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NIH - NINDS Peripheral Neuropathy Information Page “Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body. More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves -- motor, sensory, or autonomic -- that are damaged. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired.”
NIH - Peripheral neuropathy (Medical Encyclopedia) “In some cases, the failure of nerves that control blood vessels, intestines, and other organs results in abnormal blood pressure, digestion problems, and loss of other basic body processes. Peripheral neuropathy may involve damage to a single nerve or nerve group (mononeuropathy) or may affect multiple nerves (polyneuropathy). There are numerous reasons for nerves to malfunction. In some cases, no cause can be identified. Damage to nerves can result from one of the specific conditions associated with neuropathy, including: • Hereditary disorders o Charcot-Marie-Tooth disease o Friedreich's ataxia • Systemic or metabolic disorders o Diabetes (diabetic neuropathy) o Dietary deficiencies (especially vitamin B-12) o Excessive alcohol use (alcoholic neuropathy) o Uremia (from kidney failure) o Cancer • Infectious or inflammatory conditions o AIDS o Hepatitis o Colorado tick fever o Diphtheria o Guillain-Barre syndrome o HIV infection without development of AIDS o Leprosy o Lyme disease o Polyarteritis nodosa o Rheumatoid arthritis o Sarcoidosis o Sjogren syndrome o Syphilis o Systemic lupus erythematosus o Amyloidosis • Exposure to toxic compounds o Sniffing glue or other toxic compounds o Nitrous oxide o Industrial agents -- especially solvents o Heavy metals (lead, arsenic, mercury, etc.) • Neuropathy secondary to drugs (many drugs can cause neuropathy) • Miscellaneous causes o Ischemia (decreased oxygen and blood flow) o Prolonged exposure to cold temperature “
NHS - Peripheral neuropathy “Causes of peripheral neuropathy Some people will inherit peripheral neuropathy, but it can also be acquired as a result of injury, disease, infection or an immune disorder: • Injury: Broken bones, slipped disks and injuries from sports, road accidents or falls can damage the peripheral nerves. • Disease: Diabetes mellitus often causes peripheral neuropathy because high blood sugar levels can damage nerves. Other diseases that can cause nerve damage are alcoholism, kidney disease, blood disease, malignant disease and vitamin deficiency. Some drugs may damage nerves. • Infection: Bacteria or viruses infecting the body can cause peripheral neuropathy. For example, HIV and the herpes varicella-zoster virus (which causes shingles and chickenpox) can attack nerve tissue, as can the bacteria that cause Lyme disease. • Immune disorder: This is where the body’s immune system attacks and damages the peripheral nerves (known as ‘autoimmune disease’). Guillain-Barre syndrome is a rare but serious autoimmune disease affecting these nerves. Charcot-Marie-Tooth disease is the name given to a set of inherited conditions that cause peripheral neuropathy.”
NIH - Autonomic neuropathy (Medical Encyclopedia) “Autonomic neuropathy is a group of symptoms caused by damage to nerves that regulate blood pressure, heart rate, bowel and bladder emptying, digestion, and other body functions. Causes: Autonomic neuropathy is a form of peripheral neuropathy. Autonomic neuropathy is a group of symptoms, not a specific disease. There are many causes. Autonomic neuropathy involves damage to the nerves that run through a part of the peripheral nervous system. The peripheral nervous system includes the nerves used for communication to and from the brain and spinal cord (central nervous system) and all other parts of the body, including the internal organs, muscles, skin, and blood vessels. Damage to the autonomic nerves causes abnormal or decreased function of the areas connected to the problem nerve. For example, damage to the nerves of the gastrointestinal tract makes it harder to move food during digestion (decreased gastric motility). Damage to the nerves supplying blood vessels causes problems with blood pressure and body temperature. Autonomic neuropathy is associated with the following: • Alcoholic neuropathy • Diabetic neuropathy • Parkinson's disease • Disorders involving sclerosis of tissues • Surgery or injury involving the nerves • Use of anticholinergic medications “Highlighted Articles
The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology (Brain 2008) “Small fibre neuropathy (SFN), a condition dominated by neuropathic pain, is frequently encountered in clinical practise either as prevalent manifestation of more diffuse neuropathy or distinct nosologic entity. Aetiology of SFN includes pre-diabetes status and immune-mediated diseases, though it remains frequently unknown. Due to their physiologic characteristics, small nerve fibres cannot be investigated by routine electrophysiological tests, making the diagnosis particularly difficult. Quantitative sensory testing (QST) to assess the psychophysical thresholds for cold and warm sensations and skin biopsy with quantification of somatic intraepidermal nerve fibres (IENF) have been used to determine the damage to small nerve fibres.”
Approach to the patient with chronic polyneuropathy (Acta Neurologica Scandinavica 2007) " Results – All patients should undergo a routine investigation for the most common causes of polyneuropathy by asking for diabetes, heredity, alcohol abuse, toxic medications and agents, symptoms of Sjögren's syndrome, renal failure, and the following laboratory tests; glucose, haemoglobin, leucocytes, thrombocytes, ESR, creatinin, ALAT, GT, vitamin B12, serum electrophoresis, TSH and thyroxin. If routine investigation is negative, a targeted approach based on clinical type and electrophysiological findings is recommended. The most common type with slowly progressive, symmetric sensory symptoms beginning in the feet can often be classified as cryptogenic without further investigation."
Diabetic neuropathy--a review. (Nat Clin Pract Neurol. 2007) "The vast majority of patients with clinical diabetic neuropathy have a distal symmetrical form of the disorder that progresses following a fiber-length-dependent pattern, with sensory and autonomic manifestations predominating. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients experience pain, trophic changes in the feet, and autonomic disturbances. Occasionally, patients with diabetes can develop focal and multifocal neuropathies that include cranial nerve involvement and limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, and mostly in patients with long-standing diabetes mellitus."
Neuropathies in the older patient (Reviews in Clinical Gerontology (2006/2007) ) "The elderly population is at higher risk of peripheral neuropathy, as there is a correlation between age and impairment of the peripheral nervous system. The natural aging process affects adversely the function of peripheral nerves and of their target organs, resulting in the development of motor, sensory and autonomic symptoms in the absence of additional damage of other causes. In addition, the increased prevalence of chronic systemic disorders causing neuropathy, as well as the use of neurotoxic drugs in older patients, contribute to the onset of neuropathy."
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