Polyneuropathy is one of the most severe neurological disorders. Characterized by multiple lesions of peripheral nerves. When the first symptoms of the disease appear, you should immediately consult a doctor to receive surgical treatment aimed at weakening or eliminating the cause of the pathology.
Neuropathy is a disease that occurs due to dysfunction of a nerve. Neuropathy of the lower extremities, symptoms and treatment, which may vary, can only be detected by an experienced doctor.
What is polyneuropathy of the lower extremities
The name of the disease is translated from Greek as “disease of many nerves,” and this translation fully conveys the essence of polyneuropathy of the lower extremities. In this case, almost all endings of the peripheral nervous system are affected.
There are several forms of the disease:
- Sensory polyneuropathy of the lower extremities. It manifests itself to a greater extent as a sensitivity disorder in the affected area, for example, numbness, a tingling or pins and needles sensation, a burning sensation. Treatment consists of controlling sensory symptoms with medications. Distal sensory polyneuropathy of the lower extremities brings a lot of inconvenience to the victim, since initially suspecting the disease is quite problematic, but the longer treatment is delayed, the more difficult it will be.
- Motor. The main symptom is muscle weakness to the point of complete inability to move arms or legs. This can very quickly lead to muscle atrophy.
- Sensorimotor. Combines symptoms of sensory and motor polyneuropathy. In most cases, this form is diagnosed.
- Vegetative. It differs in that in the foreground there are symptoms of damage to vegetative fibers. Direct symptoms include paleness of the skin, increased sweating, dizziness, disruption of the gastrointestinal tract, constipation, and tachycardia. Autonomic disorders signal several problems at once, so it is imperative to consult a doctor.
- Mixed. This form is diagnosed if all of the above symptoms are observed.
Expert opinion
Author: Alexey Vladimirovich Vasiliev
Neurologist, Head of the Research Center for Motor Neuron Disease/ALS, Candidate of Medical Sciences
Polyneuropathy is a complex disease characterized by atrophy of nerve fibers as a result of disturbances in the functioning of the peripheral nervous system. The pathology affects the upper and lower extremities and is accompanied by impaired sensitivity of the integumentary tissues, muscle performance, and deterioration of blood circulation.
Polyneuropathy is divided into 2 types:
- Primary is deadly, can be observed in any healthy person, progresses very quickly, and often ends in Landry’s paralysis.
- Secondary develops as a result of metabolic disorders and is a consequence of diabetes mellitus, vitamin deficiency in the body, general intoxication, infections, and injuries.
Symptoms of polyneuropathy of the lower extremities are pronounced. Initially, a person feels weakness in the legs, a feeling of numbness of the feet appears, gradually spreading to the entire limb. Some patients complain of burning and pain, tingling in the legs; in advanced cases, there is an unsteady gait and dysfunction of motor skills. Depending on the severity of the condition, symptoms such as dark circles under the eyes, dizziness, weakness, and tremors may appear. Doctors at the Yusupov Clinic will examine the patient, based on comprehensive diagnostics, identify an accurate diagnosis, and prescribe treatment in accordance with the general condition and side symptoms of the disease.
Causes of polyneuropathy of the lower extremities
The causes of polyneuropathy of the lower extremities of various types are similar. The following points may lead to development:
- Diabetes. It is the most common cause of the disease, as it disrupts the proper functioning of the vessels that feed the nerves, thereby causing a deviation in the myelin sheath of the nerve fibers. With diabetes, the legs are most often affected.
- Severe deficiency of any of the B vitamins. The work of the nervous system is based on them, and therefore their long-term lack can lead to the development of the disease.
- Exposure to toxic substances on the body. Toxins include chemical toxic substances, alcoholic beverages, as well as intoxication due to various infectious diseases: diphtheria, human immunodeficiency virus, herpes. When the body is poisoned with carbon monoxide or arsenic, distal polyneuropathy can develop in just a few days, and with alcoholism and infections a longer development is typical.
- Traumatization. Nerve fibers are damaged by injury or surgery. The first include compression of the nerves, which is characteristic of spinal diseases such as herniated intervertebral discs and osteochondrosis.
- Guillain-Barre syndrome. Autoimmune disease often develops in the human body after infectious pathologies.
- Hereditary predisposition. Researchers have proven that certain disorders in proper metabolism that lead to polyneuropathy are transmitted genetically.
