Polyneuropathy of the lower extremities is a common pathology associated with damage to peripheral nerves. The disease is characterized by trophic and vegetative-vascular disorders affecting the lower extremities, manifested by sensory disturbances and flaccid paralysis.
The danger of the pathology is that over time its manifestations worsen, problems with movement arise, which affects the ability to work and interferes with a full life. Today we will talk about the symptoms and treatment of polyneuropathy of the lower extremities, and also consider methods aimed at preventing further progression of the pathology.
Polyneuropathy of the lower extremities is not an independent disease. According to ICD 10, this condition is considered a neurological syndrome that accompanies a variety of diseases:
The cause of the disease can be a wide variety of health disorders and chronic diseases. Cancerous tumors can disrupt the functioning of the peripheral nervous system. In addition, signs of polyneuropathy may appear after a course of chemotherapy.
Infectious and inflammatory processes in the joints and any types of intoxication of the body (drugs, alcohol, chemicals) can cause problems with impaired sensitivity and damage to nerve fibers. In children, this disease is most often hereditary; for example, symptoms of porphyritic polyneuropathy appear in a child immediately after birth.
Thus, doctors divide all the factors that provoke the development of a pathological condition into several groups:
Polyneuropathy never occurs as an independent disease; damage to nerve fibers is always associated with an etiological factor that negatively affects the state of the peripheral nervous system.
Polyneuropathy of the upper and lower extremities begins with increasing muscle weakness, which is associated with developing damage to the nerve fibers. The distal parts of the limbs are damaged first. In this case, a feeling of numbness occurs in the area of the feet and gradually spreads to the entire leg.
Patients with polyneuropathy complain of a burning sensation, crawling, tingling, and numbness of the limbs. Various types of paresthesia are complicated by muscle pain. As symptoms increase, patients experience severe discomfort even when accidentally touching the problem area. In the later stages of the disease, there is unsteadiness of gait, loss of coordination of movements, and a complete lack of sensitivity in the area of damage to nerve fibers.
Muscular atrophy is expressed in weakness of the arms and legs and in severe cases can result in paresis or paralysis. Sometimes unpleasant sensations in the limbs occur at rest, causing reflex movements. Doctors characterize such manifestations as “restless legs syndrome.”
The pathology is accompanied by autonomic disorders, which are manifested by vascular disorders (a feeling of cold in the affected limbs, marbled pallor of the skin) or trophic lesions (ulcers and cracks, peeling and dry skin, the appearance of pigmentation).
Manifestations of polyneuropathy are difficult to miss; as the pathology progresses, they become obvious not only to the patient, but also to the people around him. The gait changes and becomes heavier, as the legs become “wobbly”, difficulties arise with movement, the person has difficulty covering even short distances that he previously covered in a few minutes. As the pathology progresses, the feeling of numbness in the limbs increases. A pain syndrome arises, which manifests itself in different ways; some patients feel only minor discomfort, while others complain of aching or sharp, burning pain.
Patients experience swelling of the extremities, impaired knee reflexes, and lack of response to stimuli. In this case, only one or several characteristic symptoms may appear, it all depends on the severity of the damage to a particular nerve trunk.
According to the nature of the course, polyneuropathy of the lower extremities can be:
Taking into account the damage to nerve fibers, polyneuropathy is divided into several types:
Depending on the damage to cellular nerve structures, polyneuropathy can be:
The demyelinating form of polyneuropathy is the most severe form of the disease, the mechanism of development of which is still not fully understood. However, as a result of a number of studies, scientists have put forward a theory about the autoimmune nature of the pathology. In this case, the human immune system perceives its own cells as foreign and produces specific antibodies that attack the roots of nerve cells, destroying their myelin sheaths. As a result, nerve fibers lose their functions and provoke innervation and muscle weakness.
If polyneuropathy is suspected, the patient will have to undergo a series of diagnostic procedures, including laboratory and instrumental studies. After collecting an anamnesis, the doctor will conduct an external examination, examine reflexes, and then send the patient to the laboratory to donate blood for a general and biochemical analysis.
In addition, the patient will undergo an ultrasound of the internal organs, x-rays of the affected areas, and cerebrospinal fluid will be collected. If necessary, a biopsy of nerve fibers will be taken for examination. The choice of treatment regimen begins only after a full examination and diagnosis.
The basis of therapeutic measures for polyneuropathy is a combination of medication and physiotherapeutic methods aimed at preventing the progression of pathology and restoring impaired innervation of nerve fibers. Treatment methods will largely depend on the cause contributing to the development of the pathology.
If severe chronic diseases are to blame, first of all they treat the underlying disease. Thus, for diabetic polyneuropathy, drugs are selected that will not affect the level of the glycemic index, and the therapy itself is carried out in stages. First, the diet is adjusted, body weight is normalized, and a complex of therapeutic exercises is developed for the patient. Subsequently, neurotropic vitamins and alpha-lipoic acid injections are included in the treatment regimen, immunosuppressive drugs and glucocorticoids are prescribed.
If the disease is of a toxic nature, detoxification measures are carried out first, after which the necessary medications are prescribed. If the pathology develops against the background of dysfunction of the thyroid gland, hormonal drugs are used in the treatment process. Malignant neoplasms are treated surgically, removing the tumor that compresses the nerve roots.
