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Neuropathy

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Disease Awareness Page for R3 Stem Cell – Neuropathy

 

Neuropathy

What is it?

Neuropathy is a general term that is used to describe a disease affecting the nerves in the body. There are significant differences between neuropathy and other diseases that affect the nerves. First of all, neuropathy affects the peripheral nerves, meaning nerves outside the brain and spinal cord.

This is different from demyelinating conditions like multiple sclerosis (MS) that affects the nerves in the Central Nervous System (CNS). The other difference is that while CNS focused diseases like MS are autoimmune (caused by the body’s immune system attacking healthy tissues), neuropathy is often due to diseases like diabetes, trauma, or even excessive alcohol consumption.

What happens in neuropathy?

As mentioned earlier, neuropathy affects the peripheral nerves, and what happens is that the nerves are either damaged or destroyed, and this affects the way that they conduct impulses. Nerves are the connecting systems of the brain, and their jobs are to pass signals from one part of the body to another.

They carry sensory information (feelings like taste and touch, and pain) from the body to the brain, and they carry motor information from the brain to the body. These motor impulses are often in response to some sensory information. There are three types of peripheral nerves in the body

  • Sensory nerves
  • Motor nerves
  • Autonomic nerves. These are responsible for controlling the functions within the body. Their jobs revolve around dealing with things outside of conscious control, like breathing, and blood pressure and heart rate regulation.

Neuropathy can affect any of these nerves, and the extent of its effect determines the symptoms that the individual experiences.

Are there types of neuropathy?

Neuropathy can be classified into different types, based on the number and distribution of the nerves it affects. The types of neuropathy include:

  • Mononeuropathy: This kind of neuropathy affects a single nerve. The most common cause of this is compression or trauma. Examples of compression neuropathies are carpal tunnel syndrome and axillary nerve palsy.
  • Polyneuropathy: Polyneuropathy affects a large number of nerves and in more than one area of the body. Polyneuropathy does not conform to any specific orders when affecting the nerves.

For example, in one pattern called distal axonopathy, only the axons of the nerve are affected. In another, called demyelinating polyneuropathies, the myelin sheath of the nerves is affected. Polyneuropathies are usually caused by processes that affect the entire body, like diabetes.

  • Mononeuritis multiplex: It is also called mononeuritis multiplex, and is a situation in which at least two separate nerve trunks are affected. Both the motor and the sensory nerves of these nerve trunks are affected, and the damage is very random and asymmetrical. However, as it progresses, the patterns in the way it affects the nerves start to emerge. It is particularly painful and is caused by diseases like sarcoidosis and leprosy.
  • Autonomic neuropathy: This is polyneuropathy that affects the nerves of the autonomic nervous system, like the ones that supply internal organs like the bladder, cardiovascular system and digestive tract.

What is peripheral neuropathy

Technically speaking, all neuropathies are peripheral neuropathy, since neuropathy only affects the peripheral nerves. However, the phrase is sometimes used in opposition to diabetic neuropathy. The logic is that while diabetic neuropathy is caused by Diabetes Mellitus, peripheral neuropathy has other causes. However, besides their causes, there is no difference between them.

Distinguishing the types of neuropathy present in a person is important because of the causes. Factors like diabetes and excessive alcohol consumption are more likely to cause widespread neuropathy (polyneuropathy). On the other hand, mononeuropathy is more than likely to be caused by trauma or infection.


As mentioned earlier, this is usually polyneuropathic since the disease affects the entire body and not just one area. Even though diabetic neuropathy is a type of neuropathy, it is often considered and classified as a separate condition because of its distinct cause and accompanying symptoms.
What is Diabetic neuropathy?

What are the causes of neuropathy?

Both type 1 and type 2 diabetes mellitus can cause neuropathy, and the extent of nerve damage is proportional to diabetes.