In rare cases, pathology occurs in pregnant women who seem to be absolutely healthy. The disease can manifest itself at any time - both in the first and third trimester. Scientists agree that the cause is precisely a deficiency of B vitamins, prolonged toxicosis and an unpredictable reaction of the pregnant woman’s immune system to the fetus.
Causes of neuropathic pain
Listed below are some common causes of neuropathic pain.
- Chemotherapy drugs. For example, the following: cisplatin;
- paclitaxel;
- oxaliplatin;
- vincristine.
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The first signs of polyneuropathy of the lower extremities
The first symptoms are found mostly on the distal parts of the legs. First of all, the foot disease is affected, and then the symptoms of polyneuropathy of the lower extremities gradually spread upward, so it is important to start treatment on time.
Initially, patients experience discomfort:
- burning;
- tingling;
- "goosebumps";
- numbness.
Then pain appears, and it is possible even from a light touch. Additionally, there may be a disturbance in sensitivity in the area of damage to the nerve fibers - it can either decrease or increase.
Symptoms are complicated by muscle weakness. In extremely rare situations, restless legs syndrome occurs.
Due to improved blood circulation in the affected areas, tropical and vascular disorders occur over time on the victim’s skin, which manifest themselves in:
- worsening or hyperpigmentation;
- peeling;
- cracks;
- ulcers.
Vascular type disorders include excessive pallor of the skin and a feeling of cold in areas prone to the disease. Symptoms of polyneuropathy of the lower extremities cannot be seen in the photo, so you should listen to your feelings.
Symptoms
Symptoms of polyneuropathy depend on its cause and the characteristics of the damage to the fibers. The most common signs of pathology include:
- decreased sensitivity of the feet and palms, leading to the subjective sensation of wearing socks or gloves;
- pain in the affected limbs (sharp or dull, short-term or nagging, usually worse at rest and at night);
- spasms and twitching of muscle fibers;
- pain when touching the skin or pressing on the affected limb;
- decreased reflexes;
- increased sweating of the extremities;
- trophic disorders: swelling, changes in skin color and dryness, trophic ulcers;
- weakness of the muscles of the arms and legs, slight tremors;
- paresthesia: pathological sensations of crawling, burning, coldness;
- muscle atrophy;
- restless legs syndrome.
Alcoholic polyneuropathy
This form of the disease most often affects the lower extremities. It develops with prolonged uncontrolled consumption of alcoholic beverages and manifests itself primarily as a burning sensation and tingling sensation in the legs. With the further development of the pathology, the patient begins to feel numbness and muscle cramps, which develop due to the concomitant lack of B vitamins.
Diabetic polyneuropathy
Elevated sugar levels cause damage to the nerves of the feet (distal version) and the upper legs (proximal version). In the first case, a person experiences a characteristic set of symptoms:
- numbness and decreased pain sensitivity;
- periodic burning pain;
- muscle weakness;
- decreased reflexes;
- impaired coordination of movements, manifested by unsteadiness of gait.
The combination of polyneuropathy with damage to small vessels leads to the appearance of trophic ulcers in the lower part of the leg. The proximal version of the lesion is characterized by sharp pain in the buttock and upper thigh, as well as gradual muscle atrophy in this area.
Symptoms of polyneuropathy of the lower extremities
The causes of polyneuropathy of the lower extremities are different, but the symptoms are always similar. They are expressed as follows:
- muscle weakness;
- decreased sensitivity, which may disappear altogether;
- lack of reflexes;
- burning;
- swelling;
- trembling fingers;
- increased sweating;
- cardiopalmus;
- lack of coordination;
- respiratory dysfunction;
- difficulty with balance;
- slow healing of wounds.
Symptoms can vary in severity. Therefore, the disease can develop either over years or in a matter of days.
Diagnosis of polyneuropathy of the lower extremities
The presence of polyneuropathy can be determined without special tests, based on the symptoms and first signs. It is necessary to conduct special tests to identify the cause of the disease. Due to the abundance of symptoms, diagnosis can be difficult. In this case, a number of instrumental and laboratory studies will be required.
