What is neuropathy. Features of the manifestation of neuropathy with damage to nerves of various locations
Neuropathy ( or neuropathy) called non-inflammatory nerve damage related to diseases of the nervous system. Neuropathy can affect both peripheral and cranial nerves. Neuropathy accompanied by damage to several nerves at the same time is called polyneuropathy. The incidence of neuropathy depends on the disease in which it develops. Thus, diabetic polyneuropathy develops in more than 50 percent of cases of diabetes mellitus. Asymptomatic alcoholic neuropathy in chronic alcoholism is observed in 9 cases out of 10. At the same time, clinically pronounced alcoholic polyneuropathy with cerebellar disorders, according to various sources, is observed in 75–80 percent of cases.
Various types of hereditary neuropathies occur with an incidence of 2 to 5 percent. With periarteritis nodosa, polyneuropathy is observed in half of all cases. With Sjögren's syndrome, neuropathies are observed in 10 to 30 percent of cases. With scleroderma, neuropathy is observed in one third of cases. In this case, 7 out of 10 patients develop trigeminal neuropathy. Multiple neuropathies with allergic angiitis develop in 95 percent of cases. Various types of neuropathies with systemic lupus erythematosus are observed in 25 percent of patients.
According to average statistical data, neuropathy of the facial nerve is observed in 2–3 percent of the adult population. In one in ten, the neuropathy recurs ( worsens again after treatment). The incidence of trigeminal neuropathy is one case per 10–15 thousand population.
With multiple injuries, burns, and crash syndromes, nerve damage almost always develops. Most often, post-traumatic neuropathies of the upper and lower extremities are observed. In more than half of the cases, these neuropathies develop at the level of the forearm and hand. In one fifth of cases, combined trauma of several nerves is observed. Brachial plexus neuropathy accounts for 5 percent.
Vitamin B12 deficiency is accompanied by neuropathy in 100 percent of cases. With a lack of other B vitamins, neuropathy also occurs in 90–99 percent of cases. Representatives of traditional Chinese medicine use an interesting approach to defining and treating neuropathy. According to Chinese healers, this disease is a Wind type disorder ( influence of air on human well-being) against the background of immune system failures. Despite the fact that many people do not trust the methods of Chinese medicine, using an integrated approach, doctors achieve positive results in about 80 percent of cases of treating this disease.
The ways in which Chinese doctors treat neuropathy are:
- manual therapy;
- hirudotherapy ( use of leeches);
- stone therapy ( massage with stones);
- vacuum ( canned) massage.
For neuropathy of the facial nerve, acupuncture uses active points on the canal of the large and small intestines, urinary and gall bladder, and stomach. Using acupuncture points ( areas on the body where blood and energy accumulate), Chinese doctors not only minimize pain, but also improve the general condition of the patient.
Massage in Chinese traditional medicine
Manual therapy is used not only for treatment, but also for diagnosing neuropathy, as it allows you to quickly determine which muscles are tight. Acupressure improves blood circulation, gives freedom to organs and muscles and increases the body's resources to combat neuropathy.
Hirudotherapy
The use of leeches in the treatment of neuropathy is due to several effects that this method has.
The health benefits that hirudotherapy provides are:
- Effect due to enzymes– during the treatment process, the leech injects about 150 different compounds into the blood that have a beneficial effect on the body. The most common enzymes are hirudin ( improves the rheological properties of blood), anesthesin ( acts as an analgesic), hyaluronidase ( improves the absorption of nutrients).
- Relaxation– leech bites have a calming effect on the patient and make him more resistant to stress factors.
- Strengthening the immune system– most of the compounds introduced by the leech are of protein origin, which has a beneficial effect on nonspecific immunity.
- Drainage effect– leech bites, due to increased blood supply, improve the outflow of lymph, which has a positive effect on the general condition of the patient.
- Anti-inflammatory effect– the secretion of leeches has an antimicrobial and anti-inflammatory effect, without causing side effects.
The combination of hot and cold stones has a tonic effect on blood vessels and improves blood circulation. Stone therapy also has a relaxing effect and helps relieve muscle tension.
Cupping massage
Vacuum therapy improves soft tissue drainage and causes vasodilation. This method activates metabolic processes, which has a positive effect on the general tone of the patient.
How do nerves work?
The nervous system of the human body includes the brain with cranial nerves and the spinal cord with spinal nerves. The brain and spinal cord are considered to be the central part of the nervous system. The cranial and spinal nerves belong to the peripheral part of the nervous system. There are 12 pairs of cranial nerves and 31 pairs of spinal nerves. All structures of the human nervous system consist of billions of nerve cells ( neurons), which combine with glial elements to form nervous tissue ( gray and white matter). Nerve cells, differing from each other in shape and function, form simple and complex reflex arcs. Many reflex arcs form pathways connecting tissues and organs with the central nervous system.
All nerve cells consist of an irregularly shaped body and processes. There are two types of neuron processes - axon and dendrite. An axon is a thickened filament that extends from the body of a nerve cell. The length of the axon can reach one meter or more. The dendrite has a cone shape with many branches.
It is much thinner than an axon and shorter. The length of the dendrite is usually several millimeters. Most nerve cells have many dendrites, however, there is always only one axon.
The processes of nerve cells unite and form nerve fibers, which, in turn, unite to form a nerve. Thus, a nerve is a “cord” consisting of one or more bundles of nerve fibers that are covered by a sheath.
Neurons vary in shape, length, number of processes, and functions.
Types of neurons
| Classification parameter | Type of nerve cell | Characteristics of a nerve cell |
| By number of shoots | Unipolar neuron | Only one axon extends from the neuron body and there are no dendrites. |
| Bipolar neuron | Two processes extend from the nerve cell body: one axon and one dendrite. |
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| Multipolar neuron | One axon and more than one dendrite extend from the nerve cell body. |
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| Along the length of the axon | Long axonal nerve cells | The length of the axon is more than 3 millimeters. |
| Short axon nerve cells | The average length of an axon is one to two millimeters. |
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| By function | Touch ( sensitive) neurons | Their dendrites have sensitive endings, from which information is transmitted to the central nervous system. |
| Motor neurons ( motor) neurons | They have long axons along which nerve impulses travel from the spinal cord to the muscles and secretory organs. |
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| Interneurons | They communicate between sensory and motor neurons, transmitting nerve impulses from one to the other. |
Depending on the type of neurons and their processes included in the composition, nerves are divided into several types:
- sensory nerves;
- motor nerves;
- mixed nerves.
All nerve cells communicate with each other through their processes through synapses ( nerve connections). On the surface of the dendrites and body of the nerve cell there are many synaptic plaques, through which a nerve impulse is received from another nerve cell. Synaptic plaques are equipped with synaptic vesicles containing neurotransmitters ( neurochemicals). During the passage of a nerve impulse, mediators are released in large quantities into the synaptic cleft and close it. When the impulse passes further, the mediators are destroyed. From the neuron body, the impulse is carried along the axon to the dendrites and body of the next neuron or to muscle or glandular cells.
