Polyneuropathy

Polyneuropathy is damage and functional impairment of the peripheral nervous system, which includes all nerves outside the central nervous system, i.e. the brain and spinal cord. The peripheral nerves are divided in their functionality into motor, sensory and autonomic forms. Depending on which type of nerve is damaged, there are sensory disturbances, sensory disturbances and pain in the affected areas of the body. A polyneuropathy usually occurs as a consequence of another disease and therefore does not represent an independent disease. It can be congenital or acquired, with diabetes mellitus and alcohol abuse being among the most common causes of acquired forms. About two to three percent of the general population suffers from polyneuropathy. The disease usually begins insidiously on the feet or hands and progresses from there in a stocking or glove-like fashion. As the disease progresses, it can weaken or even eliminate reflexes and lead to paralysis, muscle weakness and atrophy. Internal organs can also be affected by polyneuropathy and cause disorders there.

this text has been written according to the highest scientific standards and has been examined by medical experts.

Last updated: 6. July, 2021

TABLE OF CONTENTS

What does medicine mean by polyneuropathy??

In medicine, the term polyneuropathy is used as an umbrella term for certain diseases of the peripheral nervous system that affect several nerves. Depending on the cause of the disease, motor, sensory or autonomic nerves are damaged. Polyneuropathy mainly affects the longest and most distal nerves that supply the hands and feet.

Which forms of polyneuropathy are there??

Since there are about 600 types of polyneuropathy, specialists need a useful classification system to make an accurate diagnosis.

What are the most common forms of polyneuropathy??

The most common acquired forms include diabetic and alcoholic polyneuropathy:

What is the peripheral nervous system and its function??

The peripheral nervous system (PNS) includes all nerves that lie outside the brain and spinal cord, i.e. outside the central nervous system (CNS). However, both nervous systems are interconnected. The PNS transmits impulses from the CNS to the organs and tissues it supplies and thus ensures their functionality.

What are nerves, where are they located and what are their functions?

The term nerve comes from the latin nervus, which means thread, tendon or cord. This is a nerve cell, technically known as a neuron, together with parallel running nerve fibers, so-called axons and dendrites, which are surrounded by an insulating connective tissue sheath, the so-called myelin sheath.

What are the symptoms of polyneuropathy??

the symptoms of polyneuropathy depend on the damaged nerves. Doctors therefore distinguish between motor, autonomic and sensory disorders. Doctors also differentiate the symptoms according to their distribution on the body. Since the symptoms usually occur on both sides, specialists speak of a symmetrical polyneuropathy.

What are the symptoms of diabetic polyneuropathy??

The typical symptoms of a diabetic polyneuropathy are numbness or painful tingling in the hands and feet. Many sufferers experience a burning pain in their feet, which doctors call burning-feet syndrome.

What are the symptoms of alcoholic polyneuropathy??

Alcoholic polyneuropathy normally progresses slowly and manifests itself in the form of bilateral pain, insensitivity, sensory disturbances, muscle atrophy and severe muscle atrophy. Affected persons are often no longer able to stand properly.

What are the causes of polyneuropathy??

Currently, more than 200 triggers of the disease are known to the medical community, although doctors are not always able to determine a specific cause. However, polyneuropathy is most often caused by diabetes or alcohol abuse.

Which risk factors favor the development of a polyneuropathy??

Sooner or later, diabetes and excessive alcohol consumption can lead to polyneuropathy. The first signs, such as pain and tingling in the arms and legs, should therefore be taken seriously. In the worst case, a one-sided diet or stomach surgery can also cause an outbreak of the disease.

Which part of the nerve cells is damaged in polyneuropathy??

A nerve cell consists of a cell body and a long nerve extension, the so-called axon. If the disease affects the axon itself and damages it, physicians call it an axonal polyneuropathy.

How does the doctor diagnose polyneuropathy and its causes??

If you experience symptoms, you should consult a neurologist or a neurological outpatient clinic. In an initial anamnesis, the doctor will try to find out what symptoms you have and how long you have had these complaints.

Which therapy methods are used for polyneuropathy??

The therapy of a polyneuropathy depends on the determined cause as well as the symptoms. The following therapeutic measures are used:

What can i do myself against polyneuropathy??