There is also a multitude of diseases that have been shown to cause it, and as a result, it is difficult to narrow down a list. However, the causes can be broadly grouped like this:

  • Toxic causes: Drugs’ herbicides’ excess metals
  • Inflammatory diseases: Guillain-Barre syndrome, systemic lupus erythematosus
  • Metabolic diseases: diabetes mellitus, kidney failure, hypothyroidism
  • Vitamin deficiencies
  • Trauma
  • Exposure of chemotherapy
  • Alcoholism

In addition to these factors, mononeuritis multiplex is also caused by the following:

  • Immune-mediated diseases like systemic lupus erythematosus and rheumatoid arthritis
  • Infections like leprosy, Lyme disease, and HIV
  • Sarcoidosis
  • Exposure to chemical agents like dapsone

What are the symptoms of neuropathy

As discussed earlier, neuropathy can affect either a single nerve or a multitude of nerves. It can also affect motor nerves, sensory nerves, or the nerves of the autonomic nervous system. As a result, the symptoms vary, based on which types of nerves are affected.

The symptoms for motor neuropathy are;

  • Muscle weakness
  • Cramps
  • Muscle spasms
  • Loss of motor function

The symptoms of sensory neuropathy could include the following

  • Loss of coordination
  • Impaired sensation (tingling, numbness, pins and needles, and so on)
  • Reduction or exaggeration of reflexes

Symptoms of autonomic neuropathy are

  • Abnormal blood pressure or heart rate
  • Loss or impaired bladder and bowel control
  • Nausea and vomiting
  • Diarrhoea

These are only some of the symptoms of the condition, as they are often different from individual to individual. They can also be present in their multitude or be nonexistent in some individuals.

How common is it, and who is at risk?

Despite the numerous causes of neuropathy, about 30% to 40% of the cases are idiopathic, meaning the cause is unknown or can’t be determined. Research shows that about 40% of patients who have diabetes experience neuropathy. Another study showed that between 5 to 2,400 people in every 10,000 individuals have neuropathy. The disease is also known to be common in older populations, with the prevalence being higher in individuals over 40.

The risk factors include:

  • Diabetes
  • Alcohol abuse
  • Infections like the ones listed above
  • Autoimmune diseases like rheumatoid arthritis
  • Family history of neuropathy

How is neuropathy diagnosed?

Because neuropathy has a lot of possible causes, its diagnosis usually requires a full medical history, a neurological examination, as well as several lab tests. However, the symptoms are quite evident and easily noticeable, so diagnosing the disease is not as difficult as diagnosing others.

The history will assess things like symptoms, the lifestyle of the individual, possible exposure to infections and toxins, drinking habits, and family history of the condition.

The neurological examination is focused on assessing the symptoms, as they affect the motor and sensory nerves. The tests include checking for muscle control and strength, coordination, tendon reflexes and skin sensation are carried out.

Tests are also carried out to assess other aspects of the disease. For example, a blood test can reveal vitamin deficiencies, diabetes, as well as abnormalities in the immune system. Imaging tests can also reveal lesions, tumours and other abnormalities.

How is neuropathy treated?

The treatment of neuropathy begins with an accurate diagnosis. With that, the cause of the disease can be identified and resolved, or at least its progression can be slowed down. The following can help achieve this:

Medication

Besides treating infections and other causes, medication can also be used to relieve the symptoms. Analgesics, anti-depressants, and topical gels have all been shown to help manage the pain involved in neuropathy

Electrical stimulation

Transcutaneous Electrical Nerve Stimulation (TENS) can be used to improve the function of sensory and motor nerves.

Physical therapy

The muscle weakness and loss of coordination can be tackled with physiotherapy. Exercises that can strengthen the muscles and train coordination and other adaptations can be prescribed, as well as assistive devices like canes and wheelchairs to improve the quality of life of the individual.

Surgery

This approach is most useful in cases of mononeuropathies, where the impairment is caused by pressure from tumours and trauma.  A surgical procedure can help to reduce the pressure on the nerves.

 

Learn More about ongoing clinical studies sponsored by R3 Stem Cell HERE.

 

References

https://my.clevelandclinic.org/health/diseases/14737-neuropathy

https://www.emedicinehealth.com/neuropathy/article_em.htm

https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies

http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/five/000067367.htm

Campellone JV. “Mononeuritis multiplex”. MedlinePlus. Retrieved 24 March 2016.

Gilron I, Baron R, Jensen T (April 2015). “Neuropathic pain: principles of diagnosis and treatment”. Mayo Clinic Proceedings. 90 (4): 532–45.doi:10.1016/j.mayocp.2015.01.018. PMID 25841257

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5822644/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586108/

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