Neuropathy and polyneuropathy( neuritis, neuropathy) - Causes, symptoms and treatment. MF.

Neuropathy ( sometimes called neuropathy, these terms are equivalent) - violation of the integrity or inflammation of an individual nerve or myelin sheath; polyneuropathy ( or polyneuropathy) is a diffuse, symmetrical lesion of several peripheral nerves; radiculopathy - spine injury; ganglionitis - node lesion, plexopathy - plexus. In the zone of innervation of the affected nerves, sensory, motor and autonomic changes are manifested, depending on the functional specialization of the nerve.

Neuropathies and their causes:

Neuropathies can be divided into compression-ischemic, inflammatory, toxic, allergic and traumatic, mixed. The latter can be the result of damaging effects of external causes or are caused by endogenous effects, for example, compression of nerve trunks by neighboring structures( muscles, ligaments - the so-called tunnel neuropathies ).This group may include the compression of the spinal roots of the hernia of the intervertebral disc or bone growths - osteophytes.

is more common in compression-ischemic neuropathies of - that is, compression of the neurovascular bundle, for example, a person fell sound asleep, throwing his arm behind his head, woke up, and the brush "hangs."Or long work "squatting" - and "hangs" stop. The situation is exacerbated by the presence of alcohol intoxication.

At the heart of the lesion of individual nerves is most often a direct external trauma, or compression at certain levels of the nerve trunk. Predisposing factors are the superficial location of the nerve or its passage in narrow bone, muscle-ligament channels, in which degenerative-dystrophic processes are expressed.

The term " neuritis ", previously applied to the designation of these states, is not used now, since the very name implies only inflammation of the nerve.

Polyneuropathies and their causes:

1) Guillen Bar - acute inflammatory polyneuropathy. This is a progressive muscle weakness, a sensitivity disorder that starts from the periphery and rises up - feet, legs, hands, face. The defeat is symmetrical. In severe cases, respiratory failure develops as a result of weakness of the respiratory musculature. The current is heavy. The forecast is favorable.

2) Diphtheria polyneuropathy( possibly caused by the diphtheria bacillus, its exotoxin and endotoxin).Toxins manifest tropism to the heart muscle and nervous system. Diphtheria polyneuropathy is characterized by a mildly painful syndrome and a motor defect is marked - a weakness in the extremities, more pronounced in the proximal parts. Diphtheria polyneuropathy often develops with mild forms of diphtheria - mild, moderate, asymptomatic.

3) Serum polyneuropathies - with injections of tetanus antitusses, against redness, reddening occurs at the site of administration, edema, serum sickness develops and plexia - painless proximal. The prognosis is unfavorable - they are practically not restored.

4) Alcoholic polyneuropathies - characterized by a long latency period( asymptomatic) and manifested already stepping - when walking "spank" feet. Then pain in the leg muscles, sensitivity disturbance, vegetative disorders, later - bulbar disorders( stem) - defeat of 2 and 7, 8 pairs of cranial nerves, change of psyche - pseudo-Korsakov syndrome and violation of pelvic organs function. Thus, alcoholic encephaloproteinopathy is obtained.

5) Fungal polyneuropathies are arthralgias: sharp pains in the joints, edema of the joints with the development of articular contractures, tendon reflexes decrease, pronounced autonomic disturbances, sensitive disorders may or may not be present.

6) Diabetic polyneuropathies - begin with numbness and feelings of heat in the feet, freezing of the feet. Then there is awkwardness in the legs, weakness in the muscles, in the distal parts of the limbs. Diabetic neuropathy is a metabolic, toxic polyneuropathy.

7) Vegetative polyneuropathies - with occupational diseases - intoxications with manganese, hydrogen sulphide, carbon monoxide poisoning, exposure to vibration. Possible with degenerative-dystrophic pathology of the spine.

Earlier, polyneuropathies were referred to as " polyneuritis ", this term in relation to the above conditions is not currently used in medicine.

Symptoms of neuropathy, polyneuropathies:

Peripheral nerves are mixed, motor and sensitive. Accordingly, the symptoms of neuropathy will depend on the function of the affected nerve and what is lost.

Depending on the severity of the disease, motor disorders can manifest from a mild sensation of weakness in the muscles of the innervation zone of the nerve, to the plethia - complete absence of movement. Sensitive disorders in neuropathy range from mild numbness, tingling to total loss of sensitivity. Vegetative disorders - pain, burning, swelling, redness, hyperhidrosis( sweating) - varying degrees of severity.

Diagnosis of neuropathy, polyneuropathy:

Diagnosis of neuropathy and polyneuropathy is based on the patient's complaints, a history of the disease, a neurological examination and already on these data it is possible to put a preliminary diagnosis.

Diagnosis of the level and nature of damage to the nerve or several nerves is carried out by electromyroscopy - ENMG.ENMG allows to determine the level of the lesion, the presence of the tunnel syndrome, to determine the inflammatory and degenerative process in the nerve, the severity of the damage is the complete or partial loss of the impulse along the nerve, the nerve or muscle, the peripheral nerve or the spine is affected. ENMG is also used to monitor the treatment and dynamics of the disease.

In the presence of neuropathy and polyneuropathy, it is extremely important to conduct a differentiated diagnosis with other diseases, to find the true cause of the pathology. Similar symptoms are observed with multiple sclerosis, stroke, brain tumor, etc., in the detection of which the medical tactics

significantly changes. Treatment of neuropathy and polyneuropathy.

Treatment of neuropathies and polyneuropathies depends on the cause of the disease and is aimed mainly at reducing pain and restoring the function of the affected nerve.

In the acute period, use vascular therapy, antioxidant, detoxification therapy, improve metabolic processes, carry out dehydration, hormone therapy, use B vitamins, anticholinesterases, nonsteroidal anti-inflammatory drugs and gabapentin pain syndrome.

In the subacute period of neuropathy, massage, physiotherapy and physiotherapy are added:

1. Electrointestinal stimulation( Stimulus, Mioton. ..) is the use of impulse currents for restorative treatment, stimulation of impulse conduction along the nerve and the formation of a muscle response to it.
2. Electroplating( galvanization) is the application of a continuous continuous( galvanic) current of low voltage and small force to a medical purpose.
3. Mud treatment is an application in the treatment of mineral and organic muds and dirt-like substances, ozocerite.
4. Darsonvalization is the application of a pulsed current of high frequency and voltage with a curative purpose, but little force to improve microcirculation.
5. Acupuncture is the method of treatment by introducing special needles into biologically active points in a certain sequence, restoring reduced sensitivity, relieving pain and muscle weakness. In biologically active points it is possible to enter medicinal preparations - proserin, ATP, traumel.
6. Underwater shower massage is a massage of a person's body immersed in a bath with water by a stream of water of different pressure, temperature and direction.
7. Ultrasound therapy is a method based on the action of high-frequency sound waves on the tissue. Phonophoresis - the introduction of medicinal substances with the help of ultrasound.
8. Magnetotherapy
9. Laser therapy
10. Balneotherapy - four-chamber baths, two-chamber baths, baths and common baths.

Doctor neurologist Kobzeva S.V.