You should pay attention to a balanced diet and exercise regularly, as well as perform physiotherapeutic exercises, so that there are no movement restrictions.

What is the course of a polyneuropathy??

Depending on the length of the disease, doctors distinguish between an acute course – about four weeks – subacute – four to eight weeks – and chronic course – longer than eight weeks. Basically, the course of the disease can be positively influenced by the early use of the right therapy.

What is the prognosis of polyneuropathy??

A cure is usually not possible for a slow-onset polyneuropathy. Nevertheless, the functional limitations in everyday life are limited. However, the prognosis is generally better the earlier the nerve damage is recognized and treated.

How can I prevent polyneuropathy??

Basically, you should consult a doctor at the first signs of pain or discomfort. Especially after infections, such as measles or herpes, you should pay special attention to possible indications.

How much does the treatment of a polyneuropathy cost??

Depending on the method and medication used, the cost of treatment can vary. If you need rehabilitation, it can cost between 300 and 400 euros per day.

Does health insurance cover the costs of polyneuropathy??

The health insurance companies cover the cost of any appropriate diagnostic and therapeutic measures necessary for the diagnosis and treatment of polyneuropathy.

Summary of the most important facts

Polyneuropathy is a group of disorders in which several or many peripheral nerves are damaged

The most common causes are diabetes, alcohol abuse or medication

Common complaints are pain, tingling, sensory disturbances, sensitivity disorders and numbness in the legs and/or arms. Muscle weakness, muscle spasms and paralysis may occur as a consequence of these disorders. In severe cases, disturbances of bladder emptying, digestion or potency as well as life-threatening cardiac arrhythmias can occur

A polyneuropathy is treated causally, if possible. painkillers, antidepressants, antispasmodics or physical therapy methods are used

ICD-10-GM-2020 G60-64

What does medicine understand by polyneuropathy??

In medicine, the term polyneuropathy is used as an umbrella term for certain diseases of the peripheral nervous system that affect several nerves. Depending on the cause of the disease, motor, sensory or autonomic nerves are damaged. Polyneuropathy primarily affects the longest and most distal nerves that supply the hands and feet.

Rather more rarely the illness occurs close to the body. Depending on the type of nerve fiber involved and the region of the body affected, patients experience different symptoms. Doctors distinguish between acute and chronic courses. They also differentiate between symmetrical (focal) and asymmetrical (multifocal) and between congenital and acquired forms of polyneuropathy. The most common forms of symmetrical polyneuropathies are diabetic polyneuropathy, caused by diabetes mellitus, and alcoholic polyneuropathy, caused by alcohol abuse.

What are the different forms of polyneuropathy??

Since there are approximately 600 types of polyneuropathy, specialists need a useful classification system to make an accurate diagnosis.

Doctors make a basic distinction as to where the disease originated, i.e distal – distal to the extremities or proximal – body close to the torso. For the diagnosis, it is also important to ask whether a polyneuropathy takes an acute course – lasting up to four weeks, a subacute course – lasting between four and eight weeks, or a chronic course – lasting longer than eight weeks.

The fact whether the polyneuropathy is symmetrical or asymmetrical also plays a role, the presence of the disease on both sides or on one side has a major influence on an accurate diagnosis. A further distinction is made in medicine with regard to the accompanying symptoms, i.e. whether other (pre-)diseases, such as ataxia or cranial nerve involvement, are present.

The final differentiation is made by means of electroneurography, which doctors use to examine the function of nerves and thus also detect possible damage to individual nerves. Polyneuropathy can affect either the insulating layer of the nerves, known medically as myelin, or the nerve fibers, known as axons, themselves. Doctors refer to this as either a demyelinating or axonal polyneuropathy.

In principle, polyneuropathies can be congenital or acquired, although congenital forms are much less common. They are usually caused by a hereditary disease, such as enzyme defects, altered proteins or restricted nerve conduction velocity. Acquired polyneuropathies, on the other hand, develop as a consequence of other diseases or an external trigger.

What are the most common forms of polyneuropathy??