To develop limbs and eliminate movement disorders, methods of physical therapy (physical therapy) are used. B vitamins help restore sensitivity; to relieve pain, analgesics are prescribed in the form of ointments, tablets or injections.
These are the drugs of first choice in the treatment of polyneuropathy; their therapeutic effect is aimed at improving blood circulation in the area of damage, improving tissue trophism and regeneration of nerve fibers. Most often, medications from this list are included in the treatment regimen:
The action of the drugs is aimed at improving neuromuscular conduction, accelerating metabolism, and improving the supply of tissues with blood and oxygen. Metabolic agents can have an antioxidant effect, fight free radicals, stop the processes of destruction of nervous tissue and help restore impaired functions.
In the treatment process, an important role is played by B vitamins (B1, B12, B6). Preference is given to combination drugs that are released in tablet form or as injections. Among the injection forms most often prescribed:
In addition to the optimal set of vitamins, these medications include lidocaine, which additionally provides an analgesic effect. After a course of injections, vitamin preparations are prescribed in tablet form - Neuromultivit, Neurobion, Keltican.
For polyneuropathy, the use of conventional painkillers (Analgin, Pentalgin, Sedalgin) does not give the desired effect. Previously, lidocaine injections were prescribed to relieve pain. But its use provoked surges in blood pressure and heart rhythm disturbances. Today, a safer option has been developed that allows the anesthetic to be applied topically. To relieve pain, it is recommended to use the Versatis patch, which is based on lidocaine. It is simply fixed to the problem area, which allows you to achieve pain relief without irritation or adverse reactions.
If the pain syndrome has a clear localization, you can use local remedies - ointments and gels with an analgesic effect (for example, Capsicum).
Anticonvulsants - Gabapentin, Neurontin, Lyrica, which are produced in the form of capsules or tablets, cope well with the manifestations of pain syndrome. Taking such drugs begins with minimal doses, gradually increasing the volume of the medicine. The therapeutic effect is not immediate, it accumulates gradually. The effectiveness of the drug can be judged no earlier than 1-2 weeks from the start of administration.
In severe cases, when the pain cannot be relieved by the above remedies, opioid analgesics (Tramadol) are prescribed in combination with the drug Zaldiar. If necessary, your doctor may prescribe antidepressants. Most often, Amitriptyline is prescribed; if it is poorly tolerated, Ludiomil or Venlaxor are prescribed.
In the process of treating polyneuropathy, drugs that improve the conduction of nerve impulses to the arms and legs must be used. Tablets or injections of Axamon, Amiridin or Neuromidin help restore sensitivity. The course of therapy with these drugs is quite long - at least a month.
During the treatment process, the doctor can combine different groups of drugs to achieve the most pronounced therapeutic effect.
Along with physical therapy methods, the complex treatment of polyneuropathy necessarily includes physiotherapeutic procedures. The doctor may recommend the following methods:
The patient must undergo therapeutic exercises under the guidance of an experienced instructor, who will individually select a rehabilitation program and conduct health-improving classes.
Regular courses of physiotherapy will help restore muscle tone, restore lost sensitivity, improve the supply of tissues with oxygen and nutrients, activate nerve conduction and literally put the patient on his feet.
When the nervous system is damaged, or rather, dystrophic destruction of nerve fibers, a condition is diagnosed as polyneuropathy of the lower extremities. This disease is characterized by the formation of paralysis, complete or partial loss of sensitivity, as well as a number of other lesions of the lower extremities.
When the disease “polyneuropathy of the lower extremities” occurs in a person, the nerve fibers that nourish the feet are affected. As a result of the dystrophic process, the sensitivity of the legs disappears, and it is difficult for a person to move.
Polyneuropathy in medicine is classified into 4 main types - let's look at them:
Polyneuropathy can occur in both acute and chronic forms. There is also a specific axonal form, which results in damage to the nerve fibers in the area of the axial cylinder. Also, there is a demyelinating form of polyneuropathy, which appears after damage to the myelin sheath of nerve endings.
Polyneuropathy of the lower extremities can be caused by factors such as:
Damage to the lower extremities of a person by polyneuropathy occurs due to the fact that it is our legs that initially respond to all those pathological processes, infectious and bacterial lesions. The nerve endings of the lower extremities immediately receive from the blood all the viruses that can harm the body.
If we talk about the first symptoms of polyneuropathy, then we can say that in the human body there is a disturbance in the motor function of the legs and a gradual or, in some clinical cases, a sharp decrease in sensitivity begins.
You can understand that you have polyneuropathy of the lower extremities by symptoms such as:
If polyneuropathy of the lower extremities begins to rapidly progress, then all this leads to complete muscle atrophy. A person develops extensive trophic ulcers on his legs, and Guillain's syndrome also occurs (this means that complete paralysis of the legs has occurred, the person is paralyzed; after this condition, paralysis of the respiratory muscles may occur).
The course of polyneuropathy can be extremely sluggish, almost unnoticeable - this means that the disease occurs in the most dangerous - chronic form. Also, polyneuropathy can strike at one moment - a person is paralyzed and the likelihood of restoring motor activity is extremely low.
After contacting a medical institution and establishing a diagnosis of polyneuropathy of the nerve limbs, treatment should be exclusively comprehensive (both drug and non-drug therapy are used).
If secondary polyneuropathy of the lower extremities occurs, that is, this condition appeared after damage to a number of internal organs (for example, this is a consequence of diabetes mellitus or a malfunction of the thyroid gland), then it is necessary to initially eliminate the primary disease.
