Peripheral neuropathy is a condition where the nerves in the peripheral nervous system become damaged; which leads to weakness, numbness and pain, usually in the hands and feet. Peripheral nerve disorders are very common neurological problems and are often seen in an outpatient setting.
Peripheral neuropathies can happen in either motor nerves, sensory nerves and autonomic nerves. Motor nerves control the movement of all muscles under voluntary conscious control (ability to walk, grasp objects, or the ability to talk). Sensory nerves transmit information from sensory organs through the spinal cord to the brain and lastly autonomic nerves that control involuntary body functions such as breathing, food digesting and heart beating.
It is estimated that 2% to 7% of the population suffered from such disorders and those who are older are at higher risk. A study shows that 8% of those aged 55 years and above are suffered from peripheral neuropathy. People with certain diseases will have a higher risk of possessing peripheral neuropathy; studies show that those with type 2 diabetes mellitus are on way higher risk than those who don’t.
The common causes of peripheral neuropathy include
- Immune-mediated neuropathies （Guillain-Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, Sjogren’s Syndrome and systemic lupus erythematosus）
- Diabetes and impaired glucose tolerance
- Vitamin B1 deficiency (happens in those undergone laparoscopic gastric banding, alcoholism)
- Vitamin B6 deficiency (concurrent use of medicines such as isoniazid and hydralazine, alcoholism and peritoneal dialysis)
- Vitamin B12 deficiency (lack of dietary vitamin B12 and inability to absorb vitamin B12)
- Heavy metal poisoning (lead, mercury, arsenic and thallium)
- Neurotoxic drugs
- Infections like HIV, hepatitis C
The presentation and symptoms are different among each patient and they are depending on the type of nerves that are affected. Patients may complain feeling of numbness, tingling, burning, aching, swelling, tightness and electric-like shocks in the distal lower extremities. In severe cases, the symptoms can spread upward toward the torso and other central parts of the body. These may lead to muscle cramps, muscle weakness, paralysis, atrophy of the foot muscles and ankle weakness as well as with the increased risk of falls and loss of dexterity. When autonomic nerves are affected (autonomic neuropathy), the patient may experience urinary hesitancy, early satiety, diarrhea or constipation, weight loss, sexual performance problems, sweating disturbances, abnormal blood pressure or heart rate and light-headedness.
Peripheral neuropathy is very worrying as it can lead to many serious complications. Diabetic patients with peripheral neuropathy are prone to develop diabetic foot ulcers and subsequently gangrene; though gangrene can also occur among non-diabetic patients as a result of an infected wound that goes unnoticed due to numbness or loss of sensation due to peripheral neuropathy. Patients with peripheral neuropathy also at risk of developing cardiovascular autonomic neuropathy (CAN); which eventually leads to cardiovascular mortality.
The current treatment for peripheral neuropathy includes the treatment of underlying cause and managing the symptoms experienced by the patient. The usual treatment for peripheral neuropathy includes:
- Treating the deficiency of vitamin B1, B6 and B12 (https://biobay.com.my/product/biobay-methylcobalamin-plus/)
- Controlling patients’ blood glucose level (lifestyles modifications, dietary management, administration of hypoglycaemic drugs) (https://biobay.com.my/product/biobay-gym-cumin/)
- Immune-mediated neuropathies can improve with the treatment of autoimmune disease like using immunosuppressants
- Physical treatment, injections and surgery
In addition to the above management, below measures can be conducted by the patients at home in order to manage their peripheral neuropathy.
- Patients should be advised to take care of their feet, especially in those with diabetes. Proper foot care includes daily checking of blisters, cuts, or calluses.
- The patient is advised to exercise at least 3 times or more in a week. The recommended exercise includes brisk walking, yoga, swimming, and tai chi.
- Patients may also opt for physiotherapy and occupational therapy in order to increase their strength, improve their balance and range of motion.
- Use of walking aids
- Smoking cessation
- Practice healthy eating
- Avoiding alcohol consumption.
In conclusion, peripheral neuropathy is a common neurological disorder if left untreated can leads to many serious complications. Therefore, people with this disorder should closely manage the condition in order to improve their quality of life.