The Peripheral neuropathy , Also known as peripheral neuritis, is a type of neurological pathology caused by the presence of damage or injury in The peripheral nerves (Pai, 2009).
This disorder, in its most frequent form, produces episodes of pain and numbness in the extremities, especially in the hands and feet. Likewise, the People with some form of peripheral neuropathy describe the presence of constant burning or tingling sensations in the affected areas (American Chronic Pain Association, 2016).
Peripheral neuropathies are a relatively common pathology and are associated with a wide variety of genetic and acquired causes: pathologies Nervous agents, toxic agents, traumatic injuries, mechanical nerve compression, bacterial and viral infections, autoimmune reactions, cancer, Nutritional deficiencies or diabetes, the latter being more frequent (Cleveland Clinic, 2016).
In the medical and experimental literature, more than 100 different types of peripheral neuropathies have been described, classified into different categories: Motor, sensory, autonomous, and finally mixed neuropathies (Johns Hopkins Medicine, 2016).
The diagnosis of neuropathies is based on the study of individual and family medical history, physical examination and neurological evaluation. Thus, some of the complementary tests include Electromyography , Assessment of nerve conduction velocity, nerve biopsy, puncture Lumbar, magnetic resonance, blood analysis, etc. (Foundation for Peripheral Neuropathy, 2016).
As for treatment, the essential aim of this is to control and improve the underlying symptoms. Pharmacological therapies are usually based on the Prescription of analgesic and anti-inflammatory drugs, antiepileptic medication, topical treatments and Antidepressants .
On the other hand, Intervention is beneficial through therapies such as electrical neurostimulation, plasma exchange and blood globulin, rehabilitation Physics and surgery (Mayo Clinic, 2016).
Characteristics of peripheral neuropathy
It is the term used to designate a series of disorders caused by a type of injury in the nervous system. Specifically, they are due to the presence of lesions in the peripheral nervous system (Johns Hopkins Medicine, 2016).
Classical neuroanatomic classifications divide our nervous system into two main systems, on the one hand, the central nervous system and, for Other side, the peripheral nervous system.
Specifically, the peripheral nervous system is made up of nerve ganglia, cranial nerves, and peripheral nerve branches (Waxman, 2010).
This system is responsible for connecting the nerve branches that are distributed from the brain and spinal cord Towards the rest of the body (arms, legs, Internal organs, skin, etc.), allowing bi-directional transmission of sensory and motor information (Foundation for Pheripheral Neuropathy, 2016).
Therefore, peripheral neuropathy develops when different events affect the nervous structure of the peripheral system. Depending on the Level of injury, we can distinguish the presence of a polyneuropathy (injury of multiple nerves) or a mononeuropathy (Injury of an individual nervous branch or an isolated nervous group) (Foundation for Pheripheral Neuropathy, 2016).
Apart from this, the clinical course of peripheral neuropathy will depend mainly on the type of nerve that is damaged (National Institute of Neurological Disorders and Stroke, 2016):
- Motor nerves: Are responsible for the control and transmission of voluntary motor information.
- Sensory nerves: Are responsible for the control and transmission of sensory experiences and perceptions.
- Autonomic nerves: Are responsible for the control and transmission of information related to non-conscious activities or processes or Involuntary
In this way, some neuropathies may predominantly affect one of these functional areas or several simultaneously, so we can distinguish Various types (Foundation for Peripheral Neuropathy, 2016):
- Motor neuropathy: Tissue or mechanical lesions affect the nerves located in the peripheral motor branches. In this case, Usually affect the nerves that control the production of speech or body movements, especially in the extremities.
- Sensory neuropathy: Tissue or mechanical lesions affect the nerve branches responsible for the transmission of information Sensorial In this case, it usually affects the sensorial thresholds and the transmission of information related to pain.
- Autonomic neuropathy: Tissue or mechanical lesions affect the nerve branches responsible for the transmission of information Biological awareness. In this case, it usually affects the control of breathing, gastrointestinal functions or heartbeats Cardiac disorders. It is one of the most serious and alarming forms of peripheral neuropathy.