If the damage is caused by primary polyneuropathy, then medications such as vitamins, hormonal therapy, Pregabalin, Amitriptyline, Tramadol, Paracetamol, Lidocaine ointments, special patches, Baclofen are used).
With polyneuropathy, for various reasons, many peripheral (distant from the brain and spinal cord) nerves are damaged, which is why a person develops various symptoms: weakness, numbness, burning, paralysis, difficulty moving the arms and legs.
There are many diseases (from diabetes to HIV) in which polyneuropathy develops; it can also be caused by certain drugs, as well as toxic substances. But often finding its real cause can be quite difficult.
When a person comes to the doctor with symptoms typical of polyneuropathy, the doctor must first understand whether he is really dealing with this condition. Sometimes the problem turns out to be a muscle problem (myopathy) or damage to the central nervous system—the brain or spinal cord (such as a stroke or brain tumor). In order to determine in which area of the nervous system the cause is located, it is necessary to conduct a neurological examination, as well as check the characteristics of movements. For example, if reflexes are significantly depressed or absent altogether, then the problem may be polyneuropathy caused by Guillain-Barré syndrome. “Cock” gait (steppage, peroneal gait), when a person needs to raise his knees higher than usual in order to walk despite weakness in the feet, occurs with Charcot-Marie-Tooth disease with polyneuropathy.
Loss of hair on the legs also occurs with polyneuropathy, as does Tinel's sign in different places (tapping on a nerve causes tingling or pain in distant parts of the limb).
Polyneuropathy can also be combined with myopathy, that is, muscle diseases. This, for example, happens when taking colchicine (a drug for gout), connective tissue diseases, and in seriously ill patients with general weakness.
If numbness, weakness and other symptoms are accompanied by loss of vision, nausea, vomiting, deterioration of mental abilities, poor coordination of movements, then most likely the problem is not polyneuropathy, but damage to the central nervous system.
Sometimes weakness in the limbs is a consequence of taking glucocorticoids or cholesterol-lowering drugs.
An obligatory part of the diagnosis for suspected polyneuropathy is electrodiagnostic tests: electromyography and/or nerve conduction studies. If the abnormalities identified on these tests do not contradict the symptoms, then polyneuropathy is diagnosed, and thanks to such studies it can be determined whether it is axonal or demyelinating.
When it becomes clear that a patient has polyneuropathy, the doctor must find out what caused it. There are two types of polyneuropathy: axonal and demyelinating. Axonal appears when axons are damaged - long processes of nerve cells that conduct impulses, in particular to muscle cells. They can no longer perform their primary function of telling the muscles how to move. If this is a sensory nerve, which, on the contrary, transmits information about sensations to the central nervous system, then the person ceases to feel pain, cold, heat, etc. This, for example, happens with hypothyroidism, HIV, Lyme disease, etc.
The cause of demyelinating polyneuropathy is damage to the myelin sheath of the axon. Myelin protects this process from the influence of surrounding tissue and allows the electrical signal to travel faster. Without myelin, it becomes impossible to transmit impulses to muscles or, conversely, to the brain about sensations from the limbs. Such polyneuropathies occur in Charcot-Marie-Tooth disease, Guillain-Barre syndrome, etc.
How does a doctor accurately determine whether it is axonal or demyelinating polyneuropathy? Electrodiagnostic tests are not everything. An examination and history of the development of symptoms can reveal a lot. Sometimes the cause of the problem becomes clear almost immediately. For example, if a person has diabetes or alcoholism and the symptoms are typical, the doctor will quickly suspect a corresponding polyneuropathy. Otherwise, the doctor will ask about recent viral illnesses, other symptoms, medications you have recently started taking, exposure to solvents, heavy metals or other potential toxins, and a family history of neurological diseases.
The doctor will carefully check whether your movements are okay. For example, atrophy of the muscles of the foot or leg can be detected. In more severe cases, the same problems are found in the hands. The doctor may detect loss of sensitivity to light touch, vibration, cold, etc., absence or decreased reflexes. This will also give the doctor a hint.
In cases where tests do not give a clear answer as to whether the polyneuropathy is axonal or demyelinating, a nerve biopsy is performed, that is, a small part of it is taken for further research. It must be said that this is usually a situation where there is some asymmetry in the manifestation of symptoms, and foci of manifestation can be identified.
Sometimes electrodiagnostic tests do not show any abnormalities, a nerve biopsy also does not reliably indicate the disease, but the person suffers from burning, numbness and paresthesia (pins and needles, tingling and other unusual sensations) of the limbs. Then a skin biopsy is performed. It can show disruption of small nerve fibers that are not surrounded by myelin.
Since there is no specific treatment for polyneuropathy, and recovery can take many months, it is useful for such patients to undergo rehabilitation with the participation of a physiotherapist, occupational therapist and rehabilitation specialist. This is especially important for people who have suffered irreversible damage: such patients need to learn how to establish life in new conditions. For example, a physical therapist can tell you what to do if walking is difficult. Sometimes it is necessary to select an orthosis (a device worn on a joint), sometimes to apply a splint, in some cases a cane or other device that supports walking is sufficient.
