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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.
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
Neuropathy can affect any of these nerves, and the extent of its effect determines the symptoms that the individual experiences.
Neuropathy can be classified into different types, based on the number and distribution of the nerves it affects. The types of neuropathy include:
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.
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?
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:
In addition to these factors, mononeuritis multiplex is also caused by the following:
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;
The symptoms of sensory neuropathy could include the following
Symptoms of autonomic neuropathy are
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.
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:
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.
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:
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
Transcutaneous Electrical Nerve Stimulation (TENS) can be used to improve the function of sensory and motor nerves.
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.
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.
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