damaged, it is known as autonomic neuropathy.

Focal neuropathy – this refers to nerves from only one area of the body.
Symptoms and signs of neuropathy

These are characteristic and not related to the cause of neuropathy.
Damage to sensory nerves (nerves carrying receptors of taste, touch, smell, vision and hearing) cause loss of pain sensation and is common in the feet of those suffering from diabetics.

Damage to motor nerves (nerves connected to muscles and ligaments) leads to gait abnormalities, loss of reflexes, weakness in limbs and cramps.

Damage to autonomic nerves (supplying internal organs) leads to constipation, bloating of the abdomen, dizziness, intolerance to heat, blurred vision, impotence and urinary symptoms.

Diagnosis of neuropathy

If you experience any of the above symptoms or are a diabetic, visit your doctor who will take a complete history. This includes family history, history of recent surgeries and exposure to poisons. A complete general and neurological examination should be done to check sensory and motor nerves.
Investigations to diagnose neuropathy

Depending on the cause, several investigations are prescribed. Routine tests like CBC, ESR, liver and kidney function tests, urine and stool analysis and tests to detect HIV, rheumatoid factor and tumour markers are done in certain cases.

Nerve conduction velocity test is done to determine nerve function. This is a simple test and can be done in the clinic. It measures the rate at which a signal travels through the nerve.

EMG or electromyogram is also important as it gives an indicator of nerve function. A thin needle is inserted into a muscle and an electrode within the needle measures muscle activity.

In some cases, a nerve biopsy may be required to reach a diagnosis.
Treatment of neuropathy

The treatment of the cause is important. Nutritional deficiencies must be corrected, alcoholics should be advised to abstain from alcohol and exposure to poisons should be avoided.

If there is pressure on the nerve due to a tumour, surgery to remove the latter should be done soon.

Drugs:

Drugs for pain relief should be prescribed. Simple analgesics like ibuprofen and paracetamol are ineffective in controlling nerve pain. Many types of drugs are used to relieve pain. They include:
Anti-convulsants like lamotrigine, carbamazepine and gabapentin.
Anti-depressants like imipramine, amitriptyline, paroxetine and duloxetine
Opioid analgesics like tramadol

Others: Topical creams containing capsicain (a natural substance forund in bell peppers) or lignocaine help. Antioxidants like alpha-lipoic acid are effective in diabetes.

TENS is a short form for trans-cutaneous electrical nerve stimulation and is used when drugs become ineffective. It is useful for diabetics.

Prevention of neuropathy

Diabetics should go for regular check-up and check their feet for injuries and sores every day. Avoid wearing tight socks and ill-fitting shoes.
Persons working in industries should avoid exposure to poisonous substances.
Inherited conditions causing neuropathy cannot be prevented.
Long term glucose control for diabetics is a must.Written by Dr Nisreen Nakhoda, General Physician

http://www.mdhil.com/neuropathy-causes-classification-and-treatment/