What is Neuropathy
Weakness, numbness, and pain in limbs – Are you suffering from these symptoms, not knowing how to get rid of the reduced quality of life and having a big impact on functioning daily? Neuropathy, which collectively gives a clue about all those features, is defined as a pathology related to the peripheral nervous system, which includes nerve roots, nerves, and synapses as opposed to the central nervous system which consists of the brain and spinal cord.
Neuropathy can be an ultimate result of various underlying medical conditions and sometimes occur without any identifiable cause which will then be referred to as ‘idiopathic.’
The main focus of this article is to see what causes neuropathy other than diabetes; however, here we will be looking at neuropathy in more detail and covers,
1. Types of Neuropathy and Features
2. Causes of Neuropathy
3. Diagnosis and Treatment
Types of Neuropathy and Features
Sensory nerves regulate sensations in the body, and their irritation will result in:
- Tingling sensation and numbness in hands and feet.
- Pins and needles sensation
- Hypersensitivity
- Decreased pain threshold
- Impaired ability to detect changes in warmth and cold.
- Loss of co-ordination
- Loss of proprioception.
- Burning, stabbing, lancing, dull or shooting pains which normally exacerbate at night.
- Changes in hair, skin, and nails
- Ulcers of foot and legs, infection resulting in gangrene.
Motor nerves are responsible for the functioning of power and movement and any pathology will ultimately cause,
- Weakness of feet and hands
- Muscle wasting
- Muscle twitching and cramping
- Muscle paralysis
Autonomic nerves are responsible for regulating the sphincter and muscular activities in the bladder and gut and, any disturbance to their structure or function can give rise to,
- Increased metabolism (changes in heart rate and blood pressure)
- Dizziness and fainting attacks
- Reduction in sweating
- Bloating, constipation and Diarrhea
- Heat intolerance
- Bladder incontinence
- Impotence
A neuron structure
Depending on the number of nerve roots affected, neuropathy can be further categorized into,
- Mononeuropathy- single nerve is affected (postherpetic neuralgia, ulnar nerve palsy, carpal tunnel syndrome
- Polyneuropathy- several nerve roots are affected
What Causes Neuropathy Other Than Diabetes
1. B12 and folic acid deficiency
– This is a major cause of peripheral neuropathy which is often found in elderly people due to the poor intake and malabsorption of sufficient nutrients.
2. Drugs
– Chemotherapy and other pharmacological agents used to treat HIV/AIDS can cause damage to peripheral nerves.
3. Poisonous agents or toxins
– Pesticides, insecticides, and weedicides are the commonest toxins which can result in peripheral nerve damage and usually seen in farmers and workers in the related factories producing these agents.
4. Malignancies
– Lymphoma and Multiple Myeloma are two common malignant conditions which can end up in peripheral neuropathy.
5. Excessive intake of alcohol
– Long term usage of alcohol can result in nerve damage due to the contents of alcohol as well as due to the malabsorption of nutrients.
6. Chronic kidney disease
– Mal-regulation of salts, electrolytes, and chemicals can cause peripheral neuropathy.
7. Chronic liver disease
8. Injuries
– Bone fractures which are treated by the application of tight splints and plaster casts can apply a direct pressure on the nerves, which could potentially lead to nerve damage.
9. Infections
– Infections such as Shingles, HIV infection, and Lyme disease. Guillain-Barré syndrome a specific type of peripheral neuropathy triggered by an infection.
10. Connective tissue diseases
– Rheumatoid arthritis, Sjögren’s syndrome, and systemic lupus erythematosus
11. Inflammatory diseases
– Diseases like Sarcoidosis and Coeliac disease
12. Hereditary diseases
– Diseases like Charcot-Marie-Tooth syndrome and Friedreich’s ataxia
13. Idiopathic peripheral neuropathy
– No identifiable condition
Micrograph showing peripheral neuropathy
Diagnosis
A complete history and thorough physical examination can diagnose neuropathy in a clinically suspected individual; nerve conduction studies and electromyography will help in further confirmation. For some patients, nerve biopsy or skin biopsy will be used to find out the etiology.
Treatment
The mode of intervention for neuropathy depends on the type of impairment (whether single or multiple nerves are affected), the severity and underlying cause. In cases where the underlying etiology cannot be corrected, treatment will mainly focus on symptomatic pain relief and halting or reducing the disease progression.
For example, if the cause is toxins or drugs, they can be eliminated, or pharmacological medication can be reviewed and altered.
Drug therapy
- Gabapentin, Pregabalin, and Carbamazepine are anti-convulsant drugs which are usually used to treat neuropathy.
- Tri-cyclic antidepressants
- Opioid painkillers
- Anticholinergic/antispasmodic drugs
Image Courtesy:
“Nerve.nida” (Public Domain) via Commons Wikimedia
“Vasculitic neuropathy – plastics – low mag” By Nephron – Own work (CC BY-SA 3.0) via Commons Wikimedia
