Diseases of peripheral nerve trunks and plexuses

The peripheral nervous system connects the central nervous system to the organs and limbs. Unlike the central nervous system, the peripheral nervous system is not protected by bones and has no physiological barrier separating it from the circulatory system. Therefore, the peripheral nervous system may be susceptible to mechanical damage and is more easily affected by toxins.

Diseases of peripheral nerves are neuropathies. They are characterized by damage to the axons and myelin sheath of the nerves. Diseases of the nerve trunks and plexuses rank second in prevalence among the population after diseases of the spinal roots (“radiculitis”). Therefore, issues of prevention, early diagnosis and subsequent treatment of neuropathies remain pressing problems.

Types

• Demyelinating. The conduction of excitation through neurons is disrupted. Occurs in cases of lead poisoning, diphtheria, polyradiculoneuropathy, and diabetic polyneuropathy. The patient's health is restored within a few weeks if treatment is started in a timely manner.
• Axonopathies. In this case, the damage concerns the axons (the processes of nerve cells) - these are severe disorders of nerve function. As a result, muscle atrophy occurs. The cause of these disorders is the abuse of alcohol and other toxic substances.

Neuropathies of mixed origin are most common. Full recovery and restoration of nerve function depends in part on the severity of the damage.

If the recovery process is absent 3 months after the onset of the disease, then the prognosis is most often unfavorable.

Types of neuropathy

• Mononeuropathies. One nerve or a specific part of the nerve plexus is injured. The causes of damage can be trauma, compression of any level of the nerve trunk. Also, mononeuropathies are observed in diabetes mellitus, atherosclerosis, vascular damage, etc. Hypothermia and herpetic infections are not the least important factors in the functioning of one nerve.
• Multifocal neuropathies are a syndrome of partial damage to individual nerve trunks or their complete damage. Such neuropathies occur slowly and sequentially (from several days to several years). Causes: arthritis, vasculitis and a number of systemic connective tissue diseases.
• Polyneuropathy. Lesions of peripheral nerves are multiple. Moreover, the process is widespread and symmetrical. It occurs both acutely and chronically. It happens that the spinal roots are also affected.

The causes of diseases of the peripheral nerve trunks and plexuses can be:

• injuries received
• decrease in normal immune system function
• hereditary diseases
• intoxication with various substances
• infections
• lack of vitamins
• habitual intoxication (drug addiction and alcoholism)
• allergies

Diagnostics

Diagnosing peripheral neuropathy can sometimes be difficult due to the variability of symptoms. A complete neurological examination is often required, including: the patient's symptoms, occupation, social habits, the presence of any toxins, the presence of chronic alcoholism, the possibility of HIV or other infectious disease, and a history of relatives with neuropathy, performing tests that can identify the cause of the neuropathy, and conducting examinations to determine the degree and type of nerve damage.

General examination tests and tests may reveal the presence of nerve damage due to systemic disease. Blood tests can diagnose diabetes, vitamin deficiencies, liver or kidney failure, other metabolic disorders, and signs of abnormal immune system activity. Examination of the cerebrospinal fluid, which circulates in the brain and spinal cord, can reveal abnormal antibodies associated with neuropathy. More highly specialized tests can detect blood diseases or cardiovascular diseases, connective tissue diseases, or malignancies. Muscle strength tests showing signs of muscle twitching or fasciculations may indicate motor neuron damage. Assessing the patient's ability to perceive vibration, soft touch, body position (proprioception), temperature and pain sensitivity helps determine damage to sensory fibers of both large and small sensory fibers. Based on the results of a neurological examination, physical examination, and a detailed medical history, additional tests and examinations may be prescribed to clarify the diagnosis.

Computed tomography is an atraumatic, painless study that makes it possible to visualize organs, bone and soft tissue. A CT scan can reveal bone or vascular changes, brain tumors, cysts, herniated discs, encephalitis, spinal stenosis (narrowing of the spinal canal), and other disorders.