Patients with polyneuropathy have an increased risk of developing foot ulcers, wounds, and other injuries that can become infected and lead to amputation. Therefore, you need to carefully care for your feet and nails, check the water temperature before washing your face, washing dishes, etc. using a thermometer or a part of the body that has not lost sensitivity. Also, if you have movement disorders, you should adapt your apartment or house to suit you (leave the lights on, remove objects that interfere with walking) and wear comfortable shoes.
At the Yusupov Hospital you can always receive qualified medical care in the treatment of polyneuropathy of various origins. Our rehabilitation medicine clinic employs competent specialists (occupational therapists, physiotherapists, rehabilitation specialists) who will help maintain quality of life with polyneuropathy.
Polyneuropathy of the lower extremities is a plural lesion of nerve fibers. The disease is characterized by fragmentary paralysis of the legs, lack of sensitivity to touch and temperature, and other disorders of the lower extremities.
With this disease, the nerves responsible for mobility and sensitivity, as well as the distant zones of neurons located in the feet, are affected. The factors and intensity of symptoms depend on the type of disease.
There are such types of illness:
Note! Polyneuropathy can be acute or chronic, axonal (the axial cylinder of the nerve fiber is affected) and demyelinating (appears due to pathological changes in the membrane of neurons).
In the chronic form, the disease develops slowly. But it can also progress very rapidly, quickly moving from the peripheral system to the central nervous system.
The disease can develop under the influence of many factors; unfortunately, they cannot always be identified.
There are many reasons that influence the progression of polyneuropathy. These include autoimmune diseases (disorders in the functioning of the immune system that appear as a result of an imbalance in the body), industrial (lead) or intoxication with low-quality food and alcohol-containing drinks.
In addition, factors that influence the occurrence of the disease are tumors, genetic predisposition, all kinds of infections that provoke inflammation of the nerve fibers.
Other reasons for the progression of polyneuropathy may be: uncontrolled use of drugs (penicillin, streptomycin, azaserin, etc.), disturbances in the functioning of the liver, kidneys, pancreas, vitamin deficiencies and endocrine diseases (diabetes mellitus).
But, as a rule, polyneuropathy of the legs appears when the distal nerve sections are the first to respond to pathological actions occurring in the system.
Another reason lies in the fact that distant neurons do not have a blood-brain barrier.
Therefore, various viruses and infections can easily enter the nerve connections from the bloodstream.
With polyneuropathy, damage to tactile fibers and neurons responsible for movement is observed. Pathologies occurring in nerve tissues can be caused by:
Also with polyneuropathy, symptoms such as decreased or absent tendon reflexes and bursting and acute pain in the area of peripheral nerves are observed. At the same time, symptoms appear in the form of paresthesia and “goosebumps”, and the gait changes due to degenerative distortion of the muscles.
Important! “Cock gait” is one of the main signs that occurs if polyneuropathy is not treated.
In the later stages of the disease, polyneuropathy of the lower extremities is characterized by the fact that the muscles completely atrophy, Guillain-Barré syndrome develops (paralysis of the legs, and then the respiratory muscles), and trophic ulcers appear, which also act as important symptoms of the problem.
This disease is diagnosed by a differential method, during which the doctor carefully analyzes all the symptoms of the pathology, thereby excluding other ailments with similar symptoms. Sensorimotor polyneuropathy can also be detected here.
When diagnosing polyneuropathy, the doctor is guided by clinical signs, paying attention to all symptoms.
At the same time, the doctor does an external examination, checks the reactions and finds out the hereditary history (do close relatives have similar diseases?), carefully examines all the symptoms.
If the disease progresses rapidly and an acute form is suspected, or if sensorimotor polyneuropathy develops, the doctor asks the patient what medications and products the patient used.
The following instrumental diagnostic methods are often used:
Treatment of polyneuropathy, like any other disease associated with the nervous system, is complex. A variety of methods are used.
In the case of a secondary form (diabetes, thyroid pathology), then treatment is prescribed for the original cause of neuronal damage.
The following medications are used in the treatment of primary polyneuropathy:
In the case of a toxic form of the disease, the doctor prescribes plasmaphoresis (hardware blood purification procedure).
Treatment of chronic and hereditary polyneuropathy is a long process consisting of many stages.
Drug treatment is complemented by physiotherapeutic measures, such as physical therapy (to maintain muscle tone in shape) and magnetic therapy, in which magnetic fields are directed to problem areas of the lower extremities.
Treatment is also accompanied by electrical stimulation, reflexology, and massage is prescribed for diabetes. Sometimes the doctor prescribes a diet for the patient, in which it is prohibited to consume carbohydrate and fatty foods.
During the treatment process and during the recovery stage, the patient should not smoke or consume tablets and drinks that have a stimulating and stimulating effect.
Note! With timely and complete therapy, the prognosis can be very favorable.
An exception is the treatment of hereditary type of polyneuropathy. In this case, the disease cannot be completely eliminated, but the complexity and severity of the symptoms can be alleviated.
Preventive measures are no less important than treatment and are aimed at eliminating factors that can have a direct impact on neuronal damage.
In order to prevent polyneuropathy, it is necessary to promptly treat internal and infectious diseases, and also not to drink alcohol-containing drinks.
In addition, doctors recommend using protective agents when working with aggressive toxic components, not abusing medications (not taking medications without a doctor’s prescription) and monitoring the quality of food consumed.
As a rule, polyneuropathy cannot be prevented. However, at the first symptoms of the disease, you can immediately consult a doctor. Due to this, the time of subsequent treatment will be significantly reduced, and the risk of adverse complications will be significantly reduced.
