Polyneuropathies – Prickling Sensations

30. September 2010

Plenty of nerves - loads of problems. In neuropathies, the neurons outside the spinal cord get damaged. Patients complain about discomforts like prickling and numbness. Once you know the reason, you can start according therapies.

Polyneuropathies are not exactly common diseases. Scientists estimate that only 40 out of 10,000 suffer from them. And there are large regional differences given by the standards in nutrition, hygiene and medical care available. But no neuropathy is like the other: In about 34 percent of all cases, diabetes mellitus is considered the most frequent cause, followed by alcohol (11 percent). Autoimmune diseases and infections with bacteria respectively viruses as well as congenital types of polyneuropathies are rather rare. Given the large number of mechanisms, the search for the triggering factor is number one of the list.

When the metabolism beat gets out of control

Whenever the blood glucose is not adjusted correctly, diabetes mellitus does not only damage blood vessels but also the nerves. Thus a diabetic neuropathy is unavoidable – including physical and psychological agony. Professor Dr. Göran Hajak at the university hospital in Regensburg/Germany knows: “Diabetes and sleeping disorders, depressions and anxiety disorders, lack of energy and appetite create a psycho-internal syndrome in some patients.” And if the body pours out the stress hormone cortisol, it is an additional strain for the already bad metabolic situation.

Especially important from a therapeutic point of view is the improvement of blood glucose values by frequent measuring and adjusted insulin provision. But in order to break the vicious circle of pain and stress, it takes for example anticonvulsants and antidepressants. The ‘Deutsche Gesellschaft für Neurologie’ (German association for neurology) recommends Duloxetin, Gabapentin, Pregabalin, Amitriptylin, Nortriptylin and Venlafaxin against neuropathic pains. According to a Canadian study, the combination of Nortriptylin with Gabapentin has proven particularly compatible. These recommendations are completed by opioids like Tramadol and Oxycodon. Tapentadol, a drug not admitted in Germany yet, shows the same effectiveness but much better tolerance. Pharmacists expect admission within the year. For discomforts in legs and pain in the nerves, a new therapy procedure created at the university hospital Heidelberg/Germany provides remedy. Professor Dr. Peter Nawroth, medical director at the department endocrinology and metabolism emphasizes: “We consider muscle stimulation an effective therapy helping many patients without putting additional strain on them. Especially its positive effect on a good night’s sleep should participate in the life quality of the patients suffering from the disease.” In the process the physicians stimulate the muscular system of the upper thigh with electric impulses. A study showed: 73 percent of the participants profited from this therapy after only 4 weeks. Also blocking toxic metabolic pathways brings relief. Benfotiamin, a pre-stage of the vitamin B1 (thiamine) especially reduces the production of damaging decomposition products of proteins and glucoses accumulating in a negative metabolic situation. “Compared to a healthy person, diabetics have a 75 percent lower thiamine concentration in their plasma”, explains adj. professor Dr. Burkhard Herrmann, director of the institutes for cardio-diabetes and endocrinology at the technology center Ruhr-University Bochum/Germany. This deficit leads to an accumulation of toxic metabolic products and thus to an additional damaging of the nerves. During a study, 600mg Benfotamin per day over a period of six weeks helped the patients by activating detoxicative enzymes.

If the body fights against itself

Instead of a healthy defense reaction holding bacterial and viral attackers at bay, a chronic inflammatory, demyelinating polyneuropathy (CIPD) attacks the own nerves: Their enveloping structures are dismantled successively. Without treatment this disease sooner or later causes paralysis. A highly dosed, long-term therapy with corticoids stops those inflammatory processes, but with textbook side effects: Gain of weight, decalcification of the bones or changes in the skin are the orders of the day. To be able to reduce the dosage, physicians use complementing immune-suppressive substances.
In acute cases specialists apply plasma exchange: Protein components of the sick person can be exchanged with a solution of salts, buffers and albumin – a procedure promising success but also highly stressing and effective for a max of eight weeks. Intravenously applied immunoglobulins show a comparatively similar effect but significantly more gentle. Professor Dr. Falk Nimmerjahn and his working group at the Friedrich-Alexander-University at Erlangen-Nuremberg showed just how this treatment works: Due to a genetic defect, patients suffering from CIPD have a lack of molecules of a regulatory protein controlling the immune system. When using immunoglobulins, the process normalized by the body’s increased production of this regulatory molecule.

Life threatening paralysis

While CIPD build comparatively slowly and the symptoms are limited to the extremities, the Guillain-Barré-Syndrome causes paralysis within a few days which can affect the entire body. Particularly threatening is the loss of function of the respiratory muscles, but also cardiac arrhythmia has been described. Accordingly, stationary therapy concentrates – in addition to suppressing the autoimmune reaction – on stabilization of the cardiovascular system and respiratory system as well as thrombosis prophylaxis. In severe cases this requires weeks of intensive medical care.

What triggers these processes in the end – scientists were not able to prove beyond doubt yet. During assessment of patient data they found out though that about two thirds of the patients had bacterial or viral inflammations in the run-up to the disease. Perhaps the immune system activated at any rate already reacts not only to the surface structure of the pathogens but also to the chemically similarly built membrane of the nerve fibers. On the other hand, vaccinations as a trigger could neither be confirmed nor demented.

Poisoned nerves

Some chemicals particularly damage the nerves. Especially alcohol is one of them: Ethanol as well as the decomposition product acetyldehyde are toxic. In addition, chronic alcohol abuse unbalances the entire metabolism. But also drugs like chemotherapeutics or heavy metal salts like arsenic, lead and thallium attack the neurons and cause polyneuropathies. Top priority here is the detoxification of the body and the tracing of the causes. And alcohol abuse requires long-term pharmacological and psychotherapeutic approaches.

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