Polyneuropathy is a disease of several of the body’s nerves. It usually begins in the nerves of the legs and gradually leads to a worse feeling in the feet and harder to walk. Eventually, the trouble may move up the lower leg. Even if you do not get rid of the disease, the symptoms can be relieved with the right treatment.

The disease can also cause discomfort in the hands and forearms. Symptoms above knee height or elbow height are uncommon. 

Guillain-Barré syndrome is an unusual form of polyneuropathy caused by the immune system attacking the nerves in connection with an infectious disease.

Symptoms of polyneuropathy

Polyneuropathy usually starts with the same problems on both feet. The following symptoms are common:

  • You get tingling and numbness in your feet.
  • It feels like you’re walking on pillows.
  • It burns and hurts your feet.
  • You are very sensitive to touch.
  • You feel that temperature fluctuations feel troublesome.
  • Your skin on your feet gets dry.
  • You get problems with the balance.

You can have several of the problems at once and they can spread upwards along the lower legs. You can also get trouble from your hands with numbness and stupidity when, for example, you have to push buttons.

Slow development

Usually, the symptoms develop slowly. At first, you can only notice them sometimes, but over time, the hassles can become more constant.

When the skin on your feet becomes dry, you get lighter cracks. Because the feeling is impaired, you do not feel, for example, a shoe scab, and this makes it easier for you to get wounded. When the nerves do not work as they should, the ability for wounds to heal is also affected.

When you get polyneuropathy, it can feel painful to move or exercise. Moving less makes your muscles weaker. You may find it difficult to walk upstairs and to sit or get up from a chair. Eventually, you may find it harder to walk and to keep balance.

It is unusual for symptoms to develop rapidly, but they do occur. Guillain-Barré syndrome often comes quickly and has a faster course than other forms of polyneuropathy.

When and where should I seek care?

Contact a health care center if you suspect you have polyneuropathy.

Seek care directly at a health care center or on-call reception if you suddenly get numbness in your feet, especially if you are at the same time feeling weaker in the legs or arms.

Polyneuropathy can sometimes be because you have been drinking a lot of alcohol for a long time and have a hard time quitting. You can then seek help at a health care center, at the occupational health service or at a reception in the dependency care.

What can I do for myself?

It may feel difficult to be physically active if you have polyneuropathy. It is important that you still move regularly, in order to maintain as good a function as possible in the legs and feet. Moderate exercise such as walking stimulates blood circulation and musculature and increases joint stability. Swimming and cycling are also good. Avoid heavy weight muscle training.

Regardless of the circumstances that cause the disease, you can be very helpful in making changes in your daily habits. 

The fact that you move regularly affects your well-being. Try to find the activities you think are fun and move as much as you can in everyday life. It also helps against overweight, which can aggravate the disease. You can also get the support of a dietician if you are overweight and want to lose weight.

Try to avoid alcohol altogether, as the problems can otherwise be exacerbated.

Those who smoke or sniff may feel better in the long run by quitting nicotine. To help stop the tobacco, you can take any of the medicines available. Here you can read more about quitting smoking and what support there is for those who want to quit nicotine.

By taking care of your feet every day, you reduce the risk of getting bigger sores and cracks. Lubricate your feet with a softening cream to prevent sores.

Investigations

When you come to the doctor, you first have to tell you about your complaints. Then they do a body examination which usually begins with a study of the heart, lungs, blood pressure and stomach.

Test of feeling

Your doctor will test your sensitivity to touch, stab and vibration. The skin’s sensitivity to cold and warm is also tested.

Examination of skeletons, joints, muscles, and skin

The muscle reflexes are tested and the doctor also examines whether the muscles have become thinner and if there are any defects in the joints. Muscle strength is also tested.

The skin of the feet is examined to see if it is dry and if there are any cracks or wounds. The doctor also usually measures the pulse rate in the blood vessels on the feet.

Blood sample

You will also be given blood tests. The following samples are taken:

  • Blood status including blood value
  • P-glucose, that is, blood sugar
  • Vitamin B12 
  • metabolism Trial
  • Blood proteins.

Samples for, for example, borrelia and HIV can be taken if there are suspicions that the trouble is caused by an infection. Additional supplementary blood tests may sometimes need to be taken. This applies, for example, to the exclusion of celiac disease, rheumatic disease or hereditary forms of polyneuropathy.

