Neuropathy, Peripheral

Neuropathy, Peripheral

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Neuropathy, Peripheral is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Mononeuritis, Peripheral
  • Mononeuritis Multiplex
  • Mononeuropathym Peripheral
  • Multiple Peripheral Neuritis
  • Peripheral Neuritis
  • Polyneuritis, Peripheral
  • Polyneuropathy, Peripheral

Disorder Subdivisions

  • Ulnar Nerve Palsy
  • Tardy Ulnar Palsy
  • Peroneal Nerve Palsy
  • Radial Nerve Palsy
  • Saturday Night Palsy

General Discussion

Peripheral neuropathy is an umbrella term that denotes a disorder of, or damage to, the peripheral nervous system. The peripheral nervous system consists of all the motor and sensory nerves that connect the brain and spinal cord to the rest of the body (i.e., the nerves outside the central nervous system). The symptoms and physical findings associated with peripheral neuropathies vary greatly from case to case and may be extremely complex.



More than 100 different peripheral neuropathies are recognized, each with a distinguishing set of symptoms, development path, and prognosis. Disorders affecting only one nerve are described as a mononeuropathies while disorders affecting more than one nerve are called polyneuropathies. If two nerves affecting different parts of the body are involved, the disorder is described as a mononeuritis multiplex.



In some cases, symptoms emerge abruptly, progress rapidly, and are slow to subside. Some chronic forms emerge only gradually and progress slowly. Some chronic forms appear to be resolved but are subject to relapses. Most often, symptoms such as pain, tingling, and/or muscle weakness start in both of the feet (bilateral) and progress up the legs. This is usually followed by symptoms in the hands that progress up the arms.

Symptoms

The symptoms of peripheral neuropathy are produced by disease of a single nerve (mononeuropathy, mononeuritis), several nerves in asymmetric areas of the body (mononeuritis multiplex), or many nerves simultaneously (polyneuropathy, polyneuritis, multiple peripheral neuritis). These symptoms may involve sensory, motor, reflex, or blood vessel (vasomotor) function. Lesions, usually degenerative and only rarely accompanied by signs of inflammation, may occur in the nerve roots or peripheral nerves.



The symptoms of peripheral nerve damage depend on the type of nerve affected. Muscle weakness, with or without muscle cramping, uncontrolled muscle twitching (fasciculations), loss of muscle mass, and bone erosion are usually the result of damage to a motor nerve. However, on occasion, such changes may be due to damage to sensory or autonomic nerves as well.



Symptoms arising from sensory nerve damage include reduced ability to touch and/or feel vibrations, with increasing numbness in the feet and hands. Many patients feel as if their hands and feet were covered, as if they were wearing gloves or stockings. Loss of posture sense or position sense leads to difficulty in walking, using buttons, or maintaining balance. Associated pain varies but may become intense and difficult to control.



It is not unusual for patients to lose the ability to feel pain or to sense changes in temperature. Such sensory loss may be particularly dangerous to patients with heart disease or diabetes. Patients may fail to register the signs of an impending heart attack or to realize the degree of damage to a foot, thus contributing to the course of preventable gangrene.



Autonomic nerve damage generates a different set of symptoms, depending on the organ or gland involved. Cardiovascular or pulmonary involvement may lead to life-threatening circumstances. Other symptoms include reduced capability to sweat properly, loss of bladder control, and the inability to control the muscles that help maintain blood pressure. Other symptoms of autonomic nerve damage include problems related to digestion, eating and swallowing.

Causes

Peripheral neuropathy may have many different causes. It may be acquired or inherited. Acquired peripheral neuropathies are caused by systemic disease, e.g. tic douloureux that is caused by damage to the trigeminal nerve, or trauma, or autoimmune disorders or infections. Inherited peripheral neuropathies include several forms of Charcot-Marie-Tooth disease, peripheral neuropathy with optic atrophy, and hereditary neuropathy with liability to pressure palsies. Peripheral neuropathies without known cause are called idiopathic.



The causes of peripheral neuropathy may be classified in the following way:



Physical injury or trauma is the most common cause of damage to a nerve. Accidents and sports-related injuries may sever, crush, stretch, or compress one or more peripheral nerves.



Systemic diseases, including metabolic and endocrine disorders such as diabetes, are often accompanied by peripheral neuropathies. The accumulation of toxic substances as a result of kidney disorders may often lead to peripheral neuropathy. Hormonal disorders such as acromegaly may lead to bone overgrowth that may exert pressure on nerve tissue leading to neuropathy. Alcoholism and/or vitamin deficiencies may lead to neuropathies because of a lack of vitamins E, B1, B6, or B12. Because alcoholism interferes with nutrition, it too may lead to vitamin deficiencies and neuropathies. Diseases of the blood and/or vascular system can have serious effects on nerve tissue if the oxygen supply is affected. Connective tissue disorders and chronic inflammation of nerve tissue may lead to neuropathies, and if sufficient connective tissue is destroyed the nerves become more vulnerable to compression and thus to damage as well. Cancers and benign tumors may compress nerves sufficiently to cause damage and neuropathy in disorders such as neurofibromatosis. Repetitive stress frequently leads to entrapment neuropathies such as carpal tunnel syndrome. People exposed to heavy metals and other toxins are often subject to peripheral neuropathies.