I am 59.5 years old. An old-age pensioner and a disabled person of the 2nd group with polyneuropathy of the lower extremities. I went to the doctors with the first symptoms in 1993. They treated me with all sorts of things and did not go through any kind of physical procedures, including massage and acupuncture. The disease is slowly eating me away. I received group 3 disability in 2012, when I could no longer move without a cane and had been on an old-age pension for 5 years. The next year they give group 2 and subsequently unlimited. What were you thinking about before?! I live in the Far North, in the city of Anadyr, and if I lived in the Central Distribution Center, I would still be half a year away from retirement! In Anadyr we did not and do not have an electromyography device. The stage of development of the disease is determined by eye, hammer and needle! And this is in the 21st century?! In 10 years, we managed to replace 2 tomographs, and this device costs 16 thousand dollars, but there is no money for it. And there is no money to send to Magadan or Khabarovsk, these devices are available there. Please answer, what should I do? I don’t leave the house for months, only as a last resort, with a social worker or a friend, by taxi. Every year I undergo medical examination: Combilipen in ampoules and tablets, and Octolipen. Meloxicam at night and that's it! Wait until paralysis of the legs gets to me, and so I can barely move around the apartment, and the last stage is paralysis of the respiratory tract?! I don’t even know what stage my illness is at? Hammer, awl and doctor's eye. Tell me what should I do? I can’t even get to Khabarovsk on my own. I’m not supposed to have an accompanying person, but how can I pay from my own pocket? I've been retired for 10 years already! What should I do, lie down and wait for pulmonary paralysis? I will be waiting for your response with great attention! Anatoly (Chukotka).
Which ointment is best to use for polyneuropathy of the lower extremities? Redness and burning of the skin
In neurology, a wide variety of symptoms are often encountered, which are called “focal neurological symptoms.” This means that some kind of misfortune has occurred with one or more functions of the central or peripheral nervous system.
An example of focal symptoms is weakness and tremors in the upper or lower extremities, paralysis of the facial nerve, increased tendon reflexes, and so on.
But there is a term that combines damage to many nerves at once, but at the same time they, as a rule, are most distant from the central nervous system and are located on the periphery. Let's try to explain this tricky and vague definition of “polyneuropathy” in simple words.
Polyneuropathy is translated from Greek as “suffering of many nerves.” These nerves can be affected by external factors that affect them for a long time and impair their functioning. Unlike a brain tumor or stroke, which cause a strictly defined set of symptoms depending on the location, polyneuropathy reveals a special clinical picture, which will be discussed below.
First of all, polyneuropathy is caused by diseases in which any substances that have a harmful effect on the nerves accumulate in the body. Such diseases include endocrine pathology and diabetes mellitus.
High levels of glucose in the blood, which last for a long time, contribute to impaired conduction of peripheral nerves. The result is diabetic polyneuropathy. It belongs to the group of dysmetabolic disorders.
If the culprit of the disease is not an ordinary substance (after all, everyone has glucose in their blood, there is simply too much of it in diabetes), but some external toxin, then toxic damage to the peripheral nerves, both sensory and motor, occurs.
This is how toxic damage to peripheral nerves develops, and the most striking example is alcoholic polyneuropathy, which occurs in people who drink heavily and for a long time.
Malignant neoplasms, which poison the entire body with the products of their metabolic activity and decay, can also cause nerve damage. This polyneuropathy is called paraneoplastic, and it is a serious sign of advanced cancer.
Sometimes serious infections cause nerve damage. Such polyneuropathies can be classified as both infectious and toxic - since microorganisms often use strong toxins, for example, diphtheria bacillus.
Finally, autoimmune polyneuropathies may occur, in which the nerves destroy the antibodies of their own body, attacking the nervous tissue “by mistake.” Such diseases include systemic scleroderma and other “major collagenoses”.
The disease has an extremely characteristic clinical picture. Before reviewing the symptoms of polyneuropathy, it should be mentioned that this nerve damage can be of the following types:
Polyneuropathy is characterized by damage to small nerves, since their myelin sheath is thinner and it is easier for all harmful substances to reach them. Therefore, most often there is damage to the hands and feet - polyneuropathy of the upper and lower extremities, the symptoms of which, as neurologists say, are of the “socks and gloves” type.
There is even a type of sensitivity disorder called the polyneuritic type. Thus, polyneuropathy of the upper and lower extremities will have the same symptoms.
The next important symptom of polyneuropathy will be the symmetry of the lesion, since the disease-causing substance circulates in the blood.
For example, symptoms of polyneuropathy of the upper extremities may include weakness of the fingers, burning pain, a feeling of chilliness, and marbling of the skin on the back of the hands (autonomic disorders).
The most common signs of nerve damage are as follows:
A special group consists of autonomic signs of polyneuropathy. These include hot flashes and the appearance of pallor and cold sweat, poor circulation (and poor healing of wounds and all kinds of damage to the skin).
The disease does not always develop over a long period of time and gradually. Thus, polyneuropathy of the lower extremities, the symptoms of which indicate a decrease in sensitivity, extinction of Achilles reflexes, and the presence of trophic disorders, may indicate a long-term process, or may appear in a matter of days and weeks, for example, with a mild degree of radiation sickness or poisoning with lead and its compounds.