Back Fluid Sample

A test of the spinal fluid may need to be taken if you soon develop symptoms of polyneuropathy. The sample is called a lumbar puncture. For example, it can show if there is an increased amount of protein, as in Guillain-Barré syndrome. It can also show if you have an infection, such as tick-borne.

Other investigations

If the symptoms are not clear, you may need to undergo further testing of the functioning of the nerves. It is done with electroneurography, also called ENG. Further testing of muscle function is done with electromyography, also called EMG. Then electrodes are placed on the skin over a nerve or inserted into the muscle to be examined. The thin nerve fibers that conduct heat and cold can be tested with a so-called quantitative sensing study. 

Sometimes you may also undergo other examinations such as x-rays. 

Treatment for Polyneuropathy

It is important that all values ​​are as good as possible if the cause of polyneuropathy is diabetes. You may need to improve your diet and exercise more. You can get support from the healthcare staff to get you started. Sometimes the medication for the disease needs to be changed.

You will be treated in the form of tablets or syringes if you are deficient in vitamin B12.

Foot care may be needed

The skin of the feet often becomes brittle if you have polyneuropathy and especially if you have diabetes. It can lead to problems with your feet. Therefore, you may need to get foot care quite often. Then hardens are ground down and you get help to keep the nails short and without sharp edges.

You may need special inserts for the shoes to keep the load on your feet even and to avoid sores. Such posts are made at an orthopedic workshop.

Physical therapy can strengthen the muscles

You may need treatment from a physiotherapist if you have weak muscles and balance difficulties. Among other things, you get help with training the muscle groups that have weakened and advice on how to exercise on your own.

Medication if you are in pain

There are several different types of drugs that can help if you are in pain. First, you usually get to try regular painkillers with acetaminophen. 

Medicines containing amitriptyline mainly used for depression may also work well against nerve pain, especially the so-called tricyclic antidepressants. These drugs are used even if you are not depressed. Drugs used in epilepsy can also have a soothing effect on nerve pain. 

Side effects of drugs

If you use paracetamol properly at the right doses, it is rare to get side effects, but medicines for depression or epilepsy can have side effects. The most common thing is that you get tired, feel ill or get dizzy. Tell your doctor if you get any side effects that are cumbersome. You may then need some other form of treatment for polyneuropathy

If you get seriously ill

When the disease arrives quickly, you are usually hospitalized. This applies, for example, to the inflammatory nerve disease Guillain-Barré syndrome. You may have trouble breathing and swallowing if you become seriously ill. Then you may need breathing help from a respirator and get nourishment directly into the bloodstream. Most people who get Guillain-Barré syndrome get healthy within a few months.

Right to information

In order for you to be active in your care and make decisions, it is important that you understand the information you receive. The healthcare staff is obliged to make sure that you do so.

What happens in the body?

The nervous system

The nervous system consists of the brain, spinal cord, and peripheral nerves. The brain and spinal cord together form the central nervous system and from them, the peripheral nerves, which consist of bundles of nerve threads, form out of the body. The longest nerve fibers go down to the legs and are the ones that are damaged first when you get polyneuropathy.

The part of the nervous system that can be controlled by the will is called the somatic nervous system. The autonomic nervous system is called the part that cannot be affected by the will and which controls, for example, the function of the intestines, heart rhythm and sweating. 

Begins at the end of the nerve fibers

If you have neuropathy, the damage starts at the very end of the nerve fibers and then slowly creeps into the nerve roots in the spinal cord. Both legs are usually affected simultaneously and in the same way. The nerve fibers start to work worse and so does the nerve fibers’ surrounding insulation, the myelin sheath. Nerve centers in the spinal cord where information to and from the brain pass-through can also be affected.

Provides various inconveniences

When the nerve fibers to the feet are damaged, the feeling becomes progressively worse. You get harder to sweat and the muscles in the foot and calf become weaker. The foot can change the appearance and become flatter, for example. 

Often, the so-called autonomic nervous system is also affected. For example, it may be more difficult for the heart to increase the rhythm when you get up after sitting or lying down and then you may have a drop in blood pressure. You may have diarrhea or constipation as well as feeling sick and vomiting if the nerves in the stomach are affected. This is especially true when you have eaten too big meals.

