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Questions
What is Peripheral Neuropathy?
There are over 500,000 people in Canada who suffer
from some form of neuropathy.
Common symptoms of Peripheral Neuropathy are:
numbness or insensitivity to pain or temperature
tingling, burning, or prickling.
sharp pains or cramps
extreme sensitivity to touch, even light touch
loss of balance or co-ordination
Peripheral Neuropathy can occur from a wide variety
of causes, the most common being diabetes mellitus. Other causes include
inflammation (chronic inflammatory demyelinating polyneuropathy (CIDP)) and
inflammation of blood vessels (vasculitis). In many parts of the world,
leprosy is a common and difficult disorder of peripheral nerves. Partial
peripheral nerve injury is associated with a pain syndrome that can be severe
and is known as "neuropathic pain". Its treatment requires different
approaches toward pain treatment. Many patients with Peripheral Neuropathy
can suffer from pain but very often feel that their family and friends do not
understand them since there is no visible and obvious disease.
The most common form of neuropathy is the distal
(e.g., lower extremities) symmetric (both sides) axonal (large
fiber) polyneuropathies (involving many nerves), whose etiologies or
causes are most frequently diabetes mellitus (1/3 to 1/2 frequency) and
alcoholism/nutritional/vitamin deficiencies (1/4 to 1/3 frequencies).
Other causes in order of frequency are: idiopathic, hereditary (usually sensory)
and medical diseases, such as; monoclonal protein disorder, metabolic and
endocrinal conditions (e.g., diabetes and hypothyroidism), connective tissues
(as with lupus and rheumatoid arthritis), infections (as with HIV or Lyme
disease), cancers and toxicities (more often prescription drugs than
environmental causes).
Early signs for these neuropathies are pain and
numbness in the feet, imbalance, sensory loss, hypoactive or absent ankle
reflexes, occasional weakness or wasting of foot, and later leg muscles.
Later signs would include sensory impairment slowly spreading up the lower legs
and on to the hands, in a stocking and glove distribution.
(Re-printed courtesy of Yolo County Peripheral
Neuropathy Support Group (Sacramento, California) from a video presentation by
Richard Olney, M.D., former UCSFMC Neurologist.
Click here to view power point images of the following: What
is Neuropathic Pain?
Neuropathic pain (NeP) is a type of chronic pain caused by injury or disease of
the nervous system that frequently results in a burning, tingling, numbness
and/or shock-like sensations. Nerve pain is often puzzling and frustrating
for people with NeP and can be a challenge to manage, as it seems to respond
poorly to standard pain therapies. It can also last indefinitely, may
escalate over time and can result in disability. Nerve pain can be so
extreme that some sufferers find that even the touch of clothing on their skin
will trigger an unbearable burning pain. Nerve pain is often
under-diagnosed and under-treated.
How the Disease Happens
Neuropathic pain most likely occurs after an injury
to some part of the nervous system. Changes in the nervous system very
likely occur as nerves attempt to heal or become persistently active after an
injury. Some injuries are associated with changes in the body's system for
detecting normal sensations. For example, some persons with neuropathic
pain have pain from a simple light touch on the skin. This is the result
of abnormal activity in the body's sensing mechanisms. These changes can
become persistent. (Source:
National Pain Foundation). Other
common symptoms of Neuropathic Pain include:
Allodynia - pain caused by something that is generally non-painful, such as;
light touch
Hyperesthesias - an exaggerated response to touch, such as; bed sheets
Hyperalgesia - an exaggerated painful response to something that is normally
painful
Hyperpathy - pain that persists even after the cause of pain has been removed
Parasthesias and dysesthesias - abnormal and unpleasant sensations that are
described as tingling and pins and needles. How would you know if you have
Peripheral Neuropathy? You may first notice numbness and tingling,
severe stabbing or burning pain in your feet. Some people feel as if they
have shoes or stockings on, even though their feet are completely bare. In
some neuropathies, these feelings can gradually spread to your legs and then to
your hands, but in others, the symptoms remain stable. You may find it
more difficult to walk; your legs feel heavy; you have to drag yourself up the
stairs and you lose your balance and your position sense. You are not
exactly sure where your feet are, you stumble into things, such as furniture and
you often fall. These falls can cause many injuries. In order to
keep your balance, you start to widen your gait – and this wide gait is very
characteristic of the disorder of Peripheral Neuropathy. You may
think you have a good grip on something, like your keys, but you notice that
they fall out of your hand without knowing it. In the worse of
cases, a person can end up in a wheelchair.
Why haven’t we heard more about Peripheral Neuropathy? Is it a new
disease?
No, Peripheral Neuropathy is not a new disease. It has
probably been around for many, many years. Over the years, many patients
have been told there is nothing that can be done for them and they will just
have to “live with it", or "it's all in your head". People who
suffer with the disorder have had nowhere to turn; they have felt isolated and
alone. Even families do not understand and start to doubt them.
