Symptoms of polyneuropathy

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How does a polyneuropathy feel?? What do you feel as an affected person?? Does a polyneuropathy always manifest itself in the same way or do the symptoms differ depending on the underlying disease?? Which body regions are affected?

This lesson is dedicated to symptoms of polyneuropathy, ranging from barely perceptible tingling to muscle cramps.

OA dr. Med. Adalbert Weissmann, senior physician at the 1. Medical department at the wilhelminenspital, answers in the video "symptoms of polyneuropathy following questions:

Video transcript

What can be the first signs of nerve damage?

The first signs of chronic nerve damage can be tingling sensations in the fingers or toes, a persistent feeling of coldness or. An increase in these sensory disturbances when exposed to cold, for example, when walking in winter without gloves or reaching for a bottle in the refrigerator and feeling slight pain.

When do they usually occur?

Symptoms of these neuropathies appear after one to three months, depending on the intensity of therapy. They usually increase during ongoing therapy.

What symptoms should I pay special attention to?

Symptoms that you should in any case mention when consulting your doctor on this subject are

Ants running,
Tingling sensations in the toes and fingers,
Possibly beginning pain, which can be partly stinging and burning,
restlessness during the night in the sense of restless legs syndrome
Or cramps.

Why are the feet often affected at an early stage?

The first symptoms usually appear on the feet or toes, because here the nerves have to travel the longest distances until they reach the target organ. Therefore, the points of attack for chemotherapy or harmful immunotherapy are much greater.

Why do the symptoms come and go from time to time??

The different intensity of the symptoms as experienced by patients is quite dependent on various factors that are not necessarily related to the primary causative drug.

For example, different concomitant medications may cause patients to feel more or less pain. But also temperature fluctuations, i.e. seasonal differences in pain intensity, can be perceived by the patient.

When should I discuss the symptoms with my treatment team??

In any case, you should discuss the symptoms with your doctor as part of your routine check-ups so that the appropriate concomitant medication can be adjusted accordingly. In the meantime, you should also ask your doctor about problems or a change in the problem situations, if the intensity of the complaints should suddenly increase or if other, previously unknown complaints should occur in addition to it.

How do effects on the central nervous system (brain, spinal cord) become noticeable??

By definition, there are no effects on the central nervous system in peripheral neuropathy, which is classified as peripheral.

However, neuropathies can also occur close to the center, i.e. in the head area, and affect eye muscles, the hearing organ or taste sensations.

Why can hearing, walking and balance problems occur??

The quite frequent problem of balance disturbances, which then lead to walking problems and mobility problems, is mostly not one of the usual vertigo in the area of the inner ear system. The causes lie in the area of motor coordination, deep sensation and therefore also the mechanical balance, which is to be established via the legs and the peripheral musculature.

Why can vision problems occur?

visual disturbances are not infrequently caused by neuropathic affection of the visual muscles. The visual muscles ensure the motor function of the eyeball.

How can polyneuropathy affect everyday life and work??

The impact of a neuropathy problem on everyday life is often underestimated.

Sensory neuropathy can be extraordinarily obstructive in everyday activities such as fastening a shirt button, picking up small objects from a flat surface, or tying shoe laces, and can require assistance from others. The possible additional painful component is then, of course, an even greater obstacle and handicap for everyday life.

In professional life, and many of our patients continue to work full time, these problems can of course be extremely disruptive, both in terms of manual activities and mobility.

How do temperature-independent and cold-induced polyneuropathies differ??

There are substances that cause mainly cold-dependent and cold-induced neuropathies. This includes, above all, oxaliplatin. These symptoms can be modified by temperature changes, although a warmer environment is usually considered quite comfortable. On the other hand, there are also situations, for example at night, where the warmth of a blanket is hardly tolerated.

Cold-independent neuropathies are caused by other substances and tend to be constant in intensity.

To the point

the symptoms depend on the choice of the substance.
Possible signs are: formication in toes and fingers, pain, restlessness during the night, cramps, persistent feeling of cold or increase of sensations when cold.