Initially, consultation with a neurologist is necessary. The doctor should examine the affected areas and check reflexes. If polyneuropathy is suspected, you must do the following:
- general blood analysis;
- check blood and urine sugar levels to rule out or confirm the presence of diabetes;
- biochemical analysis for indicators such as creatinine, urea, total protein, liver enzymes, vitamin B12 levels.
Sometimes a nerve biopsy may be necessary.
Electroneuromyography is also additionally prescribed. Neurophysiological research helps to find out how quickly the signal reaches the nerve endings. Carrying out is necessary regardless of clinical symptoms, as it helps to identify the speed of spread of excitation along the nerves. To assess the symmetry and level of the lesion, an EMG of the legs is required.
A history and physical examination can help determine the need for additional testing to determine the cause of the neuropathy.
Diagnostics
Diagnosis of polyneuropathy requires a comprehensive examination, which includes:
- survey: identifying patient complaints, clarifying the time and circumstances of the occurrence of each symptom;
- taking an anamnesis: recording all past diseases, injuries, intoxications, chronic pathologies, hereditary risk factors, etc.;
- neurological examination: assessment of skin and proprioceptive (spatial) sensitivity, motor function, muscle strength, quality of reflexes;
- consultations with specialized specialists: endocrinologist, narcologist, toxicologist, nephrologist, etc.;
- general urine test, general blood test, blood biochemistry (determination of glucose levels, lipid spectrum, vitamins and microelements, kidney function indicators and other parameters);
- blood test for HIV and other infections;
- genetic and immunological studies according to indications;
- Electroneuromyography allows you to identify lesions of nerve fibers and exclude other diseases with similar symptoms;
- biopsy of nerve and muscle tissue;
- lumbar puncture (examination of cerebrospinal fluid) to exclude neuroinfections;
- Doppler ultrasound of the vessels of the lower extremities.
The list of examinations can be adjusted depending on the form of polyneuropathy and concomitant pathology.
Treatment of polyneuropathy of the lower extremities
A patient with polyneuropathy of the lower extremities needs to prepare for long and difficult complex treatment. Since it consists not only in relieving symptoms that poison life, but also in eradicating the root cause of the disease.
As a result, the nerve fiber is destroyed, and it will take a long time to restore it. The course of treatment begins with a direct impact on the factor that caused the polyneuropathy, that is, with the relief of the underlying disease or stabilization of the patient’s condition.
For example, if the cause of the disease is diabetes mellitus, then all efforts are initially aimed at reducing blood sugar levels; in case of an infectious type, drug therapy is aimed at fighting the infection, and if the root of the problem is hidden in a deficiency of B vitamins, then it is important to compensate for the deficiency in a timely manner. If the cause of polyneuropathy is disruption of the endocrine system, the doctor prescribes hormonal therapy. But vitamin therapy is more widely used in treatment.
Positive results are demonstrated by those drugs that are aimed at improving blood microcirculation, and therefore nourishing nerve fibers.
Physiotherapeutic techniques, such as electrophoresis, are actively used in treatment. If polyneuropathy of the lower extremities is accompanied by severe pain, the patient must be prescribed painkillers, locally and orally.
It is impossible to completely insure yourself against the disease. But you can try to prevent it using simple precautions. That is, when working with toxic substances, it is imperative to use appropriate protective equipment, take any medications only after consultation and prescription of a doctor, and do not let infectious diseases take their course, preventing them from going into a chronic inflammatory period, when it will no longer be possible to cure the disease and all that remains is to treat it. exacerbations and relieve symptoms. The simplest measures to prevent problems are a balanced diet rich in vitamins, constant physical activity, and avoidance of alcoholic beverages.
Initially, treatment is aimed at eliminating the cause, and then maintenance therapy continues. It is necessary to discontinue medications and eliminate the effects on the body of toxic substances that caused the disease, adjust the diet, supplementing it with the necessary vitamins. Considering that only these measures slow down the course of the disease and reduce complaints, recovery progresses extremely slowly and may be incomplete.
If the cause cannot be stopped, all treatment is reduced to minimizing pain and disability. A rehabilitation specialist and physical therapist will recommend special orthopedic devices.
Tricyclic antidepressants and anticonvulsants are prescribed to relieve neuropathic pain such as burning or pins and needles. Medicines that affect the central nervous system are selected individually for each patient, depending on the state of the body and the patient’s psyche. It is strictly prohibited to prescribe medications on your own, so as not to cause even greater harm.
