Diseases of the nervous system

Polyneuropathy of the lower limbs - treatment, causes, symptoms

Polyneuropathy is a complex of ailments,Consisting of diffuse lesions of the peripheral parts of the nervous system and manifested by peripheral weak paralysis, paresis, sensitivity disorders, trophic disorders and vegetative-vascular dysfunctions mainly in the remote limbs. Often, in various online portals or prints, the following names for the disorder in question can be found: polyneuropathy and polyradiculoneuropathy.
Polyneuropathy is considered quite seriousNeurological pathology due to the severity and severity of manifestations. The clinical picture of the disorder in question is characterized by weakness in the musculature, muscle atrophy, decreased tendon reflexes, and sensitivity disorders.
Diagnosis of polyneuropathy is based onClarifying the etiologic factor and collecting anamnesis, conducting blood tests to detect toxins, determining glucose values ​​and protein products. In order to clarify the diagnosis, electroneuromyography of the muscular corset and peripheral nervous system, a biopsy of the nerves can also be performed.

Causes of polyneuropathy

The most common factors that cause the described disease are: diabetes mellitus and the systematic abuse of alcohol-containing fluids (alcoholism).
In addition, the causes provoking the development of polyneuropathy, also include:
- Some infectious diseases caused by bacterial infection and accompanied by toxicosis;
- decrease in the working capacity of the thyroid gland;
- malnutrition;
- lack of vitamin B12 and a number of other useful substances;
- excess of vitamin B6;
- autoimmune reactions;
- intoxication caused by poisoning, for example, lead, methyl alcohol, poor-quality food;
- administration of sera or vaccines;
- impaired liver function;
- Systemic diseases of the type of sarcoidosis(Systemic organ damage characterized by the formation of granulomas in affected tissues), rheumatoid arthritis (connective tissue disease, mainly affects small joints), amyloidosis (impaired protein metabolism, which is accompanied by the production and accumulation in the tissues of amyloid - a protein-polysaccharide complex);
- allergies;
- hereditary predisposition;
- Occupational diseases.
Less likely, but possible, factors,Leading to the appearance of the pathology in question, are the administration of medications (in particular, drugs used for chemotherapy and antibiotics), metabolic disorders, hereditary neuromuscular ailments. In twenty percent of cases, the etiology of the disease remains unclarified.
In addition, the described disorder often develops in
, Suffering from cancer, accompanied by damage to nerve fibers.
Polyneuropathy can also be triggered by physical factors such as noise, vibration, cold, mechanical stress and physical overstrain.
Currently, the most common chronicThe form of polyneuropathy occurs in patients who have a history of diabetes mellitus, with consistently high sugar levels and not taking measures to reduce them. In this case, this pathology is isolated in a separate form and is called diabetic polyneuropathy.

Symptoms of polyneuropathy

The clinical picture of the ailment under consideration, asRule, combines the signs of damage to vegetative, motor and sensory nerve fibers. The degree of involvement of fibers of different types depends on the prevalence of vegetative, motor or sensory symptoms.
Polyneuropathies of various etiologiesAre characterized by a specific clinic that will depend on the damaged nerve. So, for example, muscle weakness, limp paresis of limbs and muscle atrophy causes a pathological process that develops in motor fibers.
So, sluggish paresis occurs as a result of defeatMotor fibers. Most neuropathies are characterized by the defeat of the extremities with a distal separation of muscle weakness. For acquired demyelinating polyneuropathies, proximal muscle weakness is characteristic.
Hereditary and axonal neuropathiesThe distal distribution of lethargy in the muscles is characteristic, the defeat of the legs prevails more often, the weakness is more evident in the extensor muscles than in the flexors. With pronounced lethargy peroneal (fibular) group of muscles (three muscles located on the shin) there is a stepping walk or "cock-walking".
A rare symptom of this disease isPolyneuropathy contracture of the muscles of the lower extremities, manifested by stiffness of the muscles. Severity of motor disorders in this disease can be different - beginning with mild paresis and ending with paralysis and persistent contracture.
Acute inflammatory polyneuropathy of the lowerLimbs are characterized by the development of symmetrical lethargy in the limbs. The typical course of this form of ailment is characterized by painful sensations in the muscles of the calves and paresthesia in the fingers (tingling and numbness), followed by weak paresis. Muscle flaccidity and hypotrophy are noted in the proximal parts.
Chronic inflammatory polyneuropathy of the lowerLimbs accompanied by unhurried aggravation of motor disorders and sensitive disorders. Typical symptoms of this form of pathology are limb hypotrophy, muscle hypotension, areflexia (absence of one or several reflexes) or hyporeflexia (decreased reflexes), numbness, or paresthesia in the extremities. The chronic form of the ailment under consideration is characterized by a severe course and the presence of serious concomitant complications. Therefore, after one year from the date of the onset of this pathology, fifty percent of the sufferers suffer partial or total disability.
Polyneuropathy has a relativeSymmetry of manifestations. Periodontal and reflexes from tendons are most often reduced or absent. In the first turn, Achilles reflexes decrease, with further escalation of symptoms - carpodial and knee, while reflexes from the tendon of the two-headed and three-headed brachial muscles can be unchanged for a long time.
Sensory disorders in polyneuropathies more oftenAll are also relatively symmetrical. In the onset of the disease, they appear in the limbs (like "gloves" or "socks") and are distributed proximally. The onset of polyneuropathy is often marked by positive sensory symptoms, such as paresthesia (numbness, tingling, chills), dysesthesia (perversion of sensitivity), hyperesthesia (hypersensitivity). In the process of developing the disease, the described symptomatology is replaced by hypoesthesia, that is, dullness of sensations, their inadequate perception. The defeat of thick myelinated nerve fibers leads to disorders of vibrational and deep-muscular sensitivity, in turn, the destruction of thin fibers - to a violation of temperature and pain sensitivity. A frequent symptom of all varieties of polyneuropathies is a pain syndrome.
Vegetative dysfunction is more pronounced whenAxonal polyneuropathies (mainly the axonal cylinder is affected), since the vegetative fibers are not myelinated. More often the following symptoms are observed: a disorder of vascular tone regulation, dry skin, tachycardia, a decrease in erectile function, orthostatic hypotension, dysfunction of the digestive system. Signs of autonomic failure are more pronounced in diabetic and hereditary vegetative-sensory forms of polyneuropathies. The disorder of autonomic regulation of cardiac activity often causes sudden death. Also vegetative symptoms in polyneuropathies can be manifested by hyperhidrosis (increased sweating), a violation of vascular tone.
Thus, the clinical pictureThe disease under consideration consists of three types of symptoms: vegetative, sensory and motor. More common are vegetative disorders.
The course of the disease in question is differentVariety. Often, from the end of the second to third decade of the development of the disease, reverse paresis begins, which begins with the sites involved in the pathological process by the latter. Sensitivity is restored usually faster, longer remain atrophy and autonomic dysfunction. The duration of the recovery period can last up to six months or more. Sometimes there may be incomplete recovery, there are residual effects, for example, polyneuropathy contracture of the muscles of the lower limbs, which leads to disability. It is also often a recurrent course, manifested by recurrent exacerbations of symptoms and an increase in the manifestations of the disease. Disability terminates 15% of cases of diseases on the background of diabetes. The most significant and prolonged limitation of life activity and work capacity, as well as the social insufficiency of patients with chronic polyneuropathies of various etiologies, namely, diseases caused by toxicosis, autoimmune reaction or diabetes.