Sometimes surprising complaints arise as part of polyneuropathy. Thus, with pernicious anemia, due to a deficiency of cyanocobalamin (vitamin B 12), posterior column ataxia occurs. In this case, it is not the peripheral nerves that are affected, but the spinal cord, more precisely, its posterior cords (columns), in which the conductive bundles of joint-muscular sense, or Gaulle-Burdach bundles, are located.
What happens when they are defeated? Each of us, undoubtedly, with our eyes closed, knows how our arms and legs are positioned, even if we don’t move them. But the patient with this type of ataxia does not know. Therefore, he cannot walk in the dark, because he gets confused and does not know where and how his legs are located. But in the presence of light and visual control, such a person’s gait is normal.
There are special autonomic or autonomic neuropathies that disrupt the heart rhythm and can even lead to sudden death due to ventricular asystole or other fatal arrhythmias. This polyneuropathy is an autonomic motor cardiac form of the disease.
The diagnosis is made by a neurologist taking into account complaints, anamnesis and the development of the disease. As a rule, with polyneuropathy, making the correct diagnosis does not cause difficulties.
Neither MRI, nor CT, nor ultrasound help here. The most important method is ENMG - electroneuromyography, which allows you to fully identify conduction disturbances along the nerve fiber and determine what is affected - the axial cylinder of the nerve or the myelin “insulating” sheath.
Blood chemistry tests often show certain endocrine disorders (glucose). In extreme cases, polyneuropathy requires a nerve fiber biopsy, which is studied using histochemical and immune methods.
Treatment of polyneuropathy of the lower and upper extremities of any etiology is a complex and lengthy process. After all, a certain morphological restructuring of their structure has already occurred in the nerves, and it is necessary to “rebuild” new nervous tissue, and this is not always possible. Therefore, the disease is not a functional, but an organic lesion of the nervous system.
First of all, you need to stop the impact of the damaging factor on the nervous system. So, for diabetes, you need to reduce your glucose level, and for alcoholism, you need to stop drinking. Otherwise, drug therapy will not be effective enough. In the same way, you must first operate on a malignant tumor or conduct a course of radiation and chemotherapy.
Drug therapy and drugs for the treatment of polyneuropathy are represented by the following groups:
Polyneuropathy of the lower extremities, the treatment of which consists only of drugs, takes longer to treat than with the participation of physiotherapy and local application of products in the form of gels or ointments.
Polyneuropathy of the upper and lower extremities, the treatment of which was ineffective, progresses. As a result, a person becomes disabled because his arms and legs simply refuse to serve him. But the most dangerous situations are those in which sudden, dangerous arrhythmias occur, which can be fatal.
In diabetes, the most serious problems are poor wound healing, secondary infection and septic complications.
Finally, in rare cases, it is possible to develop ascending paralysis (Landry's type) with breathing problems. In this case, the patient is urgently hospitalized in the intensive care unit and transferred to artificial ventilation.
Fortunately, this situation usually resolves well.
Polyneuropathy is a rather dangerous disease, which is a lesion of the peripheral nervous system, the basis of which is trophic disorders, sensitivity disorders, vegetative-vascular dysfunctions, flaccid paralysis, observed primarily in the distal segments of the limbs. This disease is usually classified according to the etiological factor, pathomorphology of the pathological focus and the nature of the course.
Polyneuropathy of the extremities is considered a fairly common pathology, usually affecting the distal parts with gradual involvement of the proximal parts.
The disease in question, polyneuropathy of the upper and lower extremities, begins with muscle weakness, and first of all, in the distal parts of the legs and arms. This is due to damage to the nerve fibers. With this disease, the distal parts of the limbs are primarily affected due to the lack of sufficient protection of segments of the peripheral system (for example, the blood-brain barrier located in the brain).
Manifestations of the described pathology debut in the foot area and gradually spread up the limb. Depending on the typology of nerve fibers that are subject to destruction to a greater extent, all types of polyneuropathy are conventionally divided into four subgroups.
Due to damage mainly to the afferent long processes of neurons, patients experience positive or negative symptoms. The first is characterized by the absence of function or its decrease; positive symptoms are those manifestations that have not previously been observed.
In the first turn, in patients with the disease in question, various types of paresthesia are manifested, such as burning, tingling, crawling, and numbness. Then the clinical picture is complicated by algias of varying intensity, and the susceptibility to painful stimuli increases. As symptoms increase, patients become overly sensitive to simple touches. Later, they experience manifestations of sensitive ataxia, expressed in unsteady gait, especially with closed eyes, and impaired coordination of movement. Negative symptoms of polyneuropathy include decreased sensitivity in areas where nerve fibers are damaged.
When the axons of movement neurons are damaged, polyneuropathy of the upper and lower extremities manifests itself, firstly, as muscle atrophy and is found in weakness of the legs and arms. The described symptoms progress to the occurrence of paralysis and paresis. Less commonly, a condition manifested by unpleasant sensations in the legs, appearing mainly at rest and forcing people to make movements of a relieving nature (restless lower limbs syndrome) can be observed. In addition, fasciculations and convulsions may occur.
Autonomic dysfunctions are divided into trophic disorders and vascular disorders. The first include the appearance of pigmentation and peeling of the skin, the appearance of cracks and ulcers on the extremities. Vascular disorders include a feeling of cold in the damaged segments, dullness of the skin (the so-called “marble pallor”).
