Polyneuropathy: Information & Qualified Specialists

Polyneuropathy is a very common nerve disorder. The term “polyneuropathy” comes from Greek and means “disease of many nerves.”

It most commonly affects the nerve pathways in the feet and hands. The condition manifests as

• tingling, a “pins-and-needles” sensation, burning, and stinging, as well as
• numbness in individual toes or fingers.

A neurologist refers to this as “sensory involvement.” Paralysis can occur, including in the face. In such cases, the involvement is motor.

If both limbs are affected by polyneuropathy, the condition is symmetrical. This is often the case in the late stages. Initially, however, symptoms may occur only in specific areas, such as the forefoot or one of the two little toes.

Common causes of polyneuropathy include

• diabetes mellitus,
• alcohol abuse,
• kidney disease,
• metabolic disorders,
• inflammation, and
• substances secreted by tumors and environmental toxins, including heavy metals and chemicals.

Chemotherapy and certain medications can also cause side effects affecting the nerves. In such cases, a detailed analysis of the medications being taken is necessary to weigh the benefits against the risks.

Avoiding alcohol is a necessary first step, as alcohol is the second most common cause of polyneuropathy after diabetes. Here, too, the rule “the dose makes the poison” naturally applies.

Hereditary causes of polyneuropathy can be narrowed down through blood and tissue tests.

Polyneuropathy often causes unsteadiness when standing or walking, especially in the dark. Those affected frequently mistake this sensation for dizziness. Patients are often referred to a neurologist to investigate dizziness, who then discovers that they are actually suffering from polyneuropathy of the legs with impaired proprioception.

However, the nerves to the internal organs may also be affected in what is known as autonomic polyneuropathy. Autonomic nerve fibers are nerves that are not under voluntary control and function “on their own.” Disorders of the autonomic nerve fibers affect

• digestion,
• sweat secretion,
• blood pressure, and
• heart rate

.

For example, if the heart loses its normal rhythm, there is a risk of sudden cardiac death.

The autonomic nerve fibers can be measured indirectly. The neurologist first uses special instruments to examine reflexes and vibration sensation.

A weakening or even loss of reflexes is a warning sign and prompts the neurologist to perform further instrumental measurements. The speeds of nerve impulses within the nerve pathways can be assessed using electrical and magnetic stimuli. These nerve conduction velocities are standardized according to age and height.

In cases of polyneuropathy, the nerve roots may also be affected and cause pain similar to that of a herniated disc. Neurologists examine the nerve roots using electrical stimulation and recording so-called F-waves.

It is important to detect blockages in the nerve pathways as they travel from the spinal cord to the hands and feet, segment by segment.

Patients do not notice weakness in individual muscle fibers in the early stages of polyneuropathy. The doctor therefore uses needles to test muscle strength. It is essential to detect any abnormalities before a stepper gait or a drooping hand becomes visible even to the layperson.

Treatment for polyneuropathy is based on

• addressing the underlying causes,
• a balanced diet, including specific dietary supplements,
• pain-relieving medications,
• anti-inflammatory agents, and
• in individual cases, dialysis.

High-frequency therapy is currently offered only in a few specialized medical centers. According to recent studies, this therapy is 80 percent successful in treating polyneuropathy, particularly in people with diabetes.

The patient perceives high-frequency therapy as a deep muscle massage. It can be administered daily without causing side effects. After receiving instruction, the patient can later use the device at home.

In addition to oral medications, another treatment option involves ointments containing a pepper-like active ingredient that are applied topically to the skin.

In each individual case, the specialist must work with the patient to decide which therapy—either alone or in combination—is appropriate. The provision of assistive devices, such as orthoses, and therapeutic interventions, such as physical and occupational therapy, should depend on the stage of the polyneuropathy.

Neurologists are the specialists who treat polyneuropathy. If polyneuropathy is diagnosed, specialists always treat the underlying condition first. Since autoimmune diseases can also damage the nerves, allergists and vascular specialists may also need to be consulted.