Polyneuropathy (PNP) is a disease in which the peripheral nervous system is affected. This pathology is characterized by trophic and vegetovascular disorders, impaired sensitivity and paralysis. As a rule, localization of lesions is concentrated distally, however, it can also spread proximally. However, the favorite localization of full neuropathy is the lower extremities, which are affected symmetrically.
Looking ahead, it should be noted that polyneuropathy is not an independent disease, as a rule, it is a complication of other conditions, the causes of which are outside the nervous system. Classification is closely intertwined with the etiology of the disease. There are the following reasons:
- autoimmune processes such as Guillain-Barré syndrome;
- heredity, namely Charcot-Marie-Tooth disease;
- somatic diseases: diabetes mellitus;
- intoxication with alcohol, heavy metals;
- taking medications, such as metronidazole;
- HIV infection;
- tick-borne borreliosis;
- cytomegalovirus infection.
Manifestations of neuropathy are divided into three types depending on pathomorphology:
The main motor disorder in polyneuropathies is flaccid paresis, characterized by a decrease in trophism and muscle tone. As a rule, the lower extremities are affected, but then the process can affect the respiratory and cranial muscles. Develops muscle weakness and atrophy of the extensors of the foot. This explains the cock-like gait characteristic of such patients. When walking, the patient tries to raise his legs as high as possible so as not to touch the floor with his fingers.
Pain – the main symptom of polyneuropathy, is formed as a result of damage to the nerve fiber. The so-called neuropathic pain has a pronounced persistent, burning, itching, shooting and penetrating character, and is highly resistant to analgesics. Pain in polyneuropathies is accompanied by hyperpathy, allodynia, dysesthesia.
The polyneuropathic type of sensitivity disorders means that all types of sensitivity in this disease, one way or another, are involved in the process. Anesthesia or hypoesthesia of temperature and pain sensitivity occurs in the form of “socks” and “gloves”. Deep sensitivity is reduced, as a result, sensitive ataxia occurs and is manifested by instability when standing and walking. There is also a loss of joint-muscular feeling.
This disease is characterized by various kinds of paresthesia, it will manifest itself as a subjective sensation of numbness, tingling, crawling.
These manifestations will include a wide range of symptoms associated with trophic and vascular disorders. For example, thinning and peeling of the skin on the foot, which becomes purple-bluish in color, swollen, with many microtraumas resulting from loss of sensitivity. Toenails become brittle, dull.
Treatment of polyneuropathy
Treatment of a disease such as polyneuropathy should include at least three areas, namely:
Etiological treatment – Its goal is to fight the causes of the disease. Since polyneuropathy is usually indirect, without the elimination of the underlying disease, or its transfer to remission, the treatment of polyneuropathy will not give positive and lasting results.
Do not forget that each type of PNP has its own reasons, for example, polyneuropathy that has arisen against the background of intoxication with salts of heavy metals, as well as alcohol, requires the elimination of toxic substances entering the body. The main condition for stabilization, regression, and prevention of diabetic neuropathy is the normalization of blood sugar levels. In the case of PNP against the background of infectious processes of diphtheria, tick-borne borreliosis, HIV infection, the main task will be the treatment of the underlying disease. Damage to the nerve trunks in oncology, especially those with malignant growth, rarely regresses.
Symptomatic therapy – provides for the elimination or reduction of pain syndrome, for this, in practice, the following are used:
- first-line drugs are the second-generation anticonvulsants gabapentin and pregabalin,
- second-line drugs – tricyclic antidepressants – amitriptyline and serotonin and norepinephrine reuptake inhibitors – duloxetine,
- local anesthetics, for example, a transdermal therapeutic system – a patch with 5% lidocaine (Versatis). This method is convenient for patients with a small area of pain distribution.
Non-steroidal anti-inflammatory drugs in the elimination of pain in PNP are not used because of their inefficiency.
Pathogenetic therapy is aimed at restoring the function of the affected nerves with the help of:
- drugs that improve blood microcirculation in the area of nerve fibers: trintal, vasonite, pentoxifylline,
- drugs that restore cellular metabolism – mildronate, piracetam,
- antioxidants – alpha lipoic acid,
- hormone therapy – methylprednisolone.
Pathogenetic treatment is usually carried out in long courses and is not always accompanied by a rapid improvement.
A wide range of B vitamins are used in the treatment of PNP – preparations B1, B6, B12.
As rehabilitation measures, which will be aimed at maintaining the tone of the muscles of the lower extremities, improving blood circulation, physiotherapy procedures are used, as a rule, these are electrophoresis and magnetotherapy.
Among other things, other methods of restorative medicine are used:
- paraffin therapy;
- exercise therapy.
Diagnosis and treatment of polyneuropathy is a difficult task and requires close interaction of a neurologist with doctors of other specialties – general practitioners, endocrinologists, oncologists, rheumatologists, hematologists. The task is further complicated by the fact that in most cases polyneuropathy is not an independent disease, but a complication of other conditions.