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Polyneuropathy
Classification and external resources
ICD-10 G60.-G64.
ICD-9 356.4, 357.1-357.7
MeSH D011115

Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory involvement; some also involve dysfunction of the autonomic nervous system. These disorders are often symmetric and frequently affect the feet and hands, causing weakness, loss of sensation, pins-and-needle sensations or burning pain.[1] There is a very large differential for polyneuropathy.

Contents

Classification

Polyneuropathies can be classified in many different ways, such as by cause, by speed of progression, or by the parts of the body involved. It is also important to distinguish between classes of polyneuropathy according to which part of the nerve cell is mainly affected: the axon, the myelin sheath, or the cell body.

Evaluation

Evaluation and classification of polyneuropathies begins with a history and physical exam in order to document what the pattern of the disease process is (arms, legs, distal, proximal, symmetric), when they started, how long they've lasted, if they fluctuate, and what deficits and pain are involved. If pain is a factor, and it often is, determining where and how long the pain has been present is important.

One also needs to know what disorders are already present within the family and what diseases the patient may currently have. This is vital in forming a differential diagnosis.

Although often diseases are suggested by the physical exam and history alone, testing is still a large part of the diagnosis. Tests which may be employed include: electrodiagnostic testing using electromyography, muscle biopsy, serum creatine kinase (CK), antibody testing. Nerve biopsy is not used much, but is helpful in determining small fiber neuropathy. Other tests may be used, especially tests for specific disorders associated with polyneuropathies.

Causes

Acute polyneuropathy can have various causes, including infections, autoimmune reactions, toxins, certain drugs, and cancer.

Chronic polyneuropathy is often caused by diabetes mellitus or by the excessive use of alcohol, but a variety of other less common causes are known, including nutritional deficiencies, and liver or kidney failure.[1]

One Danish study in 2002 suggested a link between long term exposure to statins and increased risk of polyneuropathy,[2] although other studies have not confirmed this finding.

Treatment

If possible, treatment focuses on the underlying disease. Further, pain medications may be given and physical therapy is used to retain muscle function.

Differential

There is a large differential for polyneuropathies: vitamin deficiency, cancer, toxins, infections (ex. Guillain-Barré Syndrome, Lyme Disease), liver disease, endocrine disease (including diabetes with diabetic and pre-diabetic neuropathy), amyloidosis, genetic disorders, motor neuron disorders, motor neuropathies, kidney failure[3], paraneoplastic, polio, porphyria (some types), spinal muscular atrophy, catecholamine disorders, and many others.

See also

References

  1. ^ a b Polyneuropathy, Merck Manual
  2. ^ D. Gaist, MD PhD; U. Jeppesen, MD PhD,; M. Andersen, MD PhD; L. A. García Rodríguez, MD MSc; J. Hallas, MD PhD; S. H. Sindrup, MD PhD (2002;58). "Statins and risk of polyneuropathy -- A case-control study" (in English). Neurology (Denmark: American Academy of Neurology): pp. 1333-1337. http://www.neurology.org/cgi/content/abstract/58/9/1333. Retrieved 2009-10-06.  
  3. ^ Chronic renal failure, Medline Plus

External links








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