The typical appearance of the symptoms

Since the vulnerability of nerve fibers increases with their length, polyneuropathy is often first noticed on the feet.

This is where sensations of discomfort occur, such as tingling, tingling, ant walking or electrifying at. Subsequently, the hands, especially the fingertips, are affected.

The pattern of manifestations is typical for polyneuropathy: the complaints are described by patients as "sock-shaped" and on the hands as "glove-like" described.

What types of symptoms are there??

Polyneuropathic damage mainly affects sensitive nerves.

In the affected areas, so-called negative sensations caused by a Decrease in sensitivity. These include:

numbness
Decreased touch sensation
Decreased temperature sensation
Decreased sensation of pain

On the other hand, so-called "positive" sensory disturbances in addition, such as:

tingling
Tingling
formication
Electrify

If you, as the affected person, perceive the paraesthesia without finding it disturbing, this is called paresthesia. If the symptoms increase to an unpleasant but not yet painful level, this is called dysesthesia. Burning to stabbing (neuropathic) pain may occur as a consequence.

Quite common are restrictions in the fine motor skills of the hands as well as a decreased deep sensitivity symptoms of polyneuropathy. It leads to disturbances in coordination, for example, swaying dizziness and insecurity of balance when standing and walking. These balance insecurities are most pronounced in the dark and with eyes closed. In chemotherapy-induced polyneuropathies, damage to the nerves can also cause Disturbances of the sense of hearing and the sense of taste before.

More rarely, motor nerve pathways are affected. In this case it can lead to weakness, twitching or spasms in muscles The sensory nerves are supplied by peripheral nerves. If the corresponding cranial nerves are damaged, visual disturbances may be the result due to a restriction of eye muscle function.

If the polyneuropathy affects the autonomic nervous system, there may be dry skin or increased sweating occurrence, problems with urination, digestion and dysphagia. Also effects on the cardiovascular system with increased or decreased blood pressure, heart palpitations or heart stuttering occur.

When and how long do the symptoms appear??

When symptoms of chemotherapy-induced polyneuropathy occur and how long they last varies greatly from patient to patient and from preparation to preparation. Symptoms may begin during the first infusion and subside on the same day. It may not appear until the third cycle and may subside after chemotherapy is completed. In the best case, they disappear completely within the following months. Sometimes symptoms appear only after chemotherapy and then increase in severity. They can also persist for years or forever. If the therapy is continued unchanged despite symptoms, a worsening of the symptoms is to be expected.

how does polyneuropathy affect everyday life?

The sensory disturbances alone cause problems in everyday life for those affected. A decrease in dexterity of the hands makes many everyday actions difficult, such as fastening shirt buttons, picking up small objects, or tying shoe laces.

Refrigerator temperature may feel unpleasantly cold; conversely, warmth under the covers or in the shower may feel unbearably hot.

Dizziness and insecurity of balance can increase the risk of falling, especially in older people, and lead to consequential injuries. Impaired coordination can make it difficult to use the pedals and steering and impossible to drive or ride a bicycle independently.

If pain is also present, this places an additional burden on the patient. Often a mere touch is felt as painful. Pain restricts mobility and the desire to engage in activities and can mean a loss of quality of life.

Learn more about the symptoms of a polyneuropathy from the perspective of an affected person in the lesson experience report of an affected person.

Did you know

Polyneuropathy is not a dangerous disease. However, it reduces the quality of life, the importance of which cannot be overestimated. Reason enough for patients and physicians to take a polyneuropathic disease seriously, to clarify it immediately and to treat it properly.

Sylt is an island, as you know, without a direct connection to the road traffic by a bridge. Simply driving over with the car is not necessary.

the classic way, if you still want to take your car with you, is to cross the hindenburgdamm by car train. opened in the 1920s, the dam connects the mainland of schleswig-holstein with the easternmost tip of sylt via a railroad line, making it much easier and shorter for tourists and commuters than the previously usual journey of several hours by ferry from the danish coast.