The axon is covered with a myelin sheath, the main task of which is to continuously conduct the nerve impulse along the entire axon. The myelin sheath is formed by several ( up to 5 – 10) protein layers that are wound like cylinders onto the axon. Myelin layers contain a high concentration of ions. The myelin sheath is interrupted every 2 - 3 millimeters, forming special areas ( Ranvier interceptions). In the zones of nodes of Ranvier, ionic current is transmitted along the axon, which increases the speed of the nerve impulse tens and hundreds of times. The nerve impulse moves in leaps and bounds from one node of Ranvier to another, covering a long distance in a shorter time.
Depending on the presence of myelin, all nerve fibers are divided into three types:
- type A nerve fibers;
- type B nerve fibers;
- type C nerve fibers.
Nerve fibers are supplied with various nerve endings ( receptors).
The main types of nerve endings of neurons are:
- sensory or afferent nerve endings;
- motor nerve endings;
- secretory nerve endings.
Motor nerve endings are located in muscles and muscle tissue of various organs. From them nerve fibers go to the spinal cord and brain stem. Secretory nerve endings are located in the endocrine and exocrine glands.
Afferent nerve fibers transmit similar irritation from sensory receptors to the central nervous system, where all information is received and analyzed. In response to a nervous stimulus, a stream of response impulses appears. It is transmitted along motor and secretory nerve fibers to the muscles and excretory organs.
Causes of neuropathies
The causes of neuropathy can be very different. Conventionally, they can be divided into 2 categories - endogenous and exogenous. Endogenous causes include those that originated in the body itself and led to damage to one or more nerves. These can be various endocrine, demyelinating, and autoimmune diseases. Exogenous causes are those that act from outside the body. These include various infections, injuries, and intoxications. Endogenous causes of neuropathies are:
- endocrine pathologies, for example, diabetes mellitus;
- demyelinating diseases - multiple sclerosis, disseminated encephalomyelitis;
- autoimmune diseases - Guillain-Barre syndrome;
- alcoholism;
- vitamin deficiencies.
Endocrine pathologies
Among endocrine pathologies that cause nerve damage, the main place is given to diabetes mellitus. With this disease, both entire nerve trunks and only nerve endings can be affected. Most often, with diabetes mellitus, diffuse, symmetrical damage to the nerve endings in the lower extremities is observed, with the development of polyneuropathy.The mechanism of diabetic neuropathy comes down to a malnutrition of the nerve endings. These disorders develop due to damage to the small vessels that supply the nerves. As you know, in diabetes mellitus small vessels are primarily affected. Various pathological changes are noted in the wall of these vessels, which subsequently lead to disruption of blood flow in them. The speed of blood movement and its volume in such vessels decreases. The less blood there is in the vessels, the less it flows to the tissues and nerve trunks. Since nerve endings are supplied by small vessels ( which are affected first), then their nutrition is quickly disrupted. In this case, dystrophic changes are observed in the nervous tissue, which lead to dysfunction of the nerve. In diabetes mellitus, sensitivity disorders develop first. Various paresthesias occur in the extremities in the form of heat, goosebumps, and a feeling of cold.
Due to metabolic disorders characteristic of diabetes mellitus, swelling develops in the nerve and the formation of free radicals increases. These radicals act like toxins on the nerve, leading to nerve dysfunction. Thus, the mechanism of neuropathies in diabetes mellitus lies in toxic and metabolic causes.
In addition to diabetes mellitus, neuropathies can occur with pathologies of the thyroid gland, adrenal glands, and Itsenko-Cushing's disease.
Demyelinating diseases ( DZ)
This group of diseases includes pathologies that are accompanied by destruction of the myelin sheath of the nerve. The myelin sheath is a structure that consists of myelin and covers the nerve. It ensures the instantaneous passage of impulses along the nerve fiber.Demyelinating diseases that can cause neuropathy are:
- multiple sclerosis;
- acute disseminated encephalomyelitis;
- concentric sclerosis;
- Devic's disease or acute neuromyelitis optica;
- diffuse leukoencephalitis.
The mechanism of destruction of the myelin sheath covering the nerve fiber is complex and not fully understood. It is assumed that under the influence of various factors the body begins to produce anti-myelin antibodies. These antibodies perceive myelin as a foreign body, that is, as an antigen. An antigen-antibody complex is formed, which triggers the destruction of the myelin sheath. Thus, foci of demyelination form in the nervous tissue. These lesions are located both in the brain and in the spinal cord. Thus, the destruction of nerve fibers occurs.
In the initial stages of the disease, swelling and inflammatory infiltration develop in the nerve. Depending on the nerve, this stage is manifested by various disorders - gait disorder, weakness in the limbs, dullness of sensitivity. Next, there is a disturbance in the conduction of the impulse along the nerve fiber. At this stage, paralysis develops.
With neuromyelitis optica ( Devic's disease) of the cranial nerves, only the optic nerve is affected. Spinal nerves are affected at the level of the spinal cord where the focus of demyelination is located.
Autoimmune diseases
The most common autoimmune pathology, which is accompanied by various neuropathies, is Guillain-Barré syndrome. Various polyneuropathies are observed with this disease.Bacteria and viruses involved in the development of Guillain-Barré syndrome are:
- campylobacter;
- hemophilus influenzae;
- Epstein-Barr virus.
Types of neuropathy in Guillain-Barré syndrome are:
- acute demyelinating polyneuropathy;
- acute motor neuropathy;
- acute sensory axonal neuropathy.
Neuropathies are also observed in autoimmune diseases such as scleroderma, systemic lupus erythematosus, and rheumatoid arthritis. The mechanism of damage to nerve fibers in these diseases is different. Thus, with rheumatoid arthritis, compression of the nerves is observed, with the development of compressive neuropathy. In this case, compression of the nerve fibers occurs by deformed joints. The most common condition is compression of the ulnar nerve ( with further development of neuropathy) and peroneal nerve. A common manifestation of rheumatoid arthritis is carpal tunnel syndrome.
As a rule, with rheumatoid arthritis, mononeuropathy is observed, that is, damage to one nerve. In 10 percent of cases, patients develop multiple mononeuropathy, that is, several nerves are affected at the same time.
Scleroderma
Scleroderma can affect the trigeminal, ulnar, and radial nerves. Nerve endings in the lower extremities may also be affected. First of all, systemic scleroderma is characterized by the development of trigeminal neuropathy. Sometimes this may be the first symptom of the disease. The development of peripheral polyneuropathy is typical in later stages. The mechanism of nerve damage in scleroderma comes down to the development of systemic vasculitis. Nerve sheath vessels ( endoneurium and perineurium) become inflamed, thickened and subsequently sclerosed. This leads to oxygen starvation of the nerve ( ischemia) and the development of dystrophic processes in it. Sometimes, zones of necrosis, called infarctions, can form at the border of two vessels.
