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Sensorimotor Polyneuropathy A Rose By Any Other Name

Today's post from health.nytimes.com (see link below) is a useful description of neuropathy as a medical condition. The article is entitled 'Sensorimotor Polyneuropathy' which may confuse many people but it's basically a description of the disease we all know and hate and the information is handy for everybody with any form of neuropathy with standard symptoms. One of the problems for ordinary patients trying to learn about their condition, is the number of terms used to describe it! You can easily be baffled by the terminology alone. 'Sensorimotor' is another word for 'sensory' neuropathy which may be more familiar but if you think in terms of polyneuropathy in its many forms and with its many causes, this article may be of value to you.

Sensorimotor Polyneuropathy
New York Times Saturday, September 28, 2013

Sensorimotor polyneuropathy is a condition that causes a decreased ability to move or feel (sensation) due to nerve damage.

Alternative Names

Polyneuropathy - sensorimotor

Causes

Neuropathy means a disease of, or damage to nerves. When it occurs outside of the brain or spinal cord, it is called a peripheral neuropathy. Mononeuropathy means one nerve is involved. Polyneuropathy means that many nerves in different parts of the body are involved.

Neuropathy can affect nerves that provide feeling (sensory neuropathy) or cause movement (motor neuropathy). It can also affect both, in which case it is called a sensorimotor neuropathy.

Sensorimotor polyneuropathy is a body-wide (systemic) process that damages nerve cells, nerve fibers (axons), and nerve coverings (myelin sheath). Damage to the covering of the nerve cell causes nerve signals to slow down. Damage to the nerve fiber or entire nerve cell can make the nerve stop working.

Nerve damage can be caused by:
Autoimmune (body-wide) disorders
Conditions that put pressure on nerves
Decreased blood flow to the nerve
Diseases that destroy the glue (connective tissue) that holds cells and tissues together
Swelling (inflammation) of the nerves

Some diseases lead to polyneuropathy that is mainly sensory or mainly motor. Possible causes of sensorimotor polyneuropathy include:
Alcoholic neuropathy
Cancer (called a paraneoplastic neuropathy)
Chronic inflammatory neuropathy
Diabetic neuropathy
Drug-related neuropathy
Guillain-Barre syndrome
Hereditary neuropathy
Vitamin deficiency (vitamins B12, B1, and E)

Symptoms
Decreased 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, tingling, or abnormal feeling in any area of the body (called neuralgia)
Weakness of the face, arms, or legs, or any area of the body

Symptoms may develop quickly (as in Guillain-Barre syndrome) or slowly over weeks to years. Symptoms usually occur on both sides of the body. Most often, they start at the ends of the toes first.

Exams and Tests

An exam may show:
Decreased feeling (may affect touch, pain, vibration, or position sensation)
Diminished reflexes (ankle most commonly)
Muscle atrophy
Muscle twitches (fasciculations)
Muscle weakness
Paralysis

Tests may include:
Biopsy
Blood tests
Electrical test of the muscles (EMG)
Electrical test of nerve conduction
X-rays or other imaging tests

Treatment

Goals of treatment include:
Finding the cause
Controlling the symptoms
Promoting a patient's self-care and independence

Depending on the cause, treatment may include:
Changing medicines, if they are causing the problem
Controlling blood sugar level
Not drinking alcohol
Taking daily nutritional supplements

PROMOTING SELF-CARE AND INDEPENDENCE
Exercises and retraining to maximize function of the damaged nerves
Job (vocational) therapy
Occupational therapy
Orthopedic treatments
Physical therapy
Wheelchairs, braces, or splints

CONTROL OF SYMPTOMS

Safety is important for people with neuropathy. Lack of muscle control and decreased sensation can increase the risk of falls or other injuries.

If you have movement difficulties, these measures can help keep you safe:
Leave lights on.
Remove obstacles (such as loose rugs that may slip on the floor).
Test water temperature before bathing.
Use railings.
Wear protective shoes (such as those with closed toes and low heels).
Wear shoes that have non-slippery soles.