Vegetative-trophic symptoms also include changes in the structure of the derivatives of the dermis (hair and nails). Due to the fact that the lower extremities withstand more load, polyneuropathy of the legs is diagnosed much more often than of the arms.
The disease in question, polyneuropathy of the extremities, is a dystrophic destruction of nerve cells, causing a malfunction in the functioning of the peripheral nervous system. This disease is manifested by a decrease in motor ability, decreased sensitivity, depending on the location of the pathological focus, any part of the limbs, and muscle pain. With the disease in question, the patient’s nerve fibers that supply the feet are damaged. As a result of structural damage to the nerve fibers, the sensitivity of the legs is lost, which affects the individual’s ability to move independently.
Treatment of polyneuropathy of the lower extremities, as a rule, is quite labor-intensive and lengthy, since more often this disease is progressive in nature and develops into a chronic course.
To determine the reasons that provoke the development of the described illness, first of all, it is necessary to understand the structure of the nervous system, in particular its separate area - the peripheral system. It is based on long processes of nerve fibers, the task of which is to transmit signals, which ensures the reproduction of motor and sensory functions. The bodies of these neurons live in the nuclei of the brain and spinal cord, thus forming a close connection. From a practical point of view, the peripheral segment of the nervous system combines the so-called “conductors” that connect nerve centers with receptors and functional organs.
When polyneuropathy occurs, a separate part of the peripheral nerve fibers is affected. Therefore, manifestations of the disease are observed in certain areas. The pathology in question on the limbs manifests itself symmetrically.
It should be noted that the pathology under consideration has several varieties, which are classified depending on the functions of the damaged nerves. For example, if the neurons responsible for movement are damaged, the ability to move may be lost or impaired. This type of polyneuropathy is called motor polyneuropathy.
In the sensory form of the disorder in question, the nerve fibers that cause sensitivity are affected, which suffers greatly when this category of neurons is damaged.
Insufficiency of autonomic regulatory functions occurs when autonomic nerve fibers are damaged (hypothermia, atony).
Thus, the following significant factors that provoke the development of this disease are identified: metabolic (associated with metabolic disorders), autoimmune, hereditary, nutritional (caused by nutritional disorders), toxic and infectious-toxic.
There are two forms of the described pathology depending on the location of the lesion: demyelinating and axonal. In the first, myelin, the substance that forms the sheath of nerves, is affected; in the axonal form, the axial cylinder is damaged.
The axonal form of leg polyneuropathy is observed in all types of the disease. The difference lies in the prevalence of the type of disorder, for example, there may be a disorder of motor function or a decrease in sensitivity. This form appears as a result of serious metabolic disorders, intoxication with various organophosphorus compounds, lead, mercury salts, arsenic, as well as alcoholism.
There are four forms, depending on the tendency of the course: chronic and recurrent form of the course, acute and subacute.
The acute form of axonal polyneuropathy often develops within 2-4 days. More often it is provoked by severe poisoning of a suicidal or criminal nature, general intoxication due to exposure to arsenic, carbon monoxide, lead, mercury salts, and methyl alcohol. The acute form can last more than ten days.
Symptoms of the subacute form of polyneuropathy increase over a couple of weeks. This form often occurs with metabolic disorders or due to toxicosis. Recovery usually occurs slowly and may take many months.
The chronic form often progresses over a long period of time, six months or more. The disease usually appears against the background of alcoholism, diabetes, lymphoma, blood diseases, and deficiency of vitamins thiamine (B1) or cyanocobalamin (B12).
Among axonal polyneuropathies, alcoholic polyneuropathy, caused by prolonged and excessive abuse of alcohol-containing liquids, is most often diagnosed. A significant role for the occurrence of the pathology in question is played not only by the number of “absorbed liters” of alcohol, but also by the quality of the product consumed, since many alcoholic drinks contain many substances toxic to the body.
The main factor provoking alcoholic polyneuropathy is the negative impact of toxins that alcohol is rich in on nerve processes, which leads to metabolic disorders. In most cases, the pathology in question is characterized by a subacute course. Initially, numbness occurs in the distal segments of the lower extremities, and severe pain occurs in the calf muscles. As pressure increases, pain in the muscles increases noticeably.
At the next stage of development of the disease, dysfunction of mainly the lower extremities is observed, which is expressed by weakness, often even paralysis. The nerves that cause flexion and extension of the foot are the most damaged. In addition, the sensitivity of the superficial layers of the dermis in the area of the hands, like a “glove,” and the feet, like a “sock,” is disrupted.
In some cases, this disease can have an acute course. This mainly occurs due to excessive hypothermia.
In addition to the above clinical symptoms, other pathological manifestations may also be present, such as a significant change in the color of the skin of the legs and the temperature of the extremities, swelling of the distal parts of the legs (less often the arms), and increased sweating. The disease in question can sometimes affect the cranial nerves, namely the oculomotor and optic nerves.
The described disturbances are usually detected and increase over several weeks/months. This disease can last for several years. When you stop drinking alcohol, the disease can be overcome.
The demyelinating form of polyneuropathy is considered a serious disease, accompanied by inflammation of the nerve roots and gradual damage to their myelin sheath.
This form of the disease is relatively rare. Most often, this disease affects the adult male population, although it can also occur in the weaker half and children. Demyelinating polyneuropathy usually manifests itself as weakness of the muscles of the distal and proximal areas of the extremities, due to damage to the nerve roots.