Can have many causes

Polyneuropathy can have many different causes. In about one in four it is not possible to find out what the disease is due to. It is especially common for older people to have mild complaints of this type without finding a cause. Probably this is because the nerves can start to function worse as the body ages.

Among the known causes of polyneuropathy, diabetes is the most common. Other causes may be the following:

  •  Prolonged and high alcohol consumption
  •  Kidney failure
  •  Lack of important substances, such as vitamin B12 or metabolic hormone.

These are some other more unusual causes:

  • Some infectious diseases
  • Autoimmune diseases and inflammatory diseases
  • Cancer
  • Some drugs
  • Toxic effect of heavy metals and solvents.

Diabetes

It is not entirely known why diabetes causes polyneuropathy, but there are several theories as to why the nerves begin to function worse. For example, high blood sugar can lead to the formation of harmful substances around the nerves. Blood circulation can be impaired, leading to a lack of nutrients and oxygen in the nerves.

Alcohol

The nerves can be damaged in several ways if you have been drinking a lot of alcohol for a long time. You may be deficient in B vitamins and other nutrients your body needs. The alcohol itself and the substances that form when the alcohol breaks down in the body can be harmful to the nerves. You can get sequelae especially in the liver which can lead to nerve damage by the formation of toxic substances.

Kidney failure

When you have kidney failure, your kidneys are unable to clean the blood properly and harmful substances can accumulate in the blood. It can affect the nerves so that they work worse.

Lack of vitamin B12

Vitamin B12 is important for the nerves to function well. You may be deficient in vitamin B12 if, for example, the stomach does not produce the substance that makes it easier for the body to absorb the vitamin. It may happen if parts of the stomach have been operated on or in the case of diseases of the stomach and intestines that cause the nutrition from the food not to be absorbed properly.

infectious diseases

In some infectious diseases, the nerves can be damaged by the infection and the inflammatory reaction. Examples of such diseases are tick-borne and HIV.

Autoimmune diseases and inflammatory diseases

An autoimmune disease means that your own immune system attacks parts of the body’s own tissue. One example is rheumatoid arthritis. Some inflammatory diseases can damage the nerves. This applies, for example, to amyloidosis, which is an unusual disease. There is a hereditary form of amyloidosis called Skellefteå disease.

Cancer

Cancer diseases can sometimes damage the nerves by causing the tumor to press on the nerves or grow into them. The diseases can also cause the immune system to react in a way that damages the nerves.

Drug

Some drugs may cause polyneuropathy, but this is unusual. For example, there may be cytostatic drugs used for cancer or certain antibiotics. The symptoms of polyneuropathy usually tend to be closely related to drug treatment for polyneuropathy.

Poison Effect

Heavy metals and solvents can damage the nerves.

Can be hereditary

Polyneuropathy can be hereditary. Then the problems usually start already in toddler age or in teens, but they can also start later in life. There are several forms of hereditary polyneuropathy and one example is the so-called Skellefteå disease.

Guillain-Barré syndrome – an unusual form of polyneuropathy

Guillain-Barré syndrome is an unusual form of polyneuropathy caused by the immune system attacking the nerves in connection with an infectious disease.

Guillain-Barré syndrome often comes quickly and has a faster course than other forms of polyneuropathy. The symptoms develop and worsen over a few days to a few weeks. You get the worse feeling and weaker muscles. The trouble starts in the legs and goes upwards in the body. You may have difficulty breathing and swallowing.

The disease can be life-threatening and requires hospital care. Most people who get Guillain-Barré syndrome get well within a few months, but a few die from the disease. The disease often heals by itself but the course can be shortened by high doses of immunoglobulin in the blood or blood purification, so-called plasmapheresis.

Other diseases can cause the same symptoms

Diseases affecting the spinal cord such as tumors, hernias or multiple sclerosis, MS, can cause similar symptoms as some forms of polyneuropathy, such as Guillain-Barré syndrome. But it is then common to have other symptoms that do not correspond to polyneuropathy.

Myasthenia gravis is an uncommon disease that weakens the body’s muscles. Sometimes the symptoms can be similar to those experienced in polyneuropathy.

Ehtisham Nadeem

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