peripheral neuropathy: Definition: Damage to the messenger and messenger nerves to the spinal cord and brain that are outside the central nervous system (brain and spinal cord).
A wide range of diseases are included in this group, from the damage of one nerve such as carpal tunnel syndrome to the involvement of all peripheral nerves in diseases such as diabetes.
Peripheral neuropathy can be divided based on local involvement of one nerve (mononeuropathy) or involvement of a set of nerves (polyneuropathy).
Mononeuropathy : Reasons : Various things such as trauma or long-term pressure on a nerve after being in one position, for example sitting for a long time or doing repetitive movements that put intermittent pressure on the nerve, such as typing for a long time, can cause this type of neuropathy. One of mononeuropathy The most common causes are hand nerve canal stenosis (CTS).
Symptoms : Depending on whether the damaged nerve is sensory or motor, there may be symptoms such as weakness in the muscle related to the involved nerve or a feeling of numbness, heaviness, tingling and numbness, a feeling of swelling or coldness in the area of the involved nerve.
Sometimes nerves related to internal organs such as the heart or blood vessels may be involved, which is called autonomic neuropathy, and symptoms such as excessive sweating or low blood pressure can be seen in this type of neuropathy.
Polyneuropathy: Involvement of a large number of peripheral nerves at the same time is called polyneuropathy.
Causes and factors such as :Vitamin B deficiency, excessive alcohol consumption, cancer, chronic kidney diseases, diabetes, etc. can cause this type of neuropathy. Chronic diabetes is one of the most common causes.
symptoms: Burning sensation, pain, murmur, loss of sensation in the limbs and may be seen.
Due to the loss of feeling of heat and cold and pain, the involved tissues are exposed to the risk of injuries such as burns and repeated traumas, and these injuries may lead to chronic wounds, which are very difficult and time-consuming to treat. For this reason, this group of patients must take great care of their organs and avoid being in situations where there is a possibility of injury, such as wearing tight shoes, being close to heat sources such as heaters, etc.
If nerves related to internal organs are involved, symptoms such as: constipation, diarrhea, urinary or sexual problems may be seen.
One of the most dangerous types of polyneuropathy is Guillain-Barre. In this disease, the immune system is activated against the peripheral nerves, and in an acute case, the person suffers paralysis of the organs, and due to the possibility of involvement of the nerves of the internal organs and disturbances in the rhythm of the heart and breathing, as well as blood pressure, they must be hospitalized. Fortunately, this disease can be cured in most cases by receiving appropriate treatment.
Diagnosis: After examining the history of the disease and physical examinations, in order to complete the diagnosis process, biochemical tests or nerve and muscle tapes and in some cases biopsy of the involved nerves or even extraction of cerebrospinal fluid may be considered for laboratory tests.
Treatment:1. Fixing the underlying cause such as vitamin deficiency or blood sugar control and in cases of mononeuropathy, avoiding harmful factors such as doing hard and repetitive work with hands or considering ergonomic rules to avoid injury are the first steps of treatment. Of course, it should be noted that in many cases, if treatment measures are not started faster and the disease process leads to serious damage to the nerves, other treatment measures will not have much result, because the repair capacity of the nerves is very low.
2. We can use different drugs to control unpleasant symptoms of neuropathy. Among these drug groups, tricyclics or anticonvulsants can be mentioned.
3. Some physiotherapy modalities such as TENS can also be effective in controlling symptoms.
4. Intervention treatments in refractory cases may be considered according to the cause of neuropathy. For example, injecting steroids in the wrist and carpal tunnel in median nerve entrapment, or injecting neurolytic drugs such as alcohol in neuropathic pain caused by visceral malignancies, or using radiofrequency (RF) to block sympathetic nerves in cases such as peripheral neuropathic pain or CRPS (chronic regional pain syndrome)
Author: Dr. Hossein Arjamand