- Mixed or Combined Neuropathy: In this case, tissue or mechanical lesions may affect nerves in different ways Peripherals. Thus, in most neuropathies, all or almost all functional branches of the peripheral nervous system are usually affected, giving rise to Wide patterns of sensory, motor and autonomic dysfunction deficits.
About us
Peripheral neuropathy is considered one of the most frequent or prevalent neurological disorders in the general population. Specifically, some Research has estimated a prevalence of approximately 2.4% worldwide (Scadding & Koltzenburg, 2007).
In addition, it has been pointed out that the prevalence of peripheral neuropathy reaches 8% in the population aged 55 years or more (Azhary et al., 2010).
Specifically, in the United States, there have been about 20 million cases of disorders and pathologies related to peripheral neuropathy (National Institute of Neurological Disorders and Stroke, 2016).
Common signs and symptoms
As we have pointed out above, all the nerve branches that make up the peripheral system perform a specific function, therefore, the signs And symptoms will depend, fundamentally, on the type of nerve or nerves that is affected (Mayo Clinic, 2016).
Thus, although sensory, motor or autonomic symptoms may differ, neuropathic pain is a common feature in most Cases of peripheral neuropathy.
Although, most of the pathologies that affect the peripheral nervous system, altering its normal and efficient functioning, do not usually cause Chronic pain, but Neurological symptoms Negative, in this case, especially in sensory neuropathies, it is possible to record the presence of Recurrent episodes of pain (Scadding & Koltzenburg, 2007).
In many of the definitions of neuropathic pain, reference is made to the presence of annoying or painful episodes associated with a nerve injury.
As a result, other medical complications may occur, such as dizziness, muscle weakness, loss of energy, to concentrate, drowsiness , Loss of appetite, feelings of depression , etc. (Scadding & Koltzenburg, 2007).
In addition, specifically, depending on the type of peripheral neuropathy, we can observe a wide variety of associated signs and symptoms (Johns Hopkins Medicine, 2016):
Motor Symptomatology
- Muscle hypotonia The abnormal reduction of muscle tone and consequent weakness are one of the most common findings.
- Spasms: The sudden and painful contractions of the muscles or a large group of these are frequent, in addition they can appear Also in the form of cramp.
- Muscular atrophy: The presence of other muscular symptoms such as hypotonia, spasms or contractures, can lead to a Reduction or decrease of muscle mass.
- Loss of balance and motor incoordination: The sensory symptomatology together with the motor, will give rise to a significant deficit Of the capacity of motor coordination (thin and thick) of the person affected. In addition, you may also have an unstable or uncontrollable balance.
Sensorial Symptomatology
- Paresthesias Affected people often describe the presence of numbness, tingling or cramping sensations in the Limbs and other body areas.
- Loss of sensitivity: A significant reduction in the perception of external stimuli (touch, temperature, Pain, etc.).
- Sharp pain: Recurrent episodes of neuropathic pain often occur, especially during times of relaxation or during sleep. It is one of the most serious symptoms related to the quality of life of the affected person.
Autonomic Symptomatology
- Abnormalities in sweating: In most cases, there is a Hypohydrosis . That is, a significant reduction in the volume of Sweating in the presence of stimuli that increase body temperature and activity. In turn, it can cause major medical complications Related to the skin and control of body temperature.
- Dizziness: Some people report feelings of instability, imbalance, confusion, blurred vision, or nausea. In most of the Cases, associated with the occurrence of episodes of neuropathic pain.
- Loss of consciousness: The presence of constant dizziness, associated symptoms, and other major medical complications, may Result in a temporary loss of consciousness.
- Gastrointestinal disorders: When lesions significantly affect the nerve branches that control the functions Gastrointestinal, it is possible to observe the presence of constipation, diarrhea, or urinary incontinence, among others.
Causes
Peripheral neuropathy may appear as a consequence of a wide variety of factors that cause damage or injury to the nerve branches Peripheral (Pai, 2009).
