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Peripheral Neuropathy: Symptoms, Causes, Risk Factors, Treatment And Prevention

Peripheral Neuropathy is a condition in which the peripheral nervous system of the body is damaged. It is responsible for the passage of signals between the central nervous system and other body parts like legs, arms, feet, internal organs and face.

The central nervous system includes the brain and the spinal cord. Peripheral nerves are present all over the body and are responsible to carry all the sensory information from the different body parts to the central nervous system and vice versa. When these nerves get damaged or malfunction, it results in peripheral neuropathy, a disorder in which the normal functioning of the nerves are hindered resulting in the loss or interruption of sensory signals [1] .

Sometimes, when only one nerve is damaged, the condition is called mononeuropathy while when the damage affects two or more nerves, it is called mononeuropathy multiplex.

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Symptoms Of Peripheral Neuropathy

The symptoms of peripheral neuropathy depend on the severity and type of nerve fibres affected. Sometimes, the symptoms develop in a few days, while in some cases it takes months or years to show. In fewer cases, the symptoms go without any treatment.

There are around 100 types of peripheral neuropathy and each has its own set of symptoms which vary by the types of nerves affected. If the damage is on the motor nerves, movement of the muscles are affected, if the sensory nerves are damaged, the sensory feelings like touch and pain get affected while when the autonomic nerves get affected, the harm is caused to the unconscious activities like breathing and gland functions.

Symptoms of peripheral neuropathy according to its types are as follows:

1. Motor neuropathy [2]

  • Uncontrollable muscle twitching
  • Loss of reflexes
  • Painful muscle cramps
  • Muscle shrinking
  • Body imbalance
  • Trouble while walking
  • Lack of coordination
  • Paralysis

2. Sensory neuropathy [3]

  • Sudden loss of sensation in the feet [4]
  • Tingling and numbness
  • Clumsiness
  • Burning sensation on the skin
  • Unable to feel things which are touched
  • No sensation of heat or cold

3. Autonomic neuropathy

  • Nausea
  • Abdominal bloating
  • Difficulty in urinating
  • Dizziness
  • Diarrhoea [5]
  • Constipations
  • Heat intolerance
  • Low blood sugar
  • Blurred vision

Causes Of Peripheral Neuropathy

Conditions that can cause peripheral neuropathy are as follows:

  • Hereditary: It includes nerve disorders like Charcot-Marie Tooth Disease and HNPP. [6]
  • Diabetes: A diabetic is more prone to peripheral neuropathy and the symptoms may range from mild to severe. [7]
  • Toxins: Exposure to heavy metals like lead, mercuric and arsenic may increase the toxins in the body leading to this nerve disorder. [8]
  • Autoimmune disorders: The condition is caused due to autoimmune disorders like Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. [9]
  • Vitamin imbalances: Deficiency of vitamin B12 and high amount of vitamin B6 in the body can cause peripheral neuropathy. [10]
  • Alcoholism: Consuming alcohol for a longer period with poor dietary choices can cause peripheral neuropathy. [11]
  • Infection: Viruses that cause chickenpox, shingles, herpes, West Nile infection and HIV can also cause peripheral neuropathy by damaging the central and peripheral nervous system. [12]
  • Rare diseases: Diseases which are rare in nature like amyloidosis, Tangier disease [13] , Fabry disease and neurofibromatosis can cause peripheral neuropathy.
  • Medication: Certain chemotherapy drugs are responsible for this nerve disorder. Also, the condition does not affect all people but only a few ones [14] .
  • Uraemia: It is a condition in which excess urea and creatinine are found in the blood due to kidney failure further leading to neuropathy [15] .
  • Tumour: Some tumours cause excess pressure to the nerves nearby and damage them directly or indirectly. This leads to the disorder of the nerves [16] .
  • Injury: Due to certain trauma or injuries, the nerves get pinched for a long time and cause neuropathy. This happens due to decreased poor blood supply to the nerves [17] .