For demyelinating polyneuropathy of the legs, treatment based on immunomodulators is often used. Plasmapheresis or intravenous administration of immunoglobulins is recommended for acute inflammatory demyelination.
For chronic myelin dysfunction, plasma exchange or intravenous administration of immunoglobulin, corticosteroids or metabolic inhibitors is prescribed.
Of the entire list of vitamin preparations, preference is given to vitamins B1 and B12, which are also called thiamine and cyanocobalamin. The substances improve the level of transmission of excitation throughout the nerve fiber, which significantly reduces the manifestations of the disease, and also additionally protects the nerves from the effects of active radicals. They are prescribed over a long course in the form of injections administered intramuscularly.
Even if the treatment was successful and all or most of the nerve fibers were restored, it is too early to relax. It is necessary to carry out a long course of rehabilitation therapy, since with polyneuropathy, the muscles first suffer, losing tone. Therefore, long-term work aimed at restoring mobility is necessary; the help of several specialists may be required at once.
During rehabilitation after an illness, massage is mandatory. It repeatedly improves blood supply, restores mobility and elasticity to muscle tissue, and improves metabolic processes.
A similar effect is provided by various physiotherapeutic techniques. They also improve microcirculation, reduce pain and restore muscle cells. Physiotherapy for polyneuropathy of the lower extremities is most useful, so it is not recommended to neglect it.
In cases of severe injuries where complete recovery is not possible, the assistance of an occupational therapist may be required. Occupational therapy is action therapy. The specialist helps facilitate the patient’s process of adaptation to a state of limited movement, develops a new algorithm of movements necessary to perform everyday activities.
Due to the uniqueness of each case, the scheme of rehabilitation measures is developed individually and depends on the patient’s condition. Rehabilitation may include vitamin therapy, long-term work with psychologists, diet therapy and other techniques, depending on the specific situation.
Treatment of polyneuropathy of the lower extremities must begin immediately, without delay. As soon as alarming symptoms appear, you should consult a doctor - without timely treatment, there is a high risk of complications in the form of paralysis, disruption of the cardiovascular and respiratory systems. Timely treatment will help reduce the likelihood of complications to a minimum and maintain full functionality. Don’t forget about restorative therapy, it is this that will consolidate the effect obtained from the treatment.
Prognosis of polyneuropathy of the lower extremities
The disease is very dangerous for humans, as it does not go away on its own. If you start polyneuropathy, the consequences will be sad.
It is worth remembering that prolonged muscle weakness often leads to a decrease in the tone of the body muscles and subsequently to complete muscle atrophy. In turn, this can lead to the appearance of ulcers on the skin.
In rare cases, polyneuropathy results in complete paralysis of the distal planes of the body and respiratory organs. This is deadly for humans. A progressive disease causes a lot of inconvenience to the victim, forcing him to build a new way of life, radically changing his usual way of life. Over time, patients lose the ability to move independently and care for themselves, which is fraught with feelings of increased anxiety and depression. In this case, the help of a qualified psychologist is urgently needed. Distal polyneuropathy of the lower extremities requires long-term rehabilitation even after recovery and relief of all symptoms.
Prevention of polyneuropathy of the lower extremities
In order to prevent a disease such as polyneuropathy of the lower parts of the body, it is necessary to stop drinking alcohol, regularly monitor blood and urine sugar levels, and when working with hazardous and toxic substances, it is imperative to use special personal protective equipment.
To avoid pain after relieving the disease, it is recommended:
- wear loose shoes that do not pinch your feet;
- do not take long walks over long distances;
- do not stand still for a long time without changing position;
- wash your feet in cool water.
Do not forget about physical therapy, designed to keep muscles in constant tone, preventing atrophy. Regular physical therapy for polyneuropathy will strengthen the body. It is worth leading a calm lifestyle, avoiding emotional stress, which can negatively affect the nervous system, eating right and listening to the state of the body in order to prevent the disease from returning.
Assessment of neuropathic pain
Your healthcare provider will regularly ask you questions about your pain, such as:
- Rate your pain on a scale of 0 to 10. 0 is no pain and 10 is the worst pain you've ever experienced. If you are unable to assess your pain using numbers, you may be asked to describe it with words such as none, mild, moderate, severe, or intolerable.
For more information on how to describe pain, watch the video below.
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