Symptoms of polyneuropathy

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.

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.

Sock- and glove-shaped polyneuropathy

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.

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