With scleroderma, both sensory neuropathies develop - with impaired sensitivity, and motor neuropathies - with motor insufficiency.
Sjögren's syndrome
Sjögren's syndrome affects predominantly peripheral nerves and much less frequently cranial nerves. As a rule, sensory neuropathy develops, which is manifested by various paresthesias. In one third of cases, tunnel neuropathies develop. The development of neuropathy in Sjogren's syndrome is explained by damage to the small vessels of the nerve sheath, infiltration of the nerve itself with the development of edema in it. In the nerve fiber, as well as in the blood vessel that feeds it, connective tissue grows and fibrosis develops. At the same time, degenerative changes are observed in the spinal nodes, which cause dysfunction of the nerve fibers.
Wegener's granulomatosis
With this pathology, cranial neuropathy, that is, damage to the cranial nerves, is very often observed. Most often, optic neuropathy, neuropathy of the oculomotor, trigeminal and abducens nerves develop. In rare cases, neuropathy of the laryngeal nerves develops with the development of speech disorders.
Alcoholism
Excessive consumption of alcohol and its substitutes is always accompanied by damage to the nervous system. Asymptomatic neuropathy of the lower extremities is observed in almost all people who abuse alcohol. Severe neuropathies with gait disturbances develop in the second and third stages of alcoholism.With alcoholism, as a rule, the nerves of the extremities are affected and the lower extremities are primarily affected. Diffuse symmetrical damage to the nerve plexuses at the level of the lower extremities in alcoholism is called distal or peripheral alcoholic neuropathy. At the initial stage, this is manifested by the “slapping” of the feet when walking, later pain in the legs and a feeling of numbness occur.
The mechanism of alcoholic neuropathy comes down to the direct toxic effect of alcohol on nerve cells. Later, with the development of metabolic disorders in the body, a disorder of blood supply to the nerve endings occurs. The nutrition of the nervous tissue is disrupted, since microcirculation suffers in alcoholism. With advanced alcoholism, a disorder of macrocirculation develops ( at the level of large vessels). In addition, due to damage to the gastric mucosa by alcohol, the absorption of substances is impaired. At the same time, alcoholics have a deficiency of thiamine or vitamin B1. It is known that thiamine plays an important role in the metabolic processes of nervous tissue and in its absence various lesions occur at the level of the nervous system. Nerve fibers are damaged, followed by a slowdown in the passage of nerve impulses through them.
Distal alcoholic neuropathy can last a long time. It is characterized by an erased, latent course. However, subsequently it can be complicated by paresis and paralysis. Alcoholism can also affect the cranial nerves, namely the nerves located in the brain stem. In the later stages of alcoholism, neuropathies of the optic, facial and auditory nerves are noted.
In case of wood alcohol poisoning ( or methyl, which is used as a substitute for ethyl) varying degrees of damage to the optic nerve are observed. In this case, visual damage is usually irreversible.
Vitamin deficiencies
Vitamins, in particular group B, play a very important role in metabolic processes in nervous tissue. Therefore, with their deficiency, various neuropathies develop. So, with a lack of vitamin B1 ( or thiamine) Wernicke encephalopathy develops with damage to the oculomotor, abducens and facial nerves. This occurs because thiamine is involved as an enzyme in many redox reactions. It protects neuronal membranes from the toxic effects of peroxidation products.Vitamin B12 is also actively involved in metabolic processes in the body. It activates the synthesis of methionine, fatty acids and has an anabolic effect. With its deficiency, funicular myelosis syndrome develops. It consists in the process of demyelination of the nerve trunks of the spinal cord followed by their sclerosis. The lack of this vitamin is characterized by the so-called spotty demyelination of gray matter in the spinal cord and brain in the peripheral nerve endings. Neuropathies due to B12 deficiency are accompanied by impaired statics and movements, muscle weakness and sensory disturbances.
Exogenous causes of neuropathies are:
- trauma, including prolonged compression;
- poisoning;
- infections – diphtheria, HIV, herpes virus.
Injuries
Traumatic nerve damage is one of the most common causes of neuropathies. Injuries can be either acute or chronic. The mechanism by which nerve damage develops varies. Thus, in acute trauma, a strong blow or stretch leads to disruption of the integrity of the nerve fiber. Sometimes the nerve may remain intact, but the structure of the myelin sheath is disrupted. In this case, neuropathy also develops, since the conduction of the nerve impulse is still damaged.With prolonged compression of the nerve fiber ( crash syndromes) or when they are pinched, neuropathies also occur. The mechanism of their development in this case is a disruption of the blood supply to the nerve sheath and, as a consequence, problems with the nutrition of the nerve. Nervous tissue, experiencing starvation, begins to atrophy. Various dystrophic processes develop in it, which are the cause of further nerve dysfunction. Most often, this mechanism is observed in people trapped in rubble ( as a result of some disaster) and were in a stationary position for a long time. As a rule, the nerves of the lower extremities are affected ( sciatic) and upper limbs ( ulnar and radial nerves). Risk areas for this mechanism of development of neuropathy are the lower third of the forearm, hand, lower leg and foot. Since these are the most distal parts of the body, the blood supply to them is worse. Therefore, with the slightest compression, squeezing, or stretching, a lack of blood supply occurs in these areas. Since nerve tissue is very sensitive to a lack of oxygen, within a few hours the cells in the nerve fibers begin to die. With prolonged hypoxia, most of the nerve fibers can die and lose their functions. In this case, the nerve may become nonfunctional. If the nerve lacks oxygen for a short time, then varying degrees of its dysfunction are observed.
Traumatic damage to the cranial nerves can occur with head injuries. In this case, compression of the nerve or direct damage to it may also occur. Nerves can be damaged in both open and closed head injuries. The most common condition is post-traumatic neuropathy of the facial nerve. Damage to the facial and trigeminal nerve can also occur as a result of surgery. Traumatic injury to the third branch of the trigeminal nerve may develop after treatment or tooth extraction.
Traumatic nerve injury also includes traction ( pulling) mechanism. It is observed when falling from a vehicle, dislocations, or awkward turns. Most often, the brachial plexus is damaged by this mechanism.
Poisoning
Nerve fibers can be damaged as a result of exposure to various chemical compounds in the body. These compounds can be metal salts, organophosphorus compounds, and medications. These substances usually have a direct neurotoxic effect.The following chemicals and medications can cause neuropathy:
- isoniazid;
- vincristine;
- lead;
- arsenic;
- mercury;
- phosphine derivatives.
Lead has direct psychotropic and neurotoxic effects. It penetrates the body very quickly and accumulates in the nervous system. Poisoning with this metal is characterized by so-called “lead polyneuritis”. Lead mainly affects motor fibers and therefore motor failure predominates in the clinic. Sometimes a sensitive component is added, which manifests itself as pain in the legs, pain along the nerve. In addition to peripheral neuropathy in pigs, it causes encephalopathy. It is characterized by damage to the nervous tissue of the brain, including symmetrical nerve damage due to lead deposition in the central nervous system.