Magnetic resonance imaging (NMR or MRI ) can examine the condition of the muscle and its size, reveal the replacement of muscle tissue with fatty tissue, and determine whether there has been a compressive effect on the nerve fiber. MRI machines create a strong magnetic field around the body. Radio waves pass through the body and cause resonance, which can be detected at various angles within the body. The computer processes this resonance effect and converts it into a three-dimensional image.

Electromyography (EMG ) involves inserting a thin needle into a muscle to measure the electrical activity of the muscle at rest and during contraction. EMG tests can help differentiate between damage to the muscle itself and to the nerve fibers. Nerve conduction speed can accurately determine the extent of damage in large nerve fibers, clearly indicating whether symptoms are related to myelin sheath or axon degeneration. During this study, electrical stimulation of the fiber is performed, in response to which a response impulse appears in the nerve. An electrode placed further along the nerve measures the speed of impulse transmission along the axon. Slow transmission rates and impulse blocking typically indicate damage to the myelin sheath, while decreased impulse levels are a sign of axonal degeneration.

A nerve biopsy involves removing and examining a sample of nerve tissue, most often in the lower leg. Although this test can provide valuable information about the extent of nerve damage, it is an invasive procedure that is difficult to perform and can cause nerve damage and signs of neuropathy. In most cases, this procedure is not indicated for diagnosis and may independently cause neuropathic side effects.

Skin biopsy is a test in which a small piece of skin is removed and the endings of nerve fibers are examined.
This diagnostic method has advantages over EMG and nerve biopsy when it is necessary to diagnose damage in smaller sensory fibers. Additionally, unlike a conventional nerve biopsy, a skin biopsy is less invasive, has fewer side effects, and is easier to perform.

Symptoms

With neuropathies, symptoms can be different and depend on the affected areas. They cause a lot of discomfort to the patient:

• flaccid muscle paralysis
• pain in limbs
• change in skin sensitivity (there may be a contrast in sensations in one area of ​​the skin compared to another)
• no sensation of pain and more
• amyotrophy
• speech disorder
• feeling of numbness in the face and limbs
• muscle weakness of the limbs
• impaired motor coordination
• dry skin
• focal blanching
• redness and bluish discoloration of the injured area
• Facial asymmetry may occur (if the facial nerves are damaged)

If you find yourself with at least one of the described symptoms, you should immediately seek help from a qualified neurologist.

The most common symptoms of damage to the peripheral nervous system:

• viral (Guillain-Barré polyneuritis, viral diseases, influenza, sore throat, infectious mononucleosis, etc.);
• microbial (for scarlet fever, brucellosis, syphilis, leptospirosis, etc.);
• for chronic intoxication (alcoholism, manganese, lead, etc.);
• for toxic infections (botulism, diphtheria);
• blastomatous (for lung cancer, stomach cancer, etc.);
• sensory disturbances (pain, numbness, feeling of fullness, “crawling”, increased or decreased sensitivity of certain areas);
• movement disorders (weakness, impaired motor function of the limbs, facial muscles and eyes);
• vegetative disorders (dry or wet hands and soles, cold extremities).

Treatment

In our clinic, traditional and alternative medicine methods are used to treat neuropathies. Complex treatment is selected only individually and depends entirely on the degree of damage to the nerve(s).

Initial treatment will be aimed at restoring the functions of the peripheral nerves, therefore, the cause will be eliminated.

