Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body. When the peripheral nerves are damaged it is usually because the nerves are either traumatized, diseased or as a side effect of systemic illness. Peripheral neuropathy is a common symptom of many genetic diseases, metabolic/endocrine disorders; toxicity; inflammatory diseases; vitamin disorders and some cancers.
Impaired function and symptoms depend on the type of nerves i.e. motor, sensory, or autonomic. Both motor and sensory disturbance may be present and the symptoms range from mild to severe. Peripheral neuropathies can either be generalized and symmetrical; focal and multi-focal. Peripheral neuropathy may involve damage to a single nerve or nerve group (mononeuropathy) or may affect multiple nerves (polyneuropathy). Metabolic diseases such as: diabetes, renal failure; deficiency syndromes such as malnutrition and alcoholism, or the effects of toxins or drugs can all cause derangement of the neurones resulting in distal axonpathies. The symptoms depend on which type of nerve is affected.
The three main types of nerves are sensory, motor, and autonomic. Neuropathy can affect any one or a combination of all three types of nerves. Symptoms also depend on whether the condition affects the whole body or just one nerve (as from an injury).
Sensory symptoms vary and are divided into sensory loss and sensory gain. With sensory loss there may be numbness, tremor, and/or gait imbalance. Sensory gain includes symptoms like tingling, burning (especially at night) pain, itching, crawling, pins and needles and an inability to determine joint position, which causes inco-ordination. For many neuropathies, sensation changes often begin in the feet and progress toward the center of the body with involvement of other areas as the condition worsens. In some cases skin becomes so hypersensitive that patients are prohibited from having anything touch certain parts of their body, especially the feet. The very touch of the bed sheets, socks or shoe are unbearable and eventually the person becomes housebound.
Gains and loses in motor function are also present. Loss of function (negative) symptoms includes leg weakness, loss of muscle bulk, tiredness, heaviness, and gait abnormalities. Symptoms representing gains in function (positive) are cramps, burning (at night) tremor, and fasciculation. Pain in the muscles (myalgia) and cramps are also present. When the autonomic system is adversely affected then other symptoms may be present such as: blurred vision, decreased ability to perspire, dry skin, postural hypotension (low blood pressure), heat intolerance, upset digestion, urinary problems and impotence. The ankle jerk reflex is classically absent in peripheral neuropathy.
The symptoms of neuropathy maybe reduced but never reversed, through a balanced diet, drinking alcohol in moderation, and maintaining good control of diabetes (glucose levels) and other medical problems if present. But the outcome of treatments when available, depends on the cause, and can vary from excellent recovery to no change. In the case of a chronic inability to feel or notice injuries this can lead to infection and/or structural damage. Often co-moribund situations like poor healing, loss of tissue mass, tissue erosions, scarring, and deformity are also present.
The above does not constitute actual medical advice and if you think you have any of the above symptoms, or are a recently diagnosed Type II Diabetic and have not had a neuropathy assessment regardless of symptoms, then please consult you General Practitioner or foot physician at your earliest convenience.
Amin N & Doupis J 2016 Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities World J Diabetes.7(7): 153–164.
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