Mercury and the anticancer drug vincristine also have a direct neurotoxic effect on neurons.
Isoniazid and other antituberculosis drugs with long-term use are complicated by both cranial and peripheral neuropathy. The mechanism of nerve damage is due to inhibition of the synthesis of pyridoxal phosphate or vitamin B6. It is a coenzyme for most metabolic reactions in nervous tissue. Isoniazid enters into a competitive relationship with it, blocking its endogenous ( inside the body) education. Therefore, to prevent the development of peripheral neuropathy during treatment with anti-tuberculosis drugs, vitamin B6 should be taken.
Infections
As a rule, various types of neuropathies develop after one or another infection has been suffered. The mechanism of development of neuropathies in this case is associated with the direct toxic effect of the bacteria themselves and their toxins. Thus, with diphtheria, early and late neuropathies are observed. The former are caused by the action of the diphtheria bacillus on the nerve, and the latter by the entry of diphtheria toxin into the blood and its toxic effect on the nerve fiber. With this infection, neuropathies of the oculomotor nerve, phrenic, vagus nerves, as well as various peripheral polyneuropathies can develop.Neuropathies also develop when the body is infected with the herpes virus, namely type 3 virus, as well as the HIV virus. Herpes virus type 3 or Varicella-Zoster virus, upon initial penetration into the human body, penetrates the nerve ganglia and remains there for a long time. Further, as soon as unfavorable conditions arise in the body, it is reactivated and affects the nerve fibers. With this infection, neuropathies of the facial and oculomotor nerves, as well as polyneuropathy of various nerve plexuses, can develop.
There are also hereditary neuropathies or primary ones, which develop on their own without the background of any disease. These neuropathies are passed on from generation to generation or through one generation. Most of them are sensory neuropathies ( in which sensitivity is impaired), but also motor ones ( with impaired motor function).
Hereditary neuropathies are:
- Charcot-Marie-Tooth pathology– with this neuropathy, the peroneal nerve is most often affected, followed by atrophy of the lower leg muscles;
- Refsum syndrome– with the development of motor neuropathy;
- Dejerine Sott syndrome or hypertrophic polyneuropathy - with damage to the stem nerves.
Symptoms of neuropathies
Symptoms of neuropathies are very varied and depend on which nerve is affected. It is customary to distinguish between cranial and peripheral neuropathy. With cranial nerves, any of 12 pairs are affected. Here we distinguish optic neuropathy ( with damage to the optic nerves), auditory, facial, and so on.In peripheral neuropathy, the nerve endings and plexuses of the limbs are affected. This type of neuropathy is characteristic of alcoholic, diabetic, and traumatic neuropathy.
Also, the symptoms of neuropathy depend on the type of fibers that make up the nerve. If motor fibers are affected, movement disorders develop in the form of muscle weakness and gait disturbance. In mild and moderate forms of neuropathies, paresis is observed, in severe forms - paralysis, which is characterized by a complete loss of motor activity. Moreover, after a certain time, atrophy of the corresponding muscles almost always develops. So, if the nerves of the lower leg are affected, atrophy of the lower leg muscles develops; if the nerves of the face, then the facial and chewing muscles atrophy.
If sensory fibers are affected, sensitivity disorders develop. These disorders manifest themselves in decreased or increased sensitivity, as well as various paresthesias ( sensation of cold, warmth, goosebumps).
Disruption of the exocrine glands ( for example, salivary) is caused by damage to autonomic fibers, which also form part of various nerves or are represented by independent nerves.
Symptoms of facial nerve neuropathy
Since the facial nerve contains taste, secretory and motor fibers, the clinical picture of its damage is very diverse and depends on the location of its damage. Symptoms of facial neuropathy are:
- facial asymmetry;
- hearing disorders;
- lack of taste, dry mouth.
Facial asymmetry
It is the main symptom of facial neuropathy. It develops due to damage to motor fibers in the facial nerve and, as a consequence, paresis of facial muscles. Asymmetry occurs when the nerve is damaged on one side. If the nerve was affected on both sides, then paresis or paralysis of the facial muscles is observed on both sides.
With this symptom, half of the face on the affected side remains motionless. This is best seen when a person shows emotions. At rest, it may not be noticeable. The skin on the surface of the forehead, namely above the eyebrow surface, does not gather into folds. The patient cannot move his eyebrows, this is especially noticeable when trying to surprise him. The nasolabial fold on the affected side is smoothed, and the corner of the mouth is lowered. The patient is unable to close the eye completely, as a result of which it always remains slightly open. Because of this, tear fluid constantly flows out of the eye. It seems that the person is constantly crying. This symptom of neuropathy leads to a complication such as xerophthalmia. It is characterized by a dry cornea and conjunctiva of the eye. The eye looks red and inflamed. The patient is tormented by the sensation of a foreign body in the eye, a burning sensation.
A patient with paralysis of facial muscles experiences difficulty eating. Liquid food constantly leaks out, while solid food gets stuck behind the cheek and needs to be removed from there with the tongue. Certain difficulties also arise during conversation.
Hearing disorders
With neuropathy of the facial nerve, both hearing loss, up to deafness, and its strengthening can be observed ( hyperacusis). The first option is observed if the facial nerve was damaged in the pyramid of the temporal bone after the greater petrosal nerve departed from it. Internal auditory canal syndrome may also occur, which is characterized by hearing loss, tinnitus and facial paralysis.
Hyperacusis ( painful sensitivity to sounds, especially low tones) is observed when the facial nerve is affected before the greater petrosal nerve departs from it.
Lack of taste, dry mouth
When the taste and secretory fibers that go as part of the facial nerve are damaged, the patient experiences taste disorders. Loss of taste is not observed on the entire surface of the tongue, but only on its anterior two-thirds. This is explained by the fact that the facial nerve provides taste innervation to the anterior two thirds of the tongue, and the posterior third is provided by the glossopharyngeal nerve.
The patient also experiences dry mouth or xerostomia. This symptom is caused by a disorder of the salivary glands, which are innervated by the facial nerve. Since the fibers of the facial nerve provide innervation to the submandibular and sublingual salivary glands, dysfunction of these glands is observed with its neuropathy.
If the root of the facial nerve is involved in the pathological process, then damage to the trigeminal, abducens and auditory nerves is simultaneously observed. In this case, the symptoms of neuropathy of the facial nerve are accompanied by symptoms of neuropathy of the corresponding nerves.
Symptoms of trigeminal neuropathy
The trigeminal nerve, like the facial nerve, is mixed. It contains sensory and motor fibers. Sensory fibers are part of the upper and middle branches, and motor fibers are part of the lower. Therefore, the symptoms of trigeminal neuropathy will also depend on the location of the lesion. Symptoms of trigeminal neuropathy are:
- impaired sensitivity of facial skin;
- paralysis of the masticatory muscles;
- facial pain.
