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By Prodyut Das

What is Neuropathy

by Prodyut Das
(New Delhi, India)

The word Neuropathy is derived from two words neuron and pathology. Neuron means- nerve cell(a cell that is specialized to conduct nerve impulses). Pathology means- any deviation from a healthy or normal condition.

On clinical context Neuropathy is commonly refered to as Peripheral Neuropathy. The term peripheral neuropathy designates a disturbance in function of one or more peripheral nerves. Several types of peripheral neuropathy are distinguishable by the extent of involvement. Depending upon the underlying cause, there may be selective involvement of motor, sensory, or autonomic fibers or more diffuse involvement of all fibers in the peripheral nerve.






Symptoms of Peripheral Neuropathy

Peripheral Neuropathy produces symptoms depending upon affected nerve. They can be sensory, autonomic or motor changes. The main symptom is the numb feet with tingling and can also cause weakness, coordination problems, pain, burning and invisible ‘glove-like’ sensation and abnormal heart rate, reduced sweating and sexual problems.

Classification of Peripheral Neuropathy

Peripheral neuropathy can be classified into more than 100 forms and produces different set of symptoms and have different prognosis. Motor, sensory and autonomic nerves damage can occur. If the motor nerves are affected then imbalance occurs in the coordination of walking, holding things and other voluntary muscle movements. Damage in sensory nerves results in the loss of sensations like touching or pain whereas autonomic nerves affect the involuntary nerves controlling vital organs.
Four types depending upon number of nerve damage and the nerve cells are autonomic neuropathy, mononeuropathy, mononeuritis multiplex and polyneuropathy. When only one nerve is affected then it is called as mononeuropathy. It can be caused by compression to the nerve, carpel tunnel syndrome or some infection and nerve inflammation causing tingling feet.

MONONEURITIS
Mononeuritis multiplex occurs when multiple nerves are damaged here and there in the body due to diabetes mellitus (diabetic neuropathy), Churg-Strauss syndrome, HIV, amyloidosis and rheumatoid arthritis. It is present with dull pain in legs and back mostly at night. Diabetics may have severe pain in thigh of either side with weakness and knee reflex absence.

POLYNEUROPATHY
Polyneuropathy affects nerve cells anywhere in the body irrespective of the nerve path. It can cause changes in axon, neurons cell bodies and myelin sheath surrounding axons. Distal axonopathy is the condition affecting only the axons with intact neurons. In sensory neuronopathy and motor neuron disease sensory and motor neurons are affected respectively. Polyneuropathy attacks organs on either side. It produces symptoms such as numb feet, burning, erectile dysfunction and imbalance in bladder function. This neuropathy treatment involves three steps. It starts with removing the cause, then strengthening muscles and their function and in the last pain relief by using neuropathy creams containing capsaicin.

AUTONOMIC NEUROPATHY
The fourth pattern in the peripheral type of neuropathy is the autonomic neuropathy causing alterations in the autonomic nervous system. It affects the non-involuntary nerves reaching urinary bladder, digestive system, sexual organs and heart. Chronic diabetes patients are more prone to this neuropathy. Autonomic neuropathy is present in combination with other neuropathies. It produces symptoms such as incontinence of urine, pain in abdomen with vomiting, diarrhea or constipation, tachycardia, hypotension and impotency.


Common Causes Of Neuropathy

It's not always easy to pinpoint the cause of peripheral neuropathy, because a number of factors can cause neuropathies. These factors include:

• Alcoholism Many alcoholics develop peripheral neuropathy because they make poor dietary choices, leading to vitamin deficiencies.


• Autoimmune diseases These include lupus, rheumatoid arthritis and Guillain-Barre syndrome.


• Diabetes When damage occurs to several nerves, the cause frequently is diabetes. At least half of all people with diabetes develop some type of neuropathy.


• Infections Certain viral or bacterial infections can cause peripheral neuropathy, including Lyme disease, shingles (varicella-zoster), Epstein-Barr, hepatitis C and HIV/AIDS.


• Exposure to poisons These may include some toxic substances, such as heavy metals, and certain medications — especially those used to treat cancer (chemotherapy).


• Inherited disorders Examples include Charcot-Marie-Tooth disease and amyloid polyneuropathy.


• Trauma or pressure on the nerve Traumas, such as motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from using a cast or crutches, spending a long time in an unnatural position or repeating a motion many times — such as typing.


• Tumors Growths can form directly on the nerves themselves, or tumors can exert pressure on surrounding nerves. Both cancerous (malignant) and noncancerous (benign) tumors can contribute to peripheral neuropathy.


• Vitamin deficiencies B vitamins — B-1, B-6 and B-12 — are particularly important to nerve health. Vitamin E and niacin also are crucial to nerve health.


• Other diseases Kidney disease, liver disease and an underactive thyroid (hypothyroidism) also can cause peripheral neuropathy.

Treatments for Peripheral Neuropathy

Effective prognosis and treatment of peripheral neuropathies relies heavily on the origin of the nerve damage. For example, peripheral neuropathies caused by vitamin deficiencies can often be halted -- even reversed -- with vitamin therapy and an improved diet. Likewise, nerve damage brought on by alcohol abuse can often be improved by avoiding alcohol. Peripheral neuropathies caused by toxic substances or medications can often be corrected in much the same way. When neuropathy is related to diabetes, careful monitoring of blood sugar levels may slow its progression and curb symptoms.

Early diagnosis and treatment of peripheral neuropathy is important, because the peripheral nerves have a limited capacity to regenerate, and treatment may only stop the progression -- not reverse damage. If you have become severely impaired, you may need physical therapy to help retain strength and avoid muscle cramping and spasms.

Surgical treatment may be recommended for people with nerve damage from injury or nerve compression. Mobility aids, such as a cane, walker, or wheelchair, may be helpful. For pain, your doctor may prescribe pain medication.

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