With the car in the car train

The cars, including all their occupants, travel one after the other in the loading terminal in niebull on the mainland in the seemingly endless rows of wagons of the two providers ‘autozug sylt’ (blue) or ‘sylt shuttle der DB’ (red).

You should decide on a provider early on, even before the traffic circle, and rank accordingly; it is no longer possible to change at the payment gates later on. Once you have reached your place on a wagon, you have to do nothing for more than half an hour, because the train takes you and your car in a row over the dam to the station in westerland on the island of sylt. you can not get off!

The car train: typical for sylt. Somewhere one is always rattling along.

Especially during the vacation season, there can be long traffic jams at the terminals, so it’s best to book online in advance. i still remember the car trips with my family when i was a child, long before there was internet: the waiting time around the loading onto the motorail train was always a critical time for the nerves of all involved and the family peace after the already hours-long journey from cologne.

And only when you were squeezed in between other vacationers in the car in front of and behind you, when the train finally rattled off and you could already see the sea to the left and right, then you had almost made it and recreation, vacations and relaxation were within your grasp.

The see! There she is! All right, the tide is out, but that’s a sign: we’re almost there!

By train (without car)

But you don’t really need a car on sylt, because all the villages on the island are well served by the public bus system.

But you can travel to sylt with the german train, e.g. by car.B. Like us from cologne to westerland in 7.5 hours (okay, not exactly in the twinkling of an eye, but doable), and the whole nonstop, without changing trains! If you’re lucky enough to get a Sparpreis ticket from deutsche bahn, the entire journey costs just an incredible €20, and all children under 15 travel for free. You just have to specify it on the ticket when booking.

We like to travel by train. The possibility to take your own children with you at no extra charge is simply great for single parents, and for complete families in general, of course. If you book a family reservation for another 9€, with a little luck you will get seats in a compartment or at least at a table for 4 people.

Even if they are all taken, as it happened to us on our last short trip, you have to be honest, that even the space in the normal rows of seats is far beyond what you get in an average plane nowadays. We were really positively surprised.

Especially when traveling with very small or inexperienced children, I would always try to get at least seats at a table, so that you can spread out, or directly in a compartment, where you have more peace and quiet.

View from the train window – still on the mainland. but you can already smell the sea, soon we will be on the island!

For the crossing to sylt you can choose – as a group of people without a car – between the regional express and an extra passenger car, which is attached to the car train.

The crossing with the regionalexpress is ca. a quarter of an hour faster, because the car train still has to shunt first, but for us (one adult, two children) the slightly longer crossing, attached to the car train, was much cheaper, so we usually chose this variant.

More exact infos for the respective constellation one checks best over the reservation side of the German course, at the automat or in personal consultation directly at the counter. With the latter, however, you have to calculate waiting times most of the time.

arrival at the train station in westerland – we are here, on sylt!

In westerland itself we were not on the way, only once we left the nostalgic train station in the direction of the city for a short shopping trip.

By plane, like the celebrities

Yes, sylt has its own airport, two kilometers from westerland. It takes just one hour to fly to the island.B. From cologne, you can dig your bare toes into the sand and let the wind blow around your nose.

There are no public transport connections, at least we didn’t find any. We speculate that the usual passengers will probably be taken there by shuttle or directly by the chauffeur. We, as non-high-society-members, try to get a cab for the short distance from the train station in westerland.

the disadvantage of this way of traveling: of course it is not exactly cheap. However, the z.B. With eurowings often only for the outbound flights, the return flights can sometimes be had for a small amount of money. And so we did it: there quite comfortably in a good 7 hours by train, then back in no time for a not super cheap, but manageable amount by airplane. Jetset-like, much to the pleasure of the children.

sylt’s small airport also has – at least partially – a thatched roof. Departure on the left, arrival on the right: that’s it.

the smallest airport we have flown from so far: from the waiting area you can look directly onto the tarmac where the plane is about to land.

