Today's post from nytimes.com (see link below) is an article that may help clear up one of the many problems people have with the language of neuropathy. A patient new to the disease may be diagnosed in terms that leave him or her bewildered and because the neurological vocabulary used by doctors is so broad, you may not be aware precisely what your diagnosis means in relation to other forms of neuropathy. Take the subject of this article for instance. You'd be forgiven for thinking that 'metabolic' neuropathy is a completely different form of nerve damage to other common neuropathies, when in fact it's another general term describing pretty much the same symptoms and problems that millions of others have. Metabolism (change) is life-sustaining chemical transformations within the cells of living organisms. There is an argument that all neuropathies are metabolic in nature but the word in itself shouldn't confuse you:- if you have metabolic neuropathy, you have neuropathy, in the same way that millions of others have. It's very often used in connection with diabetes and is therefore attached to diabetic neuropathy because that's the most common neuropathic cause. Diabetes is a metabolic disease, because it affects the body’s ability to capture glucose from food for use by the cells. You're probably more confused than ever now (I haven't explained it very well - apologies😓) but the symptoms and treatment are very much the same as other forms of neuropathy, peripheral or not and metabolic or not.
Metabolic neuropathies are nerve disorders that occur with diseases that disrupt the chemical processes in the body.
Causes
Nerve damage can be caused by many different things. Metabolic neuropathy may be caused by:
A problem with the body's ability to use energy, often due to a nutritional deficiency
Dangerous substances (toxins) build up in the body
Diabetes is one of the most common causes of metabolic neuropathies. People who are at the highest risk of nerve damage from diabetes include:
Those with damage to the kidneys or eyes
Those with poorly controlled blood sugar
Other common metabolic causes of neuropathies include:
Alcoholism
Low blood sugar (hypoglycemia)
Kidney failure
Porphyria
Severe infection throughout the body (sepsis)
Thyroid disease
Vitamin deficiencies (including vitamins B12, E, and B1)
Some metabolic disorders are passed down through families (inherited), while others develop due to various diseases.
Symptoms
These symptoms occur because nerves cannot send proper signals to and from your brain:
Difficulty feeling in any area of the body
Difficulty swallowing
Difficulty using the arms or hands
Difficulty using the legs or feet
Difficulty walking
Pain, burning, pins and needles, or shooting pains in any area of the body (nerve pain)
Weakness in the face, arms, legs, or other area of the body
Usually, these symptoms start in the toes and feet and move up the legs, eventually affecting the hands and arms.
Exams and Tests
An exam may show:
Decreased feeling (may affect touch, pain, vibration, or position sensation)
Reduced reflexes (most common in the ankle)
Muscles becoming smaller (atrophy)
Muscle twitches (fasciculations)
Muscle weakness
Loss of movement (paralysis)
Tests used to detect most metabolic neuropathies:
Blood tests
Electrical test of the muscles (EMG)
Electrical test of nerve conduction
Treatment
For most metabolic neuropathies, the best treatment is to correct the metabolic problem.
Vitamin deficiencies are treated with diet or injections. Abnormal blood sugar or thyroid function may need medication to correct the problem. Alcoholic neuropathy is treated with alcohol abstinence.
In some cases, pain is treated with medications that reduce abnormal pain signals from the nerves (duloxetine, gabapentin, pregabalin). Lotions, creams, or medicated patches can provide relief in some cases.
Clinical trials of new medications include antioxidants, neuroprotectants, insulin-like drugs, and aldose reductase inhibitors.
Weakness is often treated with physical therapy. You may need to learn how to use a cane or walker if your balance is affected. You may need special braces on the ankles to walk better.
Support Groups
For additional information and support, see www.neuropathy.org and http://diabetes.niddk.nih.gov/DM/pubs/neuropathies.
Outlook (Prognosis)
The outlook mainly depends on the cause of the disorder. In some cases, the problem can easily be treated. In other cases, the metabolic problem cannot be controlled and nerves may continue to become damaged.
Possible Complications
Deformity
Injury to feet
Numbness
Pain
Trouble walking
Weakness
Prevention
Maintaining a healthy lifestyle can reduce the risk of neuropathy.
Avoid excess alcohol use.
Eat a balanced diet.
Visit the doctor regularly to find metabolic disorders before neuropathy develops.
If you already have a metabolic problem, regular doctor visits can help control the problem and reduce the chance of further nerve damage.
Patients who already have metabolic neuropathy can reduce the risk of some complications. A foot doctor (podiatrist) can teach you how to inspect your feet for signs of injury and infection. Proper fitting shoes can lessen the chance of skin breakdown in sensitive areas of the feet.
References
Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine . 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.
Montfort EG, Witte A, Ward K. Neuropathic Pain: A Review of Diabetic Neuropathy. US Pharm . 2010;35(5):HS8-HS15.
http://www.nytimes.com/health/guides/disease/metabolic-neuropathies/overview.html
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