Specifically, there may be a direct degeneration of the nervous structure resulting from a primary pathology, or a consequence of medical conditions Secondary education (Pai, 2009).
Many of the aetiological causes identified are related to the presence of toxic agents, systemic diseases, drug consumption, Chemotherapeutic agents, trauma or mechanical injury, infectious processes, autoimmune reactions, genetic abnormalities and / or deficiencies Nutritional, among many others (Pai, 2009).
However, the most common is related to the condition of the diabetes . In the United States, more than 60% of people with diabetes Develop sooner or later some form of nerve damage with variable intensity (National Institute of Neurological Disorders and Stroke, 2016).
Diagnosis
A good part of the symptoms produced by peripheral neuropathy are identifiable at the clinical level, based on the medical history, physical examination and Neuropsychological evaluation.
However, the clinical course of this pathology may include an imprecise or unclear symptomatology, because of this, it is essential to use several Complementary tests (Johns Hopkins Medicine, 2016).
Classical diagnostic approaches may include: electromyography, nerve and / or skin biopsy, magnetic resonance imaging, blood or The extraction of cerebrospinal fluid (Johns Hopkins Medicine, 2016).
Thus, the basic procedure includes (Mayo Clinic, 2016):
- Complete medical history : In this phase, it is important to analyze the presentation and evolution of symptoms, exposure to factors Etiologic risk factors, lifestyle and / or family medical history associated with nerve pathologies.
- Neurological examination: Some of the aspects that are examined are strength, sensory ability, reflexes, postures, coordination Psychomotor, etc.
- Blood analysis: Are often used to detect the presence of vitamin deficiencies, impaired immune function or Diabetes.
- Image tests: Nuclear magnetic resonance or computerized axial tomography may be useful for the detection of Tumors or other structural pathologies.
- Analysis of nerve conduction: It is frequent to use tests that determine the conduction of the information through the fibers Nervous disorders in which an alteration is suspected.
- Nerve biopsy: Is based on the extraction of a reduced portion of nervous tissue to evaluate the presence of abnormalities Microscopically.
Treatment
Therapeutic interventions designed for peripheral neuropathy have two fundamental objectives: control of the etiological cause and improvement of The associated medical signs and symptoms (Azhary et al., 2010).
The elimination of the cause of the disease is often possible thanks to the control of exposure to toxic agents, the consumption of certain Drugs, nutritional supplementation, systemic disease control, or surgical approach to possible mechanical compressions (Azhary et al. 2010).
On the other hand, the symptomatological treatment is fundamentally based on the pharmacological prescription of analgesics, anti-inflammatories, anticonvulsants, Antidepressants , Narcotics, etc. (Azhary et al., 2010).
In addition, physical complications related to motor function often require physiotherapy. This allows for better control of the balance, Brand, or fine motor skills.
On the other hand, there are also other types of therapies and procedures, less employed, but also reporting important benefits in treatment Of peripheral neuropathy: transcutaneous electrical nerve stimulation, plasma globulin exchange or surgery.
Bibliography
- AAFP. (2010). Peripheral Neuropathy: Differential Diagnosis and Management. Retrieved from the American Academy of Family Physicians.
- ACPA. (2016). Peripheral Neuropathy. Retrieved from the American Chronic Pain Association.
- Cleveland Clinic. (2016). Peripheral Neuropathies. Obtained from Cleveland Clinic.
- FPN. (2016). What Is Peripheral Neuropathy. Retrieved from The Foundation for Peripheral Neuropathy.
- Johns Hopkins Medicine. (2016). Peripheral Neuropathy. Retrieved from Johns Hopkins Medicin.
- Mayo Clinic. (2016). Peripheral neuropathy. Obtained from Mayo Clinic.
- NIH. (2016). Neuropathy. Retrieved from the National Institute of Diabetes and Digestive and Kidney Disease.
- NIH. (2016). Peripheral Neuropathy Fact Sheet. Retrieved from the National Institute of Neurological Disorders and Stroke.
- Father, S. (2009). Peripheral Neuropathy.