The mechanism of development and etiological factor of this form of the disease are, unfortunately, not known for certain today, however, numerous studies have shown the autoimmune nature of demyelinating polyneuropathy. For a number of reasons, the immune system begins to consider its own cells as foreign, as a result of which it begins to produce specific antibodies. In this form of pathology, antigens attack the cells of the nerve roots, causing destruction of their membrane (myelin), thereby provoking an inflammatory process. As a result of such attacks, nerve endings lose their fundamental functions, which causes disruption of the innervation of organs and muscles.
Since it is generally accepted that the origin of any autoimmune disease is related to heredity, a genetic factor in the occurrence of demyelinating polyneuropathy cannot be excluded. In addition, there are conditions that can change the functioning of the immune system. Such conditions or factors include metabolic and hormonal disorders, heavy physical activity, infection of the body, emotional stress, vaccination, injury, stress, severe illness and surgery.
Thus, the treatment of polyneuropathy of the lower extremities is represented by a number of features that must be taken into account, because the disorder in question does not arise independently. Therefore, when the first manifestations and signs of the disease are detected, it is necessary to immediately establish the etiological factor, since treatment, for example, of diabetic polyneuropathy differs from the treatment of pathology caused by alcohol abuse.
This disorder occurs due to damage to the nervous system and leads to paralysis of the upper limbs. With this disease, there is usually symmetrical damage to the nerve fibers of the distal areas of the extremities.
Signs of hand polyneuropathy are almost always the same. Patients experience increased sweating, impaired pain sensitivity, thermoregulation, skin nutrition, changes in tactile sensitivity, and paresthesia in the form of “goosebumps” appears. This pathology is characterized by three types of course, namely chronic, acute and subacute.
Polyneuropathy of the upper extremities is manifested, first of all, by weakness of the arms, various algias, which in their content are burning or bursting, swelling, and occasionally tingling may be felt. With this pathology, vibration sensitivity is impaired, as a result of which patients often experience difficulties in performing basic manipulations. Sometimes people suffering from polyneuropathy experience decreased sensitivity in their hands.
Hand polyneuropathy is most often caused by various intoxications, for example, due to the consumption of alcohol, chemicals, and spoiled foods. Also, the occurrence of the disease in question can be provoked by: vitamin deficiency, infectious processes (viral or bacterial etiology), collagenosis, liver and kidney dysfunction, tumor or autoimmune processes, pathologies of the pancreas and endocrine gland. Often this disease appears as a consequence of diabetes.
The described disease can occur differently in each patient.
According to pathogenesis, polyneuropathy of the upper extremities can be divided into axonal and demyelinating, and according to clinical manifestations into: vegetative, sensory and motor. It is quite difficult to encounter the listed varieties of this disease in their pure form; more often the disease combines the symptoms of several variations.
Today, treatment methods for the disease in question are quite scarce. Therefore, to this day, the treatment of polyneuropathies of various forms remains a serious problem. The level of knowledge of modern physicians in the field of the pathogenetic aspect and etiological factor of this category of diseases has determined the advisability of identifying two areas of therapeutic intervention, namely undifferentiated methods and differentiated ones.
Differentiated methods of therapeutic correction involve treatment of the underlying ailment (for example, nephropathy, diabetes) for endogenous intoxications; for pathologies of the digestive system caused by malabsorption, they require the administration of large dosages of vitamins B1 (thiamine) and B12 (cyanocobalamin).
For example, diabetic polyneuropathy is treated with drugs and their choice is determined by maintaining a certain glycemic level. Therapy for polyneuropathy due to diabetes should be gradual. At the first stage, you should adjust your body weight and diet, develop a set of special physical exercises, and monitor your blood pressure levels to normal. Pathogenetic methods of therapy involve the use of neurotropic vitamins and the injection of alpha-lipoic acid in large dosages.
Undifferentiated methods of therapeutic intervention are represented by glucocorticoids, immunosuppressive drugs and plasmapheresis.
Polyneuropathy treatment drugs should be prescribed in combination. The specificity of the choice of therapeutic measures for the pathology in question always depends on the etiological factor that provoked the disease and determined its course. For example, the symptoms of polyneuropathy caused by excess levels of pyridoxine (vitamin B6) disappear without a trace after its level is normalized.
Polyneuropathy caused by a cancerous process is treated by surgery - removal of the tumor that was putting pressure on the nerve endings. If the disease occurs against the background of hypothyroidism, then hormonal therapy is used.
Treatment of toxic polyneuropathy, first of all, involves detoxification measures, after which medications are prescribed to correct the disease itself.
If it is impossible to identify or eliminate the cause that provoked the development of the described disease, the main goal of treatment involves relieving pain and eliminating muscle weakness.
In these cases, standard physiotherapeutic methods and the prescription of a number of medications are used to relieve or relieve pain caused by damage to nerve fibers. In addition, physiotherapy methods are actively used at all stages of rehabilitation treatment.
It is quite difficult to overcome algia with the help of analgesic drugs or non-steroidal anti-inflammatory drugs. Therefore, it is more common to prescribe local anesthetics, anticonvulsants and antidepressants to relieve attacks of pain.
The effectiveness of antidepressants lies in their ability to activate the noradrenergic system. The choice of drugs in this group is determined individually, since antidepressants often cause mental dependence.
The use of anticonvulsants is justified by their ability to inhibit nerve impulses emanating from the affected nerves.