Classification of polyneuropathies

Today there is no generally accepted classificationConsidered pathology. In this case, it is possible to systematize polyneuropathy depending on the etiological factor, localization, pathogenesis, the nature of the clinical symptomatology, etc.
So, according to the pathogenetic sign, the described ailment can be divided:
- on axonal, when there is a primary lesion of the axial cylinder;
- on myelin sheaths demyelinating due to primary involvement;
- on neuronopathy - the primary pathological process in the bodies of peripheral neurons.
By the nature of clinical symptoms are isolatedAutonomic, motor and sensory polyneuropathies. These forms in the pure form are observed rather seldom, the presence of pathological process in two or three kinds of nerve endings is more often revealed.
Depending on the factors that provoked the development of polyneuropathy, we can distinguish such types of pathology:
- hereditary;
- idiopathic inflammatory polyneuropathy (demyelinating polyradiculoneuropathy);
- polyneuropathies caused by metabolic disorders and eating disorders (uremic, diabetic, vitamin deficiency);
- polyneuropathies caused by the transfer of exogenous intoxications, for example, caused by excessive use of alcohol-containing liquids, drug overdose, etc .;
- Polyneuropathy, provoked by systemic diseases such as dysproteinemia, vasculitis, sarcoidosis;
- Polyneuropathies caused by infectious diseases and vaccination;
- polyneuropathies caused by malignant processes (paraneoplastic);
- Polyneuropathies caused by the influence of physical factors, for example, cold, noise or vibration.
The pathology under consideration can beAcute, that is, the symptomatology reaches a peak in a few days, weeks, subacute (the symptomatic reaches its maximum in a few weeks, months), chronic (for a long period of symptoms develop) and recurrent.
Depending on the prevailing clinical manifestations of polyneuropathy are:
- vegetative, motor, sensitive, mixed (vegetative and sensorimotor);
- combined (simultaneously involved peripheral nerve endings, roots (polyradiculoneuropathy) and the nervous system (encephalomyelopolyradiculoneuropathy)).

Treatment of polyneuropathy

Treatment of the ailment in question begins with the diagnosis and identification of the causes of the pathology.
Diagnosis polyneuropathy implies, in the first turn, the collection of anamnesis, and then DNA diagnosis, physical and instrumental examination, laboratory studies.
The choice of therapy depends on the etiologicalFactor of the disease. So, for example, hereditary forms of the considered violation require symptomatic treatment, and the therapy of autoimmune polyneuropathies is directed, first of all, to achieving remission.
Treatment of polyneuropathy should combineDrug exposure and non-pharmacological therapy. The most important aspect of the effectiveness of treatment is exercise therapy, the purpose of which is to maintain muscle tone and prevent contractures.
Medical treatment works in twoDirections: eliminating the cause and reducing the severity of symptoms until complete disappearance. Depending on the specified diagnosis, pharmacopoeial agents may be prescribed:
- means of neurotrophic action, in other words, drugs whose therapeutic effect is aimed at enhancing growth, proliferation, regeneration of nerve fibers and slowing the atrophy of neurons;
- vitamin preparations,
- Plasmapheresis (collection of blood with subsequent purification and return of it or a separate component back to the bloodstream of the patient;
- intravenous glucose administration;
- human normal immunoglobulin (active protein fraction isolated from plasma and containing antibodies);
- preparations of thioctic acid;
- hormone therapy with glucocorticoids (steroid hormones), such as Prednisolone and Methylprednisolone;
- Tricyclic antidepressants,
Antioxidants.
In hereditary forms of the pathology in question, in some cases, surgery may be required, due to the appearance of contractures and the development of deformities of the feet.
Treatment of polyneuropathies with the help ofTraditional medicine is rarely practiced because of their inefficiency. Alternative medicine can be used in conjunction with pharmacopoeial drugs and solely for the purpose of a specialist. In general, medicinal herbs, infusions and decoctions are used as a general restorative during symptomatic and etiotropic therapy.
A successful outcome of this ailment is possible only with timely, qualified and adequate assistance.

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