Chapter: Diseases of The Brain and Nervous System(A Health Education Guide): Neuropathy - A.LD.P.

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C.I.D.P.: Treatment and Symptoms

When A.I.D.P. keeps progressing for a long time (2 months) or recurs frequently, it is known as C.I.D.P. (Chronic Inflammatory Demyelinating Polyradicul-oneuropathy).

C.I.D.P.:

When A.I.D.P. keeps progressing for a long time (2 months) or recurs frequently, it is known as C.I.D.P. (Chronic Inflammatory Demyelinating Polyradicul-oneuropathy).

If the disease has occurred only due to neurological causes, it looks like motor neuron disease.

Many a time symptoms of C.I.D.P may occur due to HIV infection, S.L.E, plasma cell dyscrasias etc.

 

Treatment :

 

·           lIf there is any other disease mentioned earlier, it isdetected and treated and especially steroids, plasma exchange, azathioprine are used. As in the treatment of A.I.D.P, immunoglobulin can also be used.

·           lPhysiotherapy plays a very important role in most ofthe neuropathies. If required, braces, splints, boots and other such instruments can be used to make life as easy as possible for the patient.

·           Painkillers can be given when the patient is in pain.

·           lAfter a period of time, minor or major surgery may beperformed to get maximum potential from the patient’s muscles, so that the weaker muscles can be assisted.

 

Bell’s palsy and other such neuropathies :

This is another disease that occurs due to virus. It paralyses only the facial muscles of one side and is called Bell’s palsy. In this disease there is an inflammation on the seventh cranial nerve, which largely occurs due to wind, infection or damage in the ears.

Symptoms :

The eyes do not shut completely. The mouth gets twisted and saliva dribbles from one side. The affected cheek cannot be blown completely. Sometimes there can be pain behind the ear, extra sounds in the ears and there may be loss of taste in the tongue. If the treatment is commenced immediately, 90% to 95 % patients get completely cured in one to two months. The virus in these cases is usually Epstein Barr, herpes or cytomegalo. Sometimes the 7th cranial nerves of both sides get affected at the same time, but usually only one side is affected. In some cases the disease persists for a long time or keeps recurring frequently causing facial paralysis again and again.

The mainstay of treatment is use of steroids, optimum physiotherapy, proper eye care and use of antiviral agents (like acyclovir in herpes virus infection) and supportive measures.


Neuropathy due to Diabetes :

Over a period of time, diabetic patients may suffer from neuropathy. Neuropathy occurs earlier in cases wherediabetes is of longer duration and uncontrolled. Longer the duration of diabetes and poorer the management, earlier the occurrence of neuropathy. Many types of neuropathies occur in diabetes, the symptoms of which are mentioned below:

·           lWeakening of the nerves causes difficulty in walking,climbing stairs etc. Due to the loss of sensation, even if the footwear comes out of the feet, the patient doesn’t know it, severe pain occurs in the feet or thighs.

·           lThere is a sensation of cushioning and burning sensationin the soles of the feet. There is tingling or numbness in hands and feet. There is lose of pain sensation. While having a bath one is unable to tell the difference between hot and cold water, sensation of the palms and soles is decreased. Ulcers on sole develop and if proper foot care and dressings are not done, this can lead to an unfortunate steps of amputation of the foot; which is a common Cx.

·           lUrinary problems, sexual weakness, loose motions orconstipation may occur. There is either very heavy or - very less sweating. There may be fluctuations in the heartbeats.

·           lBurning sensation in any of the nerves on the chestand the stomach.

Treatment :

Relief can be obtained by controlling diabetes completely, preferably with Insulin. There are suitable medicines to control the symptoms of neuropathy, which may provide more or less relief. Physiotherapy and foot care are highly important.


Leprosy :

Leprosy is quite common in our country. Mycobacterium leprae is the organism that causes leprosy and it mainly damages the sensory nerves causing loss of sensation in the fingers. One is not able to sense injury, the fingers of the hands and feet gradually fall off and the disease starts spreading. This is mainly of two types: (1) Lepromatus leprosy (2) Tuberculoid leprosy in which there is a comparatively less damage to the skin but neurological damage is high.

Medicines like dapsone, rifampicin, clofazimine, etc as well as appropriate dressing can control the disease but treatment can continue from 1.5 to 2 years or even 10 years. Vaccine is now available to prevent this disease.


If there is a cancerous lesion in any part of. the bodyit also can affect the nerves. This is known as Paraneoplastic Syndrome. Such a neuropathy is usuallyseen in lung cancer. In paraproteinemia or myeloma, neuropathy is very commonly seen. It is clear that in all the cases of neuropathy extensive investigations are very necessary.

In many cases autonomic neuropathy can occur like in diabetes. In this, rapid fluctuation of blood pressure and pulse, perspiration., loose motions, urinary. problems and other symptoms related to the nerves of the involuntary nervous system occur. Due to lack of complete scientific knowledge, even doctors may not be able to recognize the disease and the diagnosis is delayed.


Entrapment Neuropathy 

The most commonentrapment neuropathy is the carpal tunnel syndrome, in which the median nerve is compressed by the ligament situated below the palm, causing pain and tingling in the palm, which sometimes extends up to the shoulders. Gradually the muscles under the thumb get wasted. (APB muscle is weak and wasted).

 

If there is no benefit after splinting the wrist or taking steroids for some time, steroids can be injected locally in the wrist at a particular point. As a last resort a small surgical procedure can be done for decompression of the nerve.

Apart from this, compression of various nerves on various locations in their pathway can cause as many as 30 different types of entrapment syndrome.

·           lPronator syndrome of the Median nerve l Tardive ulnar palsy (near the elbow)

·           Radial palsy (between the shoulders and elbow). It occurs when the radial nerve is compressed while sleeping which is also known as “Saturday night palsy”.

 

·           Meralgiaparaesthetica: tingling and mild pain on the thigh caused by the compression of the lateral cutaneous nerve.

·           Tarsal tunnel syndrome: the posterior tibial nerve is compressed near the ankle causing tingling and pain in the sole of the feet. A small surgery can give relief. It can be concluded from experience, that these kinds of entrapment are very common. But usually the patients suffer for a long time in the absence of a proper diagnosis. Awareness should be created for this.

 

Other neuropathies :

Neuropathy can occur due to deficiency of vitamins mainly of vitamin B12 as well as folic acid. (This disease is known as SCD - Subacute Combined Degeneration). Excessive drinking of alcohol can result in deficiency of vitamin B1. causing a disease called Beriberi in which a painful neuropathy occurs.

Some of the drugs that can cause neuropathy are antibiotic -nitrofurantoin, cancer drug- Vincristine, anticonvulsant drug -phenytoin, drug for TB -isoniazid, etc. When the medicines are withdrawn, neuropathy gradually subsides. It should be remembered that every person taking these drugs would not suffer from neuropathy. There are many ways to prevent these effects of the drugs, like vitamin B6 should also be given along with TB medicine isoniazid.

The most commonly found neuropathies in our country are the ones occurring due to leprosy, diabetes, AIDS (HIV), vitamin B1 deficiency due to alcohol, nutritional deficiency of vitamin B12, and folic acid etc. It should be noted that the fast spreading neuropathy A.I.D.P. and the slow spreading neuropathy of cancer and myeloma are the most dangerous. Thus, quick diagnosis, precise investigations and appropriate treatment and physiotherapy are very important aspects of the treatment of neuropathy.

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