The most common forms acquired include diabetic and alcoholic polyneuropathy:

  • Diabetic polyneuropathy: due to long-standing and/or poorly controlled diabetes, vascular damage can occur, resulting in inadequate nourishment of the peripheral nerves. As a result, metabolic products are deposited, which can cause a loss of function of the nerves and thus a reduced feeling of pain and temperature in the toes and feet. In some cases, this also affects the autonomic nervous system. Doctors then speak of an autonomic polyneuropathy.
  • Alcoholic polyneuropathy: this form is caused by the neurotoxic effect of chronic alcohol consumption, which leads to damage to the peripheral nerves. This causes an increased sensation of pain in the affected person. Alcoholic polyneuropathy belongs to the group of toxic polyneuropathies, which can also be caused by drugs, lead, arsenic or thallium poisoning.

In addition to these two most common forms, there are the following other known types of polyneuropathy:

  • Uremic or nephrogenic polyneuropathy: this form usually develops in dialysis patients and people with long-term renal insufficiency. Substances that should normally be excreted in the urine are deposited in the kidneys and thus damage the nerves.
  • Infectious polyneuropathy: this form can occur as a result of borreliosis, tick-borne encephalitis (TBE), measles, herpes, HIV, diphtheria or malaria.
  • Guillain-barre syndrome: Guillain-barre syndrome usually occurs after a gastrointestinal or respiratory tract infection and often begins with sensory disturbances and paralysis in the feet. This is a misdirected reaction of the immune system, due to which the peripheral nerves are damaged.

What is the peripheral nervous system and its function??

The peripheral nervous system (PNS) includes all nerves that lie outside the brain and spinal cord, i.e. outside the central nervous system (CNS). However, both nervous systems are interconnected. The PNS transmits impulses from the CNS to the organs and tissues to be supplied and thus ensures their functionality.

Both nervous systems are subdivided into a somatic, voluntary nervous system for the planning and control of voluntary movements and reflexes and an autonomic, vegetative, involuntary nervous system. The latter controls vital functions such as respiration, metabolism and digestion.

What are nerves, where are they located and what are their functions??

The term nerve comes from the Latin nervus, which means thread, tendon or cord. It is a nerve cell, technically known as a neuron, together with parallel nerve fibers, so-called axons and dendrites, which are surrounded by an insulating connective tissue sheath, the so-called myelin sheath.

Nerves belong to the peripheral nervous system and serve to receive and transmit impulses. Doctors divide nerves according to their function:

  • Motor nerves: these nerves send impulses to your muscles to regulate movement.
  • Sensory nerves: with sensory nerves, you can register all signals of sensation such as pain, touch, pressure, temperature, etc. As well as perceive information about the position of your joints and muscles.
  • Autonomic nerves: the autonomic nerves run to your internal organs and regulate heart rate, blood pressure, sweat production, and breathing and digestion.

What are the symptoms of polyneuropathy??

The symptoms of a polyneuropathy depend on the damaged nerves. Doctors therefore distinguish between motor, autonomic and sensory disorders. In addition, physicians differentiate the symptoms on the basis of the distribution on the body. Since the symptoms usually occur on both sides, specialists speak of a symmetrical polyneuropathy.

Unilateral nerve damage is known as asymmetric polyneuropathy. When the disease particularly affects regions of the body that are further away from the trunk, such as the hands or feet, doctors refer to it as a distal polyneuropathy, and when it is close to the trunk, they refer to it as a proximal polyneuropathy.

Different symptoms also occur in the acute and chronic course of the disease. Acute polyneuropathy, such as Guillain-barre syndrome, is initially characterized by tingling and paraesthesia in both legs, which quickly spreads to the arms. The respiratory muscles can also be affected, which can lead to respiratory failure.

More often, however, a chronic course of the disease occurs, which becomes apparent primarily through sensory disturbances, such as numbness, tingling, a burning pain, as well as the loss of the sense of vibration and the sense of position. This is manifested by a shaky gait and subsequent muscle wasting.