Infections and immune disorders, especially virus infections, can cause serious nerve damage and peripheral neuropathies. Viruses causing such disorders as Epstein-Barr syndrome or herpes varicella-zoster (shingles) are often the cause of severe nerve damage and nerve pain. Human immunodeficiency virus (HIV) causes a number of different peripheral neuropathies, depending on the stage of disease.



Inherited forms of peripheral neuropathy are the result of genetic mutations that in many instances lead to mild neuropathies, the onset of which is usually delayed to early adulthood. The more severe inherited forms, such as Charcot-Marie-Tooth disease (CMT), usually appear in childhood. In CMT disease, there are mistakes in the coding for the protective sheath (myelin sheath) that surrounds the nerve filaments.

Affected Populations

Peripheral neuropathy affects males and females in equal numbers.

Standard Therapies

Diagnosis

Because the causes of peripheral neuropathy are so various, the diagnosis may be difficult. A thorough clinical evaluation, including a complete patient history and laboratory tests will be required. Less common tests such as electromyography, to measure the electrical discharge and conductivity of the nerve, may also be necessary to confirm the diagnosis of peripheral neuropathy.



Blood tests to measure the levels of several vitamins may be required as well. Sometimes, a nerve biopsy may be undertaken.



Treatment

Treatment is designed to relieve the condition causing the neuropathy. If, for example, the underlying condition is diabetes, the patient may be encouraged to control blood sugar levels as a means of protecting the nerve fibers.



Stitching a nerve together, surgically breaking up adhesions around a nerve (neurolysis), or nerve transplant may be advisable in some traumatic lesions. In peripheral nerve entrapment or compression neuropathy (e.g., carpal tunnel syndrome), splinting or surgical decompression of certain nerves (e.g., ulnar, median, etc.) may be beneficial.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.



For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



The National Cancer Institute is sponsoring clinical trials (2005) of possible treatments for peripheral neuropathy caused by complications from chemotherapy and treatment of solid tumors. In a Phase III study, the drug lamotrigine is being evaluated for effectiveness in reducing pain, numbness, tingling and other symptoms of peripheral neuropathy brought on by chemotherapy. In a Phase II study, which is co-sponsored by MD Anderson Cancer Center, the drug amifostine is being evaluated as a possible treatment for patients who have developed peripheral neuropathy following treatment for solid tumors. For information on both studies, contact the NIH Patient Recruitment Office or go to www.clinicaltrials.gov.



Smoked marijuana is being evaluated for its effectiveness in reducing pain in patients with HIV-related peripheral neuropathy. This study is being co- conducted by the Center for Medicinal Cannabis Research Center and the University of California in San Francisco. For information, write to hvizoso@php.ucsf.edu or go to www.clinicaltrials.gov.



In a recent study of individuals with peripheral neuropathy and carpal tunnel syndrome, there was an improvement in nocturnal awakening, pain, numbness, and weakness after carpal tunnel release surgery.

References

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:491-92; 1491-96.



Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:584-87.



Rowland LP. Ed. Merritt's Neurology. 10th ed. Lippincott Williams & Wilkins. Philadelphia, PA. 2000:604-29.



FROM THE INTERNET

Campellone JV. Peripheral neuropathy. Medical Encyclopedia. MedlinePlus. Update Date: 7/2/2004. 6pp.

www.nlm.nih.gov/medlineplus/ency/article/000593.htm



Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). Last Updated December 03, 2004. 7pp.

www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy_pr.htm



Peripheral neuropathy. MayoClinic.com. January 13, 2004. 8pp.

www.mayoclinic.com/invoke.cfm?id=DS00131



Shields RW. Peripheral Neuropathy. The Cleveland Clinic. ©2004. 11pp.

www.clevelandclinicmeded.com/diseasemanagement/neurology/pneuro/pneuro.htm



Peripheral Neuropathy. Adult Health Advisor. University of Michigan Health System. ©2004. 2pp.

www.med.umich.edu/1libr/aha/aha_perineur_crs.htm



Peripheral Neuropathy. AIDS Fact Sheet. Reviewed Apr 30,2004. 3pp.

www.aids.org/factSheets/555-Peripheral-Neuropathy.html

Resources

NIH/National Institute of Neurological Disorders and Stroke

P.O. Box 5801

Bethesda, MD 20824

Tel: (301)496-5751

Fax: (301)402-2186

Tel: (800)352-9424

TDD: (301)468-5981

Internet: http://www.ninds.nih.gov/



Neuropathy Association

60 East 42nd Street

Suite 942

New York, NY 10165

USA

Tel: (212)692-0662

Fax: (212)692-0668

Email: info@neuropathy.org

Internet: http://www.neuropathy.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



Center for Peripheral Neuropathy

University of Chicago

5841 South Maryland Ave, MC 2030

Chicago, IL 60637

Tel: (773)702-5659

Fax: (773)702-5577

Internet: http://peripheralneuropathycenter.uchicago.edu/



Foundation for Peripheral Neuropathy

485 Half Day Road

Suite 200

Buffalo Grove, IL 60089

Tel: (847)883-9942

Fax: (847)883-9960

Tel: (877)833-9942

Email: info@tffpn.org

Internet: http://www.foundationforpn.org



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.