What is it?
Peripheral neuropathies include a heterogeneous group of pathologies characterized by alterations in the peripheral nerve related to its structure and/or function. The causes of a peripheral neuropathy are multiple, as well as the clinical pictures highlighted so that various classifications have been proposed in accordance with etiopathogenetic, histopathological, anatomical and clinical parameters. It is clinically important to distinguish between polyneuropathies (diffuse and symmetrical alterations of nerve trunks) mostly of toxic, metabolic, deficiency or inflammatory origin; mononeuropathies (alterations of single nerves) mostly of traumatic origin; multineuropathies (alterations of several nerves) mostly of vascular origin. The development of new diagnostic techniques and search for new therapeutic approaches have led to many significant advances in the knowledge of peripheral neuropathies. However, in most peripheral neuropathies, treatment is still far from satisfactory, and preventive measures are still difficult to implement. Indeed, there is a great need to develop and advance neuroepidemiological studies using uniform definitions, classifications, and methods.
Which are the symptoms?
The symptoms can be numerous. Generally, there is a weakness in the distal musculature (hands and/or feet) that is associated with muscular atrophy and, in the case of sensitive neuropathies, with disturbances of sensitivity that can be positive (tingling, burning, pain) or negative (reduced tactile, thermal, painful sensitivity). Reduction of deep sensitivity causes balance disturbances. In some cases, neuropathies may also involve the autonomic (or vegetative) system and thus cause defects in the regulation of blood pressure or heart rate, sweating, and many other functions of the body regulated by this system.
- muscle weakness
- muscular atrophy
- sensory deficits
- positive sensory symptoms
- balance deficit
- vegetative disorders
How is it diagnosed?
To make a diagnosis of peripheral neuropathy, it is necessary to define general criteria regarding the clinical features of the disease and laboratory data: general minimum criteria and specific criteria for the diagnosis of neuropathy. The search for the minimum general criteria and the first formulation of the suspicion of neuropathy may concern the general practitioner, but classification and evaluation of neuropathy are up to the neurologist. For the neurologist, it is important to intensify research in the areas of pathology, genetics, neurophysiology, neurochemistry, neuropharmacology both in clinical conditions (trials) and experimental animal models. In addition, it is the task of specialized centers to standardize methodology for the detection and quantification of neuropathy, facilitating the diagnostic framework and the interpretation of epidemiological and therapeutic data.
How is it treated?
Treatment of neuropathy depends on the underlying causes. In the inflammatory forms, anti-inflammatory drugs (cortisone) and/or immunomodulatory and immunosuppressive drugs (IGEV, plasmapheresis, immunosuppressants) and biological drugs (monoclonal antibodies) are required. In toxic forms, removal of the underlying cause (e.g. chemotherapeutic drugs) is needed. In deficiency and dysmetabolic forms, restoration of metabolic homeostasis (e.g., restoration of normal blood glucose values in diabetes, thyroid function in dysthyroidism, or normal B vitamin values for hypovitaminosis) should be done. In paraneoplastic forms, it is required to remove the tumor and, if necessary, conduct immunomodulatory therapies. For genetic forms, at the moment it is possible to treat only the forms of familial amyloidosis from TTR gene mutation. No therapy is currently available for other genetic forms.
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