In summary, the following are common symptoms:

  • Tingling and numbness in the hands, fingers, feet and toes, often accompanied by pain or cramps
  • Impairment of muscle strength and function, such as dropping objects or involuntary leg movements in restless legs syndrome

If left untreated, it can lead to muscle weakness and muscle wasting as well as gait instability. In addition, affected persons often suffer from a reduced sensation of temperature or pain or feel a burning sensation on the skin. Pressure pain due to an undersupply of the damaged nerves can also occur as the disease progresses. If the autonomic nervous system is also affected, dizziness and nausea, gastrointestinal complaints, constipation, diarrhea, bladder emptying disorders or even impotence often occur.

What are the symptoms of diabetic polyneuropathy??

The typical symptoms of diabetic polyneuropathy are numbness or painful tingling in the hands and feet. Many sufferers experience a burning pain in their feet, which physicians refer to as burning-feet syndrome.

Patients feel the pain particularly bad at night or when they are at rest. These can even be aggravated by touch or temperature changes. People with diabetic polyneuropathy often have a weakened sense of pain, so that small wounds often go unnoticed and injuries, especially to the joints, occur more frequently.

If additional damage to autonomic nerves occurs as the disease progresses, complaints such as bowel dysfunction and bladder control, dysphagia, and male potency problems may occur.

What are the symptoms of alcoholic polyneuropathy??

Alcoholic polyneuropathy usually progresses slowly and manifests itself as bilateral pain, sensory disturbances, sensory disturbances, muscle atrophy and severe muscle atrophy. Affected persons are often no longer able to stand properly. In more severe cases, there may also be pupillary dysfunction or ocular muscle paralysis.

What are the causes of polyneuropathy??

Currently, more than 200 triggers of the disease are known to the medical community, although doctors are not always able to determine a specific cause. However, polyneuropathy is most often caused by diabetes or alcohol abuse. More rarely, the disease is caused by hormonal, injury-related, infectious or internal diseases, as well as autoimmune diseases, which cause damage to the nerves. Other causes may include toxic substances, medications or nutrient deficiencies, and tumor diseases.

Which risk factors favor the development of a polyneuropathy??

Above all, diabetes and excessive alcohol consumption can sooner or later lead to a polyneuropathy. The first signs, such as pain and tingling in the arms and legs, should therefore be taken seriously. Even an unbalanced diet or stomach surgery can, in the worst case, cause an outbreak of disease.

People with kidney disease, liver disease or hypothyroidism also have an increased risk of developing polyneuropathy, as this can damage the peripheral nerves. Drugs used in cancer therapy in particular can cause polyneuropathy. This also applies to toxins such as arsenic or thallium. Some people have a hereditary predisposition, which is why they also have an increased risk of contracting the disease.

Which part of the nerve cells is damaged in polyneuropathy??

A nerve cell consists of a cell body and a long nerve extension, the so-called axon. If the disease affects the axon itself and damages it, physicians refer to it as axonal polyneuropathy. However, if the insulating layer, medically called myelin layer, which surrounds the axon and accelerates the transmission of the electrical nerve signals, is damaged, doctors speak of a demyelinating polyneuropathy.

How does the doctor diagnose polyneuropathy and its causes??

If you experience any symptoms, you should consult a neurologist or a neurological outpatient clinic. In an initial consultation, the doctor will try to find out what your symptoms are and how long you have had them.

This is followed by a physical examination, during which the physician checks the reflexes and looks for possible skeletal malformations, as well as special tests that can indicate the presence of a polyneuropathy:

  • Electromyography: the electrical activity of the muscles is measured. Based on the results, the doctor can determine whether motor disturbances occur in the muscle itself or in the nerves that supply it.
  • Electroneurography: this test measures the nerve conduction velocity of certain peripheral nerves. If you have a disease, this conductivity is often reduced.
  • Lumbar puncture: the doctor takes fluid from the spinal cord and examines it for antibodies, tumor cells and inflammation.
  • Biopsy of peripheral nerves: the specialist removes a small sample of the nerve tissue through a small incision in the skin and then examines it under the microscope.
  • Blood tests: based on the values, the doctor can determine whether there is a deficiency of vitamins B12 and B1, B3, B6, folic acid and vitamin E, or whether inflammation, liver or kidney disease is present.