Risk Factors Of Peripheral Neuropathy

Several conditions which can increase the risk of peripheral neuropathy are as follows:

  • Exposure to toxins [8]
  • Drug or alcohol abuse
  • Family history [6]
  • Deficiency of vitamin B
  • Kidney failure [15]
  • Infectious diseases like hepatitis, shingles and HIV
  • Diabetes
  • Autoimmune diseases like lupus
  • Injury to the brain [17]

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Complications Of Peripheral Neuropathy

A person with peripheral neuropathy may suffer the following complications if not treated early:

  • Infection: It happens due to a lack of sensation in injured body parts due to which the person unknowingly ignores any cut or wound in the area which later becomes infected.
  • Skin trauma: When a person is unable to feel hot or cold in certain body parts which later result in skin trauma [18] .
  • Uncertain falls: It takes place due to a loss of sensation caused by weakness and other factors.

Diagnosis Of Peripheral Neuropathy

Peripheral neuropathy has many causes due to which its diagnosis becomes quite difficult. However, its diagnosis is carried out by the following processes:

  • Medical history: It includes knowing the patient's family history, work structure, diseases and other related habits which may be responsible for triggering the condition.
  • Neurological tests: To identify the cause and type of nerve damage [19] .
  • Gene tests: To know the inherited conditions behind neuropathy.
  • Blood tests: To detect conditions like vitamin deficiency, metabolic disorders, kidney or liver problems, diabetes and other conditions responsible for neuropathy [1] .
  • Body fluid tests: To determine the abnormal cells or proteins or some immune-related neuropathies.
  • Electromyography: To determine any abnormal muscle and nerve disorders [20] .
  • Nerve conduction velocity: To detect which nerve is affected due to neuropathy.
  • Nerve biopsy: A detailed test to determine the exact nerve cells affected [21] .
  • MRI: To see the nerve compression in the affected area.
  • CT scan: To check for tumours or herniated disks responsible for neuropathy.

Treatment Of Peripheral Neuropathy

The treatment of peripheral neuropathy are as follows:

  • Over-the-counter medicines: Medications like acetaminophen and nonsteroidal anti-inflammatory drugs (like ibuprofen and naproxen) are useful in treating mild to moderate pain and inflammation caused due to the condition [22] .
  • Topical medications: Local anaesthetics and analgesics topical pain relievers like gels, creams, lotions and ointments are used to treat pain in a localized area. Such medicines are directly applied to the skin for instant relief.
  • Prescribed antidepressant medications: The medicines are prescribed when the above two methods are not effective in treating neuropathy. Antidepressant drugs like amitriptyline and duloxetine improve the quality of sleep and reduce pain simultaneously [23] .
  • Transcutaneous electronic nerve stimulation: The therapy is mainly for acute nerve pain in which small electrical signals are passed to painful nerves. It is used to prevent the signals of pain from the affected area to the brain [24] .
  • Alpha-2-adrenergic agonists: These are pain-relieving drugs which are prescribed when the nerve pain do not respond to the above-mentioned therapy and treatment methods.
  • Acupuncture: This is one of the alternative therapies for treating neuropathy. It helps in reducing pain by very thin needles which are punctured into the specific points [25] .
  • Biofeedback: It is a therapy in which we can self-monitor and manage our body's physiological responses. This helps in manipulating the body's functions to limit our activities to avoid neuropathy.
  • Exercise: This includes relaxation techniques like yoga, meditation, breathing exercises and massage to relieve worse pains.
  • Surgery: The treatment is effective to cure pain and complications in neuropathy by preventing amputation and curing the symptoms of tingling and numbness [26] .

Prevention Of Peripheral Neuropathy

  • Consume vitamin B rich diet.
  • Avoid long-term exposure to toxic chemicals. If you work in some chemical industries, wear protective gear [8] .
  • Stay active and exercise regularly.
  • Quit smoking
  • Take special care of your feet if you are a diabetic.
  • Get timely treatment to prevent infections.
View Article References
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  2. [2] Garg, N., Heard, R., Kiers, L., Gerraty, R., & Yiannikas, C. (2016). Multifocal Motor Neuropathy Presenting as Pseudodystonia. Movement disorders clinical practice, 4(1), 100–104. doi:10.1002/mdc3.12336
  3. [3] Bodman MA, Varacallo M. Diabetic Neuropathy. [Updated 2019 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
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