An integrated approach is important in the treatment of neuropathies! Our specialists will take into account all the nuances of the damage and may prescribe:

• medications that improve metabolism, blood circulation and restoration processes in nervous tissue. Medicines can also be used in injection form, including intravenous drips in a cozy day hospital
• hormonal drugs (steroids) - in some cases
• therapeutic drug blockades
• certain types of physiotherapeutic treatment
• manual therapy (osteopathy)
• classic massage

Causes of peripheral neuropathy

There are many factors that can cause peripheral neuropathy, so it is often difficult to determine the cause of the disease. In general, neuropathy is classified into three main groups:

• Acquired neuropathies
  caused by exposure to toxins, injury, disease, or infection. Known causes of acquired neuropathy include: Diabetes;
• Some rare hereditary diseases;
• Alcoholism;
• Poor nutrition and vitamin deficiency;
• Certain types of cancer and the effects of chemotherapy used to treat them;
• Situations where the nerves are attacked by the body's immune system;
• Some medications;
• Diseases of the kidneys or thyroid gland;
• Some infections (Lyme disease, AIDS).

Hereditary neuropathies
are not that common. Hereditary neuropathy is a disease of the peripheral nerves that is genetically passed from parent to child.

Idiopathic neuropathy
is diagnosed when the cause of the disease is unknown. About a third of all neuropathies fall into this category.

Recommendations and prevention

The main prevention of most diseases of the nervous system is maintaining a healthy and active lifestyle, giving up bad habits, timely and adequate treatment of infectious and non-infectious diseases.

If any neurological symptoms occur, do not delay contacting a doctor. Early diagnosis and timely treatment will help prevent the development of complications, prolongation of treatment and the consequences of uncontrolled use of medications. The most complete program of preventive measures is drawn up by a neurologist for each individual patient.

Polyneuropathy (PNP)

Polyneuropathy (PN) (patient information) Polyneuropathy is one of the most common diseases of the peripheral nervous system.

What is polyneuropathy? Polyneuropathies are a group of diseases characterized by multiple and diffuse damage to roots, plexuses and peripheral nerves.

What symptoms bother a patient with polyneuropathy? Depending on which nerve fibers are more involved in the pathological process, the following complaints arise:

• sensitive symptoms: the patient is bothered by numbness, tingling, burning, “crawling” in the hands and/or feet; unsteadiness when walking, aggravated in the dark and when closing the eyes;
• motor symptoms: clumsiness, weakness in the hands and/or feet develops; weight loss in the muscles of the arms and legs; impaired fine motor skills (difficulty fastening buttons and zippers, tying shoelaces, etc.); difficulty walking (“spanking” feet, difficulty getting up and down stairs, etc.);
• vegetative symptoms: fluctuations in blood pressure, “interruptions” in the heart, constipation or diarrhea, dry skin or increased sweating, decreased libido, erectile dysfunction.

With polyneuropathy, either an isolated lesion of a certain type of nerve fiber or a combination of them can occur, which leads to the appearance of a varied clinical picture.

How does polyneuropathy develop? According to the speed of development, they are distinguished:

• acute polyneuropathies (development < 4 weeks): the most common cause is Guillain-Barré syndrome;
• subacute polyneuropathy (development within 4-8 weeks);
• chronic polyneuropathies (development over > 8 weeks): common causes are diabetes mellitus, alcohol abuse, lack of B vitamins, chronic inflammatory demyelinating polyneuropathy, hereditary causes, etc.

What are the causes of the development of polyneuropathy? The most common causes of polyneuropathy in developed countries are diabetes and alcohol abuse. Other possible reasons may be:

• dieting, poor nutrition, vegetarianism, leading to the development of vitamin B12 deficiency;
• chemotherapy, the use of neurotoxic drugs, less often - intoxication with heavy metals, etc.;
• autoimmune damage to peripheral nerves with the development of dysimmune neuropathies (Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, paraproteinemic polyneuropathy, multifocal motor neuropathy, etc.);
• chronic somatic diseases: systemic autoimmune connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjogren's disease, etc.), chronic renal or liver failure, thyroid pathology, etc.;
• infectious diseases (Lyme borreliosis, HIV infection, neurosyphilis);
• oncological diseases with the development of paraneoplastic process;
• hereditary neuropathies (hereditary motor-sensory neuropathies, hereditary neuropathy with a tendency to paralysis from compression, transthyretin familial amyloid polyneuropathy, porphyritic polyneuropathy, etc.).