Other tips include:
Check your feet (or other affected area) daily for bruises, open skin areas, or other injuries, which you may not notice and can become infected.
Check the inside of shoes often for grit or rough spots that may injure your feet.
Visit a foot doctor (podiatrist) to assess and reduce the risk of injury to your feet.
Avoid leaning on your elbows, crossing your knees, or being in other positions that put prolonged pressure on certain body areas.

Medicines used to treat this condition:
Over-the-counter and prescription pain relievers to reduce stabbing pain (neuralgia) Anticonvulsants or antidepressant
Lotions, creams, or medicated patches

Avoid pain medicine whenever possible, or use it only when necessary. Keeping your body in the proper position or keeping bed linens off a tender body part may help control pain.

Support Groups

For additional information and support, see: www.neuropathy.org.

Outlook (Prognosis)

You can fully recover from peripheral neuropathy if your health care provider can find the cause and successfully treat it, and if the damage does not affect the entire nerve cell.

The amount of disability varies. Some people have no disability. Others have partial or complete loss of movement, function, or feeling. Nerve pain may be uncomfortable and may last for a long time.

Occasionally sensorimotor polyneuropathy causes severe, life-threatening symptoms.

Possible Complications
Deformity
Injury to feet (caused by bad shoes or hot water when stepping into the bathtub)
Numbness
Pain
Trouble walking
Weakness

When to Contact a Medical Professional

Call your health care provider if you have loss of movement or feeling in a part of your body. Early diagnosis and treatment increase the chance of controlling the symptoms.

References

Katitji B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA:Elsevier Saunders; 2012:chap 76.

Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 428.

http://health.nytimes.com/health/guides/disease/sensorimotor-polyneuropathy/overview.html

Neuropathy Brought On By Medications

Today's post from arthuryinfan.wordpress.com (see link below) is an important one in that it looks at the relationship between certain drugs (and combinations of drugs) and neuropathy. There are enough well-known causes of neuropathy to set your mind spinning but when you learn that certain medications themselves can bring on the condition, there's little wonder that we get confused. The lesson is, that the doctor or specialist responsible for treating the symptoms of your neuropathy, needs to be a) aware of everything you are taking (and that includes supplements and alternative therapies) and b) exactly how they may interact with each other to possibly worsen your symptoms. A classic case in point are the drugs used to control cholesterol in your body. These are called Statins but they are also renowned for causing neuropathy. You and your physician will need to make a calculated decision as to what is the lesser of two evils and that's not easy. It's vitally important that if you have neuropathy and another condition (including, cancer, diabetes, HIV etc) you discuss all your treatments and all possible interactions with your doctor. Researching beforehand may help the discussion be more constructive.

Medication-Induced Neuropathy
November 9, 2012 by arthuryinfan

Medication-Induced Neuropathy
By Peter D. Donofrio, M.D.

You’ve undoubtedly heard the old saying, “It’s what you don’t know that can hurt you.” When it comes to neuropathy, there may be something your doctors don’t know that can hurt you as well.

Renowned New York Times health columnist Jane Brody recently shared with readers of her column that she experienced a bout of peripheral neuropathy several decades ago when a misplaced shot of morphine damaged a sensory nerve in her thigh. Obviously, her doctor never intended for that to happen. Fortunately, the nerve recovered in three years, but for much of that time, Brody couldn’t even tolerate something brushing against her leg.¹ Brody’s peripheral neuropathy can be categorized as an “iatrogenic” case—that is, a condition that is actually caused by medical care.

Iatrogenic causes for peripheral neuropathy aren’t always as blatant as a misplaced shot. In fact, peripheral neuropathy can be caused by nerve toxicity from commonly prescribed drugs: medications prescribed by physicians who are not aware of the possible relationship between the medication and the neuropathy. Why aren’t they aware? After all, aren’t these the experts you trust with your health, your well-being…your life?

Your doctors are well aware of the medications they are prescribing, but the fact is they may not be aware of medications other physicians have prescribed, nor are they aware of every uncommon adverse reaction of a medication. Many medications have hundreds of reported side effects. Often primary care physicians are inundated by a waiting room full of very ill patients requiring immediate care and don’t have time to fully review in detail every note or test result they receive.