Impaired sensitivity will be expressed in its decrease or complete loss. Various paresthesias may also occur in the form of crawling sensations, cold sensations, and tingling sensations. The location of these symptoms will depend on which branch of the trigeminal nerve is affected. Thus, when the orbital branch of the trigeminal nerve is damaged, sensitivity disorders are observed in the area of the upper eyelid, eye, and dorsum of the nose. If the maxillary branch is affected, then sensitivity, both superficial and deep, is impaired in the area of the inner eyelid and the outer edge of the eye, the upper part of the cheek and lip. Also, the sensitivity of the teeth located on the upper jaw is impaired.
When part of the third branch of the trigeminal nerve is affected, a decrease or increase in sensitivity is diagnosed in the area of the chin, lower lip, lower jaw, gums and teeth. If damage to the trigeminal nerve ganglion is observed, then the clinical picture of neuropathy includes a disturbance of sensitivity in the area of all three branches of the nerve.
Paralysis of the masticatory muscles
This symptom is observed when the motor fibers of the mandibular branch are damaged. Paralysis of the masticatory muscles is manifested by their weakness and non-functionality. In this case, a weakened bite on the affected side is observed. Visually, muscle paralysis manifests itself in the asymmetry of the oval of the face - muscle tone is weakened, and the temporal fossa on the affected side sinks. Sometimes the lower jaw may deviate from the midline and droop slightly. With bilateral neuropathy and complete paralysis of the masticatory muscles, the lower jaw may sag completely.
Facial pain
The pain symptom in trigeminal neuropathy is the leading one. Facial pain with this pathology is also called trigeminal neuralgia or facial tic.
The pain with neuropathy is not constant, but paroxysmal. Trigeminal neuralgia is characterized by short-term ( from a few seconds to a minute) attacks of shooting pains. In 95 percent of cases, they are localized in the zone of innervation of the second and third branches, that is, in the area of the outer corner of the eye, lower eyelid, cheek, jaw ( along with teeth). The pain is always one-sided and extremely rarely can radiate to the opposite side of the face. The main characteristic of pain is its strength. The pain can be so severe that the person freezes during the attack. In severe cases, pain shock may develop. Sometimes an attack of pain can cause a spasm of the facial muscles - a facial tic. Excruciating pain is accompanied by numbness of the face or other paresthesias ( goosebumps, cold).
If one of the branches of the trigeminal nerve was damaged separately, then the pain may not be paroxysmal, but aching.
An attack of pain can be triggered by any, even minor, touching the face, talking, chewing, or shaving. With frequently recurring attacks, the mucous membrane of the eye becomes swollen and red, and the pupils are almost always dilated.
Symptoms of ulnar nerve neuropathy
With ulnar nerve neuropathy, movement and sensory disorders are observed. The ulnar nerve emerges from the brachial plexus and innervates the flexor carpi ulnaris, ring finger, and little finger. Symptoms of ulnar nerve neuropathy are:
- impaired sensitivity in the area of the corresponding fingers and the eminence of the little finger;
- dysfunction of wrist flexion;
- violation of spreading and bringing together fingers;
- atrophy of the forearm muscles;
- development of contractures.
With long-term neuropathy, contractures develop. Contracture is a persistent limitation of joint mobility. With ulnar nerve neuropathy, Volkmann's contracture or claw-toe contracture occurs. It is characterized by a claw-like position of the fingers, a bent wrist joint, and flexion of the distal joints of the fingers. This position of the hand is due to atrophy of the interosseous and lumbrical muscles.
The decrease in sensitivity ends with its complete loss on the little finger, ring finger and ulnar edge of the palm.
Diagnosis of neuropathy
The main method for diagnosing neuropathies is a neurological examination. In addition to it, instrumental and laboratory methods are also used. Of the instrumental diagnostic methods, electrophysiological study of peripheral nerves, namely electromyography, is of particular importance. Laboratory methods include tests to detect specific antibodies and antigens that are characteristic of autoimmune and demyelinating diseases. Neurological examination
It consists of a visual examination, examination of reflexes and identification of specific symptoms for damage to a particular nerve.If neuropathy exists for a long time, then asymmetry of the face is visible to the naked eye - with neuropathy of the facial and trigeminal nerve, limbs - with ulnar nerve neuropathy, polyneuropathy.
Visual examination and questioning for facial neuropathy
The doctor asks the patient to close his eyes tightly and wrinkle his forehead. With neuropathy of the facial nerve, the fold on the forehead on the side of the injury does not gather, and the eye does not close completely. Through the gap between the non-closed eyelids, a strip of sclera is visible, which gives the organ a resemblance to the eye of a hare.
Next, the doctor asks the patient to puff out his cheeks, which also does not work, since the air on the affected side comes out through the paralyzed corner of the mouth. This symptom is called sails. When trying to bare teeth, asymmetry of the mouth is observed in the form of a tennis racket.
When diagnosing facial neuropathy, the doctor may ask the patient to do the following:
- close your eyes;
- frown;
- raise eyebrows;
- bare teeth;
- puff out your cheeks;
- try to whistle, blow.
The doctor pays special attention to how the disease began and what preceded it. Was there a viral or bacterial infection? Since the third type of herpes virus can persist in the nerve ganglia for a long time, it is very important to mention whether or not there was an infection with the herpes virus.
Symptoms such as pain and paresthesia in the face and ear can be very subtle. They are present in the neuropathy clinic for the first 24 to 48 hours, and therefore the doctor also asks about how the disease progressed in the first hours.
With neuropathy of the facial nerve, the corneal and blink reflexes are weakened.
Visual examination and questioning for trigeminal neuropathy
For trigeminal neuropathy, the main diagnostic criterion is paroxysmal pain. The doctor asks questions about the nature of the pain, its development, and also identifies the presence of specific triggers ( triggering pain) zones
The characteristics of pain syndrome in trigeminal neuropathy are:
- paroxysmal character;
- strong intensity ( Patients compare an attack of pain to the passage of an electric current through them);
- the presence of a vegetative component - an attack of pain is accompanied by lacrimation, nasal discharge, local sweating;
- facial tic - an attack of pain is accompanied by a spasm or muscle twitching;
- trigger zones are those zones that, when touched, cause paroxysmal pain ( e.g. gums, palate).
To identify areas with impaired sensitivity, the doctor examines the sensitivity of the facial skin in symmetrical areas of the face, and the patient evaluates the similarity of sensations. With this manipulation, the doctor can detect a decrease in general sensitivity, its increase, or loss in certain areas.
Visual inspection and questioning for ulnar nerve neuropathy
Initially, the doctor examines the patient’s hands. With long-standing ulnar nerve neuropathy, the diagnosis is not difficult. The characteristic position of the hand in the form of a “clawed paw”, atrophy of the muscles of the eminence of the little finger and the ulnar part of the hand immediately indicate the diagnosis. However, in the initial stages of the disease, when there are no obvious signs of atrophy and characteristic contracture, the doctor resorts to special techniques.