It is important to clarify the cause of polyneuropathy as early as possible, because The prognosis and treatment tactics depend on this!!!

What diagnostic methods can be used to detect polyneuropathy? An examination of a patient with polyneuropathy begins with a consultation with a neurologist, during which the doctor analyzes complaints and anamnestic information and assesses the neurological status. If there are subjective and objective symptoms indicating the presence of polyneuropathy, the doctor prescribes an examination:

• Electroneuromyography (ENMG) is the main instrumental method for diagnosing diseases of peripheral nerves, which not only confirms the fact of nerve damage, but also determines the nature of their damage (demyelinating, axonal, with conduction blocks).

In complex diagnostic cases, the doctor may recommend ultrasound of peripheral nerves, MRI of the plexuses with contrast, diagnostic lumbar puncture, morphological examination of the nerve (biopsy).

What diagnostic methods can be used to clarify the cause of polyneuropathy? To clarify the reasons that caused widespread damage to peripheral nerves, a thorough examination is necessary:

• comprehensive laboratory blood test: minimum volume - detailed general and biochemical blood test, RW, anti-HIV, HBsAg and anti-HCV, level of vitamins B1, B6, B9, B12, homocysteine ​​(if necessary, in each case individually, spectrum of laboratory examination is expanding)
• if hereditary neuropathy is suspected - molecular genetic analysis (search for mutations in the PMP22 gene, neuromuscular disease panel or full genomic sequencing), etc.;
• electrophoresis of serum and urine proteins with immunofixation + freelite;
• lumbar puncture with general analysis of cerebrospinal fluid;
• instrumental general somatic examination, including cancer screening (CT of the lungs, ultrasound of the mammary glands, mammography, ultrasound of the prostate and scrotum, endoscopy, colonoscopy, ultrasound of the abdominal and pelvic organs, PET-CT, etc.).

The examination plan is drawn up individually! It is important to remember that in every third case, after a thorough examination, it is not possible to clarify the cause of polyneuropathy - in this case, idiopathic polyneuropathy is diagnosed!!!

What treatment methods have been developed for polyneuropathy? From the standpoint of evidence-based medicine, pathogenetic treatment has not been developed for all polyneuropathies. Thus, with diabetic polyneuropathy, first of all, careful monitoring of blood glucose levels and compliance with all recommendations of the treating endocrinologist is necessary. For toxic polyneuropathy, such as alcoholic polyneuropathy, treatment begins with complete cessation of the bad habit. If deficiency polyneuropathy is detected, vitamin therapy is carried out, and the causes causing the development of the disease are eliminated.

Pathogenetic therapy (i.e. therapy aimed at correcting the mechanisms of disease development) is the main one in the treatment of dysimmune polyneuropathy (Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, paraproteinemic polyneuropathy, multifocal motor neuropathy, etc.). Depending on the type of dysimmune neuropathy, the optimal treatment method or their combination is selected individually, taking into account all the nuances of the disease. The following methods of pathogenetic therapy for dysimmune neuropathies have been developed: hormone therapy (use of high doses of glucocorticosteroid drugs), high-volume plasmapheresis, high-dose intravenous immunotherapy, as well as the use of cytostatics and monoclonal antibody preparations.

Currently, pathogenetic therapy has been developed for some hereditary polyneuropathies:

• Transthyretin familial amyloid polyneuropathy (TTR-FAP) – liver transplantation, stabilization of the transthyretin molecule;
• Fabry disease – enzyme replacement therapy;
• Porphyritic polyneuropathy - heme arginate.
• Refsum's disease - diet therapy, plasmapheresis.

Symptomatic therapy is used to eliminate unpleasant sensory sensations (numbness, burning, burning pain) in polyneuropathy. Local anesthetics, anticonvulsants, antidepressants, opioid analgesics, and psychotherapy are recommended.