Simply put, your specialists and primary physicians need your help. If you have a neuropathy and are concerned it may arise from a medication, speak up. Some medications and interactions between drugs can cause complications and even irreversible conditions. For example, thalidomide has proven to be very effective for treating skin diseases and some kinds of cancer. In fact, thalidomide has experienced a resurgence of use in the medical community for its effectiveness against several dermatological conditions. The occurrence of neuropathy, however, has also been tied to thalidomide. It is not typically related to the daily dose of the drug nor the duration of treatment; it’s more commonly found in patients who are slow drug acetylators—in other words, those patients whose bodies take longer to metabolize certain drugs.

The good news is that when patients with neuropathy stop using thalidomide, 25 percent of them recover completely, and 30 percent improve partially. What’s not so comforting is the fact that 45 percent of reported cases do not recover at all.² This example illustrates the need for you to consult with your physician if you take any of the medications associated with causing neuropathy. It is important to remember that you are not expected to be a medical expert, however, you are expected to know the names of the medications you’re taking, how long you have been taking them, and to be able to describe them to every doctor you visit. Thus, you need to assume the role of being your own patient advocate. Today’s health care system is complicated, and as such, you need to be able to provide to your doctor and to other health care providers as much information about your treatments as possible. Communication of your medications and duration of use is critical for your primary care and specialist physicians to offer you excellence in care.

Take the first step by reviewing the list of medications below that can induce neuropathy and let your physicians know if you are taking any of them. Remember to tell your physicians that you are not questioning their judgment; just asking them to review the medications in the context of your neuropathy. More often than not, they will welcome this active role in your treatment and see this as an opportunity to better educate themselves. Not only will you be helping yourself, but you could be helping others as well. Also, keep in mind that these medication do not always cause neuropathy, and it is the unique metabolism of certain patients that may cause them to develop neuropathy when prescribed a certain drug.

The following is a list of drugs that can cause neuropathy in certain patients:

Allopurinol
Amiodarone
Ara-C
Carboplatin
Cisplatin
Colchicine
Danosine (ddl)
Dapsone
Disulfiram
Docetaxel
Etoposide (VP-16)
Ethambutol
Etoposide
Gentamin
Gold
Indomethacin
Isoniazid
Lithium
L-tryptophan
contaminant Mercury
Metronidazole
Misonidazole
Nitrofurantoin
Nitrous Oxide
Paclitaxel
Perhexilene
Phenytoin
Pyridoxine
Sulfapyridine
Statins
Stavudine (d4T)
Streptokinase
Suramin
Tacrolimus
Thalidomide
TNF-alpha antagonists
Tumor Necrosis Factor
Vincristine
Zalcitabine (ddC)
Zimeldine

The peripheral nerves are protected by a blood-nerve barrier and might be perceived to be at a lessened risk than other organs for toxicity. Certain patients, however, may be at a higher risk for developing peripheral nerve toxicity due to genetic or metabolic factors. Many therapies have toxicities that must be tolerated because the treatments are necessary, such as treatments for HIV and malignancy. Developing additional therapies to prevent and/or ameliorate the toxic neuropathy associated with certain medications is an important area of
research and clinical trials are on-going.

1 Brody, Jane. “The Many Ills of Peripheral Nerve Damage.” The New York Times, October 20, 2009.

2 Zimmer, Carl. “Answers Begin to Emerge on How Thalidomide Caused Defects.” The New York Times, March 16, 2010.

Peter D. Donofrio, M.D. is professor of Neurology and director of the Neuromuscular Division of the Department of Neurology at Vanderbilt University Medical Center. He is director of our Association’s Neuropathy Center of Excellence at Vanderbilt and also serves on The Neuropathy Association’s Medical Advisory Committee.

*We have reprinted this article from the May 2010 edition of Neuropathy News.

http://arthuryinfan.wordpress.com/2012/11/09/medication-induced-neuropathy/