The airport itself is rather manageable and has almost cozy living room character. Hectic hustle and bustle is not to be found here. a bakery, which we had hoped for, since our plane leaves early in the morning, is not here either, but there is a tiny branch of the "sansibar", ubiquitous on sylt, with sweet rolls with hearty toppings, excellent coffee and a charming, slightly graying, honorable italian, who takes care of the whole thing with dignity and form, while in the background – of course – adriano celentano casually sings to himself.

And with ‘azzurro’ in our ears, we soon find ourselves humming to the beat and chewing happily on the few seats in the small waiting area as we wait for our flight home. Goodbye, sylt!

there is no bakery at the sylt airport, it is too small for that, as we discover hungry early in the morning. But in style there is even here a tiny offshoot of the zanzibar!

Playing cards, winning tricks, and then really stepping on the gas to win the race with your car in the end. In addition to the hand cards and the car, each player also receives a round cardboard disc, which is supposed to symbolize the motor. This engine can be further charged in the course of the game by means of a wind-up screw, so that the additional power can be used later, quasi as a turbo. This is stich rallye from H. J. Kook (amigo games). Currently it is on sale from ca. 13.39 euro available.

How does stich rallye?

In the game, there are fifteen ascending cards in each of three colors. As is usual in trick-taking games, the players take turns to play their hand cards, whereby the first card suit laid out must be served. If all players can use the required color, the highest card in this color wins the trick. The player who wins this trick may speed away with his car on the circuit as many fields as the value of the lowest card in this trick.

Unusual stitch mechanism

It gets interesting when the other players are not able to use the required color. As soon as a second color is played, the card with the highest value in the second color wins the trick. If there are even three colors at the end, the card with the highest value in the last color played, i.e. in the third color, wins this trick. This is really an unusual score for a tricks game, but it makes it all the more interesting.

Cute cars at Stich Rallye - photo by Axel Bungart

Loading the turnbo.

As said before, the winner of each trick is allowed to move his corresponding car forward on the race track. However, all other players who have lost the respective trick are allowed to move their engine up by one counter. To do this, they simply move the pointer on their cardboard disc to the next higher digit.

Whenever you win a trick, you can use the entire value on this counter as an additional turbo, if you wish, in order to advance your car an additional number of spaces. This allows nice tactical considerations, as it has uphill climbs and also downhill again on the race track. If you come to a stop on an ascending field, the car slides back into the valley. However, if you land above the crest of the hill on a downhill field, you use downward momentum and additionally slide forward with your car toward the goal. there you have to think about when to bring your turbo into play to position your car favorably or to move additional fields this way.

stitch rally is played in three rounds and at the end of each round the players have to use up all their turbo. Whoever is the first to cross the finish line twice or is in the lead after the three rounds wins the race and thus the game.

Family game with an unusual flow

The idea is not really new, because there was already a very similar game from the series “unser lieblingsspiel” resp. The so-called pirate game from the bookmark publisher. This was also a racing game, which worked pretty much the same or. The same game mechanics possessed. It was a ship race around the treasure island, where you could move your ships by means of cards and won tricks. nevertheless, author and publisher do much better with stich rallye. The board is very nicely designed and the small cars are easy to handle. The instructions explain the rules of the game quickly and clearly. The ideas with the unusual scoring of the tricks, the ascents and descents on the track and the wind-up or wind-down system are very interesting. Switchable engine turbo, really very successful. by the way, the game also works with two players, but with three or more players the whole thing seems much more rounded.

Stitch Rally - Material - Photo by Amigo Spiele

In addition to the extra power on the racetrack, the turbo also ensures that the field of participants always stays relatively close together, keeping the game really exciting right to the end. Even if the scoring of the tricks seems a bit unusual at first, everything is kept very simple so that even children can play along without any problems, making stitch rallye a perfect family game. We liked this title very much and it will definitely not gather dust in the game shelf. Thus from us a clear recommendation!

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