If autonomic nerve damage is suspected, the doctor may also order an electrocardiogram to determine whether the nerve fibers of the heart are affected. In addition, an ultrasound examination of the bladder can show whether residual urine remains in the bladder after urination.

Which therapy methods are used for polyneuropathy??

The therapy of a polyneuropathy depends on the determined cause as well as the symptoms. The following therapeutic measures are used:

Pain therapy

Since polyneuropathy often causes pain, doctors recommend painkillers such as acetylsalicylic acid or paracetamol. In cases of severe pain, doctors often prescribe opioids. However, these drugs can be less effective and become addictive.

In addition, physicians use anticonvulsants, so-called antiepileptics, or mood-lifting drugs, i.e. antidepressants, which reduce the sensation of pain. In addition to medication, some sufferers resort to transcutaneous electrical nerve stimulation, or TENS for short. Electrical impulses, which are emitted into the skin via electrodes, dull the pain.

Physical therapy

Especially for sensitive and motor disorders, the application of physical therapies, such as physiotherapy, alternating baths or electro treatments, has proven to be effective. These procedures improve the blood circulation and strengthen the muscles. This preserves the patient’s mobility and agility.

Further measures

Further measures may include the administration of antibiotics in the case of infections or the intake of vitamins in the case of nutrient deficiencies. If you have difficulty walking, orthopedic aids can provide relief.

What can i do myself against polyneuropathy??

You should eat a balanced diet and exercise regularly, as well as perform physiotherapy exercises to avoid movement restrictions.

What is the course of a polyneuropathy??

Depending on the length of the illness, doctors differentiate between an acute course – about four weeks – subacute – four to eight weeks – and chronic – longer than eight weeks. In principle, the course of the disease can be positively influenced by the early use of the right therapy.

The disease usually starts on both sides of the feet and becomes noticeable through insensitivity or the absence of cold, heat and pain sensations. From there it spreads upwards in the shape of a limb. Afterwards a weakening of the reflexes or their extinction can occur. Paralysis, muscle weakness and muscle atrophy can only occur at a later stage.

The disease can also affect the internal organs and cause bladder or digestive disorders, erectile dysfunction and cardiac arrhythmias. In rare cases, a very fast-acting form of polyneuropathy, known as guillain-barre syndrome, can occur, which in severe cases may require close inpatient monitoring to prevent cardiac arrest.

What is the prognosis of polyneuropathy??

A cure is not possible in most cases of slow polyneuropathy. Nevertheless, the functional limitations in everyday life are limited. In principle, however, the prognosis is better the earlier the nerve damage is recognized and treated.

Unfortunately, the disease often goes unnoticed, which is why it is often already advanced at the time of diagnosis. In most cases, the nerve damage can no longer be reversed and a complete recovery is no longer possible. Nevertheless, the right measures prevent further nerve damage and alleviate existing symptoms.

How can I prevent polyneuropathy??

Basically, you should consult a doctor at the first sign of pain or discomfort. Especially after infections, such as measles or herpes, you should pay particular attention to possible indications.

If you have diabetes, good self-monitoring of blood sugar, detailed nutritional advice and plenty of exercise will help. You should also have your blood values checked regularly and pay attention to your feet, as you cannot feel injuries as well in polyneuropathy. In the case of excessive alcohol consumption, you should contact a self-help group or seek therapy in order to become sober more easily.

How much does the treatment of polyneuropathy cost??

Depending on the method and the medication used, the cost of the treatment can vary. If you need rehabilitation, it can cost between 300 and 400 euros per day. A prescription fee must be paid for medications. The best thing to do is to ask your doctor in advance.

Does the health insurance cover the costs of a polyneuropathy??

Health insurance companies cover the costs of all appropriate diagnostic and therapeutic measures necessary for the diagnosis and treatment of polyneuropathy.

For certain examinations, however, the approval of the responsible health insurance carrier, the medical service or the chief physician, may be necessary. In addition, insurance carriers cover the costs of rehabilitation, but a deductible may also apply.

If you have private insurance, it’s best to find out in advance from your insurance provider which costs will be covered and which will not. An examination by an elective doctor may result in higher costs, but these will be at least partially reimbursed after submission to your insurance carrier.

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