Restorative and rehabilitation methods of treatment (transcutaneous electrical neurostimulation, acupuncture, biofeedback, interventional methods, massage, physiotherapy, balance therapy, robotic therapy) occupy an important place in the correction of neurological disorders in polyneuropathy.

If you have symptoms of polyneuropathy or have been diagnosed with polyneuropathy, you can undergo a comprehensive examination at the Center for Diseases of the Peripheral Nervous System of the Federal State Budgetary Institution National Center of Neurology, where they will help you clarify the diagnosis, identify the causes of damage to the peripheral nerves and prescribe therapy based on evidence-based medicine.

This area has long been one of the priorities for the Federal State Budgetary Institution Scientific Center for Science and Technology. Here, the country's first neuroreanimation department was created, which was famous for its unique methodology of caring for patients with severe forms of polyneuropathy requiring long-term artificial ventilation. Several decades ago, unique work was carried out on the diagnosis and treatment of certain forms of neuropathies: hereditary, diphtheria, dysimmune, etc. Here, for the first time in the USSR, plasmapheresis was introduced as a method of treating autoimmune diseases of the nervous system. We have accumulated unique domestic experience in the treatment and rehabilitation of patients with Guillain-Barre syndrome, severe forms of CIDP and neuropathies of other origins. The center for diseases of the peripheral nervous system includes 13 specialists, including 10 neurologists and 3 endocrinologists. All neurologists are proficient in ENMG research techniques.

Employees of the Center for Peripheral Nervous System Diseases provide consultations to patients on an outpatient basis within the framework of compulsory medical insurance and on a commercial basis.

MAKE AN APPOINTMENT AND ENMG/iEMG BY MULTI-CHANNEL PHONE +7 +7

FAQ

Three fingers on my right hand are numb and painful. What to do?

It is necessary to consult a neurologist to exclude carpal tunnel syndrome and treatment.

I had an attack of trigeminal neuralgia for a long time. Should I take something preventative to prevent another one?

It is imperative to see a neurologist. The doctor will select medications for you that need to be taken on a regular basis and prescribe preventive courses of injections (if necessary, drips in a day hospital) and tablet medications.

Severe burning pain appeared in the right half of the chest and some bubbles appeared. Which doctor should I see?

Similar manifestations, as you describe, can be observed with herpetic ganglioneuritis, the so-called. herpes zoster. This disease is treated by a neurologist.

After about 2 months, my legs began to go numb and weak. Why could this be?

Weakness and sensory disturbances in the limbs can be observed with polyneuropathies of various natures. For example, as a result of diabetes or intoxication. To establish the cause and select adequate therapy, you need to consult a neurologist. There may be a need for additional laboratory and instrumental examinations.

I developed weakness in my right hand after sleeping. Is it from the spine?

The cause of sudden weakness in the arm may also be diseases of the spine. However, a vascular cause or compression of the nerve trunk (nerve plexus) cannot be excluded. To find out the cause and prescribe treatment, you should consult a neurologist.

Can alcoholic neuropathy be cured?

Toxic and dysmetabolic polyneuropathies, incl. alcoholic diseases are most often chronic diseases. With adequate therapy, it is possible to achieve long-term and stable remission

Treatment stories

Case No. 1

Patient Yu., 40 years old, noticed sudden facial asymmetry, lacrimation from the right eye and incomplete closure of the eyelids. I contacted a neurologist at the EXPERT Clinic. The patient was diagnosed with acute neuritis of the facial nerve and prescribed treatment and examination. The patient completed a course of intramuscular and intravenous drip injections in the day hospital of the EXPERT Clinic, courses of physical therapy and acupressure self-massage. Movements in the facial muscles have been completely restored. During the examination, the oncological nature of the disease was excluded, but its herpetic nature was revealed against the background of a secondary immunodeficiency state. After consulting an immunologist, patient Yu was prescribed a course of immunomodulatory therapy.