Is Peripheral Neuropathy rare?
No, it is not rare. People think it is because its
extent and importance have not been recognized. On occasion the
disease has been misdiagnosed as some other disease, such as arthritis, or has
been thought to be merely a side effect of another disease, such as diabetes,
cancer or kidney failure. The development of new therapies has been slow
and under-funded.
How is Peripheral Neuropathy diagnosed?
Peripheral Neuropathy is often difficult to diagnose
because the symptoms are highly variable. A thorough neurological
examination is very often required and involves taking an extensive patient
history, performing tests that may identify the cause of neuropathic disorder
and conducting tests, such as, electromyography (EMG) and nerve conduction tests
(NCT) to determine the extent and type of nerve damage involved. What is
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)? 'chronic'
refers to the gradual course of the illness, often over a long period of time;
Chronic inflammatory demyelinating polyneuropathy
(CIDP) is a neurological disorder which is characterized by slowly progressive
weakness and sensory dysfunction of the legs and arms. The disorder is
caused by damage to the myelin sheath of the peripheral nerves. The myelin
sheath is a fatty covering which acts as an insulator on fibers in the nerves.
CIDP can occur at any age and in both genders; it is
not hereditary; is not infectious and it is not a psychiatric or 'nervous'
disorder. (Source: GBS Association of New South Wales).
Symptoms of CIDP include tingling or numbness in the
toes and fingers, aching pain in the muscles, weakness of the arms and legs,
loss of deep tendon reflexes, abnormal sensations and fatigue. CIDP
is somewhat related to acute Guillain-Barré Syndrome (GBS) and was once
considered the chronic counterpart of this acute disease.
Chronic Inflammatory Demyelinating Polyneuropathy
(CIDP) varies among individuals. There are some individuals who may have a
bout of CIDP followed by spontaneous recovery, while others may have many bouts
with partial recovery in between relapses. The disease is a treatable
cause of acquired neuropathy and initiation of early treatment is recommended to
prevent loss of nerve cells. However, some individuals are left with some
residual numbness or weakness. (Source: NINDS).
CIDP can be difficult to diagnose as there is no
conclusive diagnostic test for it. The diagnosis is made primarily on
clinical grounds not laboratory tests. (Source: GBS Association of
New South Wales).
What is IVIG Therapy?
IVIG is Intravenous Immunoglobulin therapy
prescribed by a doctor to treat a disease or condition. Physicians also
treat their patients with immunoglobulin therapy when more common drug
treatments are no longer effective, or when a patient experiences side effects
to a preferred drug regimen. The efficacy of using IVIG alone, or in
combination with other therapies for some diagnoses is still being explored.
(Source: NINDS).
IVIG therapy is prepared from human plasma and is
used either to replace a patient's antibodies, to restore the patient's current
network, to down-regulate the production of antibodies or to neutralize a
diseased pathway.
The following neurological conditions have been
treated with IVIG but not all of these diagnoses receive IVIG as the first line
of treatment:
Guillain-Barre syndrome (in children and adults)
Chronic Inflammatory Demyelinating Polyneuropathy
(CIDP)
Multifocal Motor Neuropathy
Myasthenia Gravis (including Lambert-Eaton syndrome)
Source: Coram Healthcare Database
Please note: Patients should discuss the benefit and prognosis of
the use of IVIG treatment for their individual needs with their physician. What
is Diabetic Neuropathy?
Diabetic neuropathy is a serious complication of
diabetes that affects millions of people every day. In fact, one in two
people with diabetes has this condition. Nerves damaged by diabetic
neuropathy can cause stinging or burning sensations, tingling, pain, numbness or
weakness in your feet or hands. You can be very sensitive to touch and
everyday activities can cause extreme pain. Diabetic Neuropathy puts you
at risk for foot injury, infection, even amputation. It is important that
you contact your healthcare provider if you are suffering from any of the above
symptoms. (Source: American Diabetes Association).
Canadian web address:
www.diabetes.ca
Prognosis of neuropathies
Some neuropathies can be cured if detected early
enough but as yet, there is no known cure for most neuropathies; however, they
can be helped. Pain can be greatly alleviated with the right medication
and patients can be made to feel much more comfortable. A patient's
quality of life can be improved but it is extremely important to be referred to
a neurologist as soon as symptoms are noticed and before the disease has a
chance to cause further sensory nerve damage
Treatment for CIDP includes corticosteroids, such
as; Prednisone, which maybe prescribed by itself or in combination with
immuno-suppressant drugs. Plasma exchange (plasmapheresis) and intravenous
immunoglobulin (IVIG) therapy are effective; IVIG maybe used even as a
first-line therapy. Physiotherapy may improve muscle strength, function
and mobility and may minimize the development of contracture.
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