When ulnar nerve neuropathy is detected, the following phenomena are noted:
- The patient is unable to fully clench his hand into a fist, since the ring finger and little finger cannot bend completely and move to the side.
- Due to atrophy of the interosseous and lumbrical muscles, the patient is unable to fan out his fingers and then bring them back.
- The patient is unable to press the hand to the table and scratch it with the little finger.
- The patient is unable to fully bend the hand in the palm.
Examination for other neuropathies
A neurological examination for nerve damage comes down to examining their reflexes. Thus, with neuropathy of the radial nerve, the reflex from the triceps muscle weakens or disappears, with neuropathy of the tibial nerve, the Achilles reflex disappears, and with damage to the peroneal nerve, the plantar reflex disappears. Muscle tone is always examined, which may be reduced in the initial stages of the disease and then completely lost.
Laboratory diagnostic methods
There are no specific markers for various types of neuropathies. Laboratory methods are used to diagnose the causes of neuropathies. Most often, autoimmune and demyelinating diseases, metabolic disorders, and infections are diagnosed.Laboratory diagnosis for diabetic neuropathy
In diabetic neuropathy, the main laboratory marker is blood glucose levels. Its level should not exceed 5.5 millimoles per liter of blood. In addition to this parameter, the indicator of glycosylated hemoglobin is used ( HbA1C). Its level should not exceed 5.7 percent.
Serological ( with determination of antibodies and antigens) the examination is reduced to identifying specific antibodies to insulin, to pancreatic cells, and antibodies to tyrosine phosphatase.
Laboratory diagnostics for neuropathies caused by autoimmune diseases
Autoimmune diseases, including connective tissue diseases, are characterized by the presence of specific antibodies in the blood serum. These antibodies are produced by the body's own cells against its own cells.
The most common antibodies detected in autoimmune diseases are:
- anti-Jo-1 antibodies– detected in dermatomyositis and polymyositis;
- anticentromere antibodies– for scleroderma;
- ANCA antibodies– with Wegener's disease;
- ANA antibodies– with systemic lupus erythematosus and a number of other autoimmune pathologies;
- anti-U1RNP antibodies– for rheumatoid polyarthritis, scleroderma;
- anti-Ro antibodies- with Sjögren's syndrome.
For pathologies accompanied by demyelination of nerve fibers, there are also specific laboratory indicators. In multiple sclerosis, these are markers DR2, DR3; in Devic's neuromyelitis optica - these are antibodies to aquaporin-4 ( AQP4).
Laboratory diagnostics for post-infectious neuropathies
Laboratory markers in this case are antibodies, antigens and circulating immune complexes. In viral infections, these are antibodies to viral antigens.
The most common laboratory parameters for post-infectious neuropathies are:
- VCA IgM, VCA IgG, EBNA IgG- when infected with the Epstein-Barr virus;
- CMV IgM, CMV IgG- with cytomegalovirus infection;
- VZV IgM, VZV IgG, VZM IgA– when infected with the Varicella-Zoster virus;
- antibodies to Campylobacter– for enteritis caused by Campylobacter. With this type of enteritis, the risk of developing Guillain-Barré syndrome is 100 times higher compared to a regular infection.
In this case, this type of diagnosis is indispensable, since the concentration of vitamins in the body can only be determined using a laboratory method. Thus, normally the concentration of vitamin B12 in blood serum should be in the range of 191 – 663 picograms per milliliter. A decrease in vitamin levels below this norm can lead to neuropathies.
Instrumental studies
In this type of diagnosis, the main role is played by electrophysiological research. The main method is to measure the speed of transmission of a nerve impulse along a fiber and electromyography.In the first case, muscle responses to stimulation of certain points on the nerve fiber are recorded. These responses are recorded as an electrical signal. To do this, the nerve is stimulated at one point, and the response is recorded at another. The speed between these two points is calculated from the latent period of action. At different points of the body, the speed of propagation of impulses is different. On the upper extremities the speed is 60–70 meters per second, on the legs - from 40 to 60. With neuropathies, the speed of nerve impulse conduction is significantly reduced, and with nerve atrophy it is reduced to zero.
Electromyography records the activity of muscle fibers. To do this, into the muscle ( for example, on the hand) small needle electrodes are inserted. Skin electrodes may also be used. Next, the muscle responses are captured in the form of bioelectric potential. These potentials can be recorded using an oscilloscope and recorded as a curve on photographic film or displayed on a monitor screen. With neuropathies, there is a weakening of muscle strength. At the beginning of the disease, only slight decreases in muscle activity may be observed, but subsequently the muscles can completely atrophy and lose electrical potential.
In addition to these methods that directly study nerve activity, there are diagnostic methods that identify the causes of neuropathy. Such methods are primarily computed tomography ( CT) and nuclear magnetic resonance ( NMR). These tests can reveal structural changes in the nerves and brain.
Indicators detected by CT and NMR are:
- thickening of the nerve - during inflammatory processes;
- a focus of demyelination or a multiple sclerosis plaque;
- compression of the nerve by various anatomical structures ( vertebra, joint) – for traumatic neuropathy.
Treatment of neuropathy
Treatment of neuropathy depends on the reasons that led to its development. Basically, treatment comes down to eliminating the underlying disease. This can be either drug therapy or surgery. At the same time, the symptoms of neuropathy are eliminated, namely the elimination of pain.Medicines to relieve pain symptoms due to neuropathy
| A drug | Mechanism of action | Mode of application |
| Carbamazepine
(trade names Finlepsin, Timonil, Tegretol) | Reduces the intensity of attacks and also prevents new attacks. It is the drug of choice for trigeminal neuropathy. | The frequency of taking the drug per day depends on the form of the drug. Long-acting forms, which last 12 hours, are taken twice a day. If the daily dose is 300 mg, then it is divided into two doses of 150 mg. The usual forms of the drug, which last for 8 hours, are taken 3 times a day. The daily dose of 300 mg is divided into 100 mg three times a day. |
| Gabapentin
(trade names Catena, Tebantin, Convalis) | Has a strong analgesic effect. Gabapentin is particularly effective for postherpetic neuropathies. | For postherpetic neuropathy, the drug should be taken according to the following regimen:
|
| Meloxicam
(trade names Rekoksa, Amelotex) | Blocks the synthesis of prostaglandins and other pain mediators, thus eliminating pain. Also has an anti-inflammatory effect. | One to two tablets per day, one hour after eating. The maximum daily dose is 15 mg, which is equivalent to two 7.5 mg tablets or one 15 mg tablet. |
| Baclofen
(trade name Baklosan) | Relaxes muscles and relieves muscle spasms. Reduces the excitability of nerve fibers, which leads to an analgesic effect. | The drug is taken according to the following regimen:
|
| Dexketoprofen
| Has an anti-inflammatory and analgesic effect. | The dose of the drug is set individually based on the severity of the pain syndrome. On average, it is 15–25 mg three times a day. The maximum dose is 75 mg per day. |
In parallel with pain relief, vitamin therapy is carried out, drugs are prescribed that relax muscles and improve blood circulation.
Medicines to treat neuropathy
| A drug | Mechanism of action | Mode of application |
| Milgamma | Contains vitamins B1, B6 and B12, which act as coenzymes in nervous tissue. They reduce the processes of degeneration and destruction of nerve fibers and promote the restoration of nerve fibers. | In the first 10 days, 2 ml of the drug is administered ( one ampoule) deep into the muscle once a day. The drug is then administered every other day or two for another 20 days. |
| Neurovitan | Contains vitamins B2, B6, B12, as well as octothiamine ( long-acting vitamin B1). Participates in the energy metabolism of nerve fiber. | It is recommended to take 2 tablets twice a day for a month. The maximum daily dose is 4 tablets. |
| Mydocalm | Relaxes muscles, relieving painful spasms. | In the first days, 50 mg twice a day, then 100 mg twice a day. The dose of the drug can be increased to 150 mg three times a day. |
| Bendazole
(trade name Dibazol) | Dilates blood vessels and improves blood circulation in nervous tissue. It also relieves muscle spasms, preventing the development of contractures. | In the first 5 days, 50 mg per day. In the next 5 days, 50 mg every other day. The general course of treatment is 10 days. |
| Physostigmine | Improves neuromuscular transmission. | 0.5 ml of a 0.1 percent solution is injected subcutaneously. |
| Biperiden
(trade name Akineton) | Relieves muscle tension and eliminates spasms. | 5 mg of the drug is recommended ( 1 ml solution) administered intramuscularly or intravenously. |
Treatment of diseases causing neuropathy
Endocrine pathologiesDiabetic neuropathy is most often observed in this category of diseases. In order to prevent the progression of neuropathy, it is recommended to maintain glucose levels at certain concentrations. For this purpose, hypoglycemic agents are prescribed.
Antihyperglycemic medications are:
- sulfonylureas– glibenclamide ( or maninil), glipizide;
- biguanides– metformin ( trade names metfogamma, glucophage);
Today, the most common antihyperglycemic drug is metformin. It reduces the absorption of glucose in the intestine, thereby reducing its level in the blood. The initial dose of the drug is 1000 mg per day, which is equal to two metformin tablets. The drug should be taken during meals with plenty of water. Subsequently, the dose is increased to 2000 mg, which is equivalent to 2 tablets of 1000 mg or 4 tablets of 500 mg. The maximum dose is 3000 mg.
Treatment with metformin should be carried out under the monitoring of renal function, as well as a biochemical blood test. The most common side effect is lactic acidosis and therefore, if the blood lactate concentration increases, the drug is discontinued.
Demyelinating diseases
These pathologies are treated with corticosteroid drugs. For this purpose, prednisolone and dexamethasone are prescribed. Moreover, the doses of these drugs are significantly higher than therapeutic ones. This treatment method is called pulse therapy. For example, 1000 mg of the drug is prescribed intravenously every other day, in a course of 5 administrations. Next they switch to the tablet form of the drug. Typically, the dose in this treatment period is 1 mg per kg of patient weight.
Sometimes they resort to prescribing cytostatics such as methotrexate and azathioprine. The regimen for using these drugs depends on the severity of the disease and the presence of concomitant pathologies. Treatment is carried out under continuous monitoring of the leukocyte count.
Vitamin deficiencies
For vitamin deficiencies, intramuscular injections of the appropriate vitamins are prescribed. If there is a lack of vitamin B12, injections of cyanocobalamin ( 500 micrograms daily), with a lack of vitamin B1 - injections of 5 percent thiamine. If there is a simultaneous deficiency of several vitamins, then multivitamin complexes are prescribed.
Infections
For infectious neuropathies, treatment is aimed at eliminating the infectious agent. For viral neuropathies, acyclovir is prescribed; for bacterial neuropathies, appropriate antibiotics are prescribed. Vascular drugs such as vinpocetine ( or Cavinton), cinnarizine and antioxidants.
Injuries
In case of injuries, the main role is played by rehabilitation methods, namely massage, acupuncture, electrophoresis. In the acute period of injury, surgical treatment methods are used. If the integrity of the nerve has been completely damaged, during the operation the ends of the damaged nerve are sutured. Sometimes they resort to reconstruction of the nerve trunks. Timely surgical intervention in the first hours after injury) and intensive rehabilitation is the key to restoring nerve function.
Physiotherapy for the treatment of neuropathy
Physiotherapy procedures are prescribed during the inactive period of the disease, that is, after the acute phase of neuropathy has passed. Their main task is to restore nerve function and prevent the development of complications. As a rule, they are prescribed in a course of 7–10 procedures.The main physiotherapeutic procedures used to treat neuropathy are:
- electrophoresis;
- darsonvalization;
- massage;
- reflexology;
- magnetic therapy;
- hydrotherapy.
Electrophoresis is a method of administering drugs through the skin or mucous membranes of the body using an electric current. During this method, a special pad moistened with medicine is placed on the affected area of the body. A protective layer is fixed on top, on which the electrode is installed.
Most often, electrophoresis is prescribed for neuropathy of the facial nerve. Medicines used include aminophylline, dibazol, and prozerin. Contraindications to the use of electrophoresis are skin diseases, acute, as well as chronic, but in the acute stage, infections and malignant formations.
Darsonvalization
Darsonvalization is a physiotherapeutic procedure in which the patient’s body is exposed to pulsed alternating current. This procedure has a vasodilating and tonic effect on the body. Through dilated vessels, blood flows to the nerve fiber, delivering oxygen and necessary substances. Nerve nutrition improves and its regeneration increases.
The procedure is performed using special devices, which consist of a source of pulsed sinusoidal currents. Contraindications to its implementation are pregnancy, the presence of arrhythmias or epilepsy in the patient.
Massage
Massage is especially indispensable for neuropathies accompanied by muscle spasms. Using various techniques, muscle relaxation and pain relief are achieved. During the massage, blood flows to the muscles, improving their nutrition and functioning. Massage is an integral method of treatment for neuropathies that are accompanied by muscle paresis. Systematic warming up of muscles increases their tone and promotes accelerated rehabilitation. Contraindications to massage are also acute, purulent infections and malignant formations.
Reflexology
Reflexotherapy is called massage of biologically active points. This method has a relaxing, analgesic and sedative effect. The advantage of this method is that it can be combined with other methods, and also that it can be used a week or two after the onset of the disease.
Magnetic therapy
Magnetic therapy uses low frequency ( constant or variable) a magnetic field. The main effect of this technique is aimed at reducing pain.
Hydrotherapy
Hydrotherapy or hydrotherapy includes a wide range of treatments. The most common are douches, rubdowns, circular and ascending showers, baths and underwater massage showers. These procedures have many positive effects on the body. They increase the body's stability and resistance, increase blood circulation, and accelerate metabolism. However, the main advantage is stress reduction and muscle relaxation. Contraindications to hydrotherapy are epilepsy, active tuberculosis, and mental illness.
Prevention of neuropathy
Measures to prevent neuropathy are:
- compliance with precautionary measures;
- carrying out activities aimed at increasing immunity;
- developing skills to cope with stress;
- carrying out health procedures ( massage, therapeutic exercises for facial muscles);
- timely treatment of diseases that may cause the development of this pathology.
Precautions for neuropathy
When preventing this disease, it is of great importance to follow a number of rules that will prevent its manifestation and exacerbation.Factors that should be avoided for preventive purposes are:
- hypothermia of the body;
- injuries;
- drafts.
Boosting immunity
Reduced functionality of the immune system is one of the common causes of this disease. Therefore, if you are prone to neuropathy, it is necessary to pay due attention to strengthening the immune system.- maintaining an active lifestyle;
- ensuring a balanced diet;
- eating foods that strengthen the immune system;
- hardening of the body.
Regularly performing various exercises is an effective means of strengthening the immune system. Physical activity helps develop endurance, which helps fight this disease. Patients who suffer from any chronic disorders should first consult with their doctor and find out what types of exercise will not be harmful.
The rules for performing physical exercises are:
- you should choose those types of activities that do not cause discomfort for the patient;
- You should engage in the chosen sport regularly, since with long pauses the acquired effect is quickly lost;
- The pace and time of the exercises should initially be minimal and not cause severe fatigue. As the body gets used to it, the duration of classes should be increased, and the loads chosen should be more intense;
- It is necessary to start classes with aerobic exercises, which allow you to warm up and prepare the muscles;
- The optimal time for training is the morning.
- swimming;
- gymnastics in water ( water aerobics);
- a ride on the bicycle;
- ballroom dancing.
Ways to increase the level of stress without special sports exercises are:
- refusal of the elevator– going up and down stairs helps strengthen the cardiovascular and nervous systems and prevent a wide range of diseases;
- walking– walking increases the overall tone of the body, improves mood and has a beneficial effect on the immune system. Walking also helps maintain muscle tone and has a positive effect on the condition of bones and joints, which reduces the likelihood of injuries and
The lack of the required amount of vitamins causes a decrease in the activity of immune cells and impairs the body's resistance to the manifestations of neuralgia. Therefore, for prevention purposes, your diet should include foods rich in these beneficial substances. Particular attention should be paid to vitamins such as C, A, E.Products that are a source of vitamins that help strengthen the immune system are:
- vitamin A– chicken and beef liver, wild garlic, viburnum, butter;
- vitamin E– nuts ( almonds, hazelnuts, peanuts, pistachios), dried apricots, sea buckthorn;
- vitamin C– kiwi, sweet peppers, cabbage, spinach, tomatoes, celery.
Deficiency of microelements causes a decrease in immunity and inhibits recovery processes in the body.The most important microelements for the proper functioning of the immune system are:
- zinc– yeast, pumpkin seeds, beef ( boiled), beef tongue ( boiled), sesame, peanuts;
- iodine– cod liver, fish ( salmon, flounder, sea bass), fish fat;
- selenium- liver ( pork, duck), eggs, corn, rice, beans;
- calcium– poppy seeds, sesame seeds, halva, powdered milk, hard cheeses, cow cheese;
- iron– red meat ( beef, duck, pork), liver ( beef, pork, duck), egg yolk, oatmeal, buckwheat.
Proteins are a source of amino acids that are involved in the formation of immunoglobulins ( substances involved in the formation of immunity). For the full functionality of the immune system, proteins of both plant and animal origin are required.Foods with sufficient protein content are:
- legumes ( beans, lentils, soybeans);
- cereals ( semolina, buckwheat, oatmeal);
- dried apricots, prunes;
- Brussels sprouts;
- eggs;
- cottage cheese, cheese;
- fish ( tuna, salmon, mackerel);
- liver ( beef, chicken, pork);
- meat ( poultry, beef).
Fats are involved in the production of macrophages ( cells that fight germs). According to the type and principle of action, fats are divided into healthy ones ( polyunsaturated and monounsaturated) and harmful ( saturated, cholesterol and artificially processed fats).Fat-containing foods that are recommended to strengthen the immune system are:
- fatty and semi-fat fish ( salmon, tuna, herring, mackerel);
- vegetable oil ( sesame, rapeseed, sunflower, corn, soybean);
- walnuts;
- seeds ( sunflower, pumpkin);
- sesame;
Carbohydrates are an active participant in the processes of generating energy, which the body needs to fight the disease. Depending on the mechanism of action, carbohydrates can be simple or complex. The first category is quickly processed in the body and promotes weight gain. Complex carbohydrates normalize the digestive system and maintain a feeling of fullness for a long time. This type of carbohydrate has the greatest benefits for the body.Products that contain an increased amount of slow (complex) carbohydrates are:
- beans, peas, lentils;
- pasta from durum wheat;
- rice ( unrefined, brown);
- oats;
- buckwheat;
- corn;
- potato.
Probiotics are types of bacteria that have a complex beneficial effect on the human body.The effects produced by these microorganisms are:
- improving the functionality of the immune system;
- replenishment of the deficiency of B vitamins ( a common factor in neuropathy);
- stimulating the strengthening of the intestinal mucous layer, which prevents the development of pathogenic bacteria;
- normalization of the digestive system.
Foods with sufficient amounts of probiotics include:
- yogurt;
- kefir;
- sauerkraut ( you should choose an unpasteurized product);
- fermented soft cheese;
- sourdough bread ( without yeast);
- acidophilus milk;
- canned cucumbers, tomatoes ( without adding vinegar);
- soaked apples.
Products that harm the immune system include alcohol, tobacco products, sweets, preservatives and artificial colors.Drinks and foods that should be reduced to prevent neuropathy include:
- baked goods and confectionery products contain large amounts of unhealthy fats and sugar, which cause a deficiency of B vitamins;
- industrially produced canned fish, meat, vegetables, and fruits - contain a large number of preservatives, dyes, and flavor enhancers;
- sweet carbonated drinks - contain a lot of sugar and also cause increased gas formation in the intestines;
- instant food products ( fast food) – a large amount of modified harmful fats is used in production;
- alcoholic drinks of medium and high strength - alcohol inhibits the absorption of nutrients and reduces the body's tolerance to various diseases.
To increase the effect of nutrients, a number of rules should be followed when choosing, preparing and consuming foods.The principles of nutrition in the prevention of damage to the facial nerve are:
- fresh fruits should be consumed 2 hours before or after the main meal;
- The healthiest fruits and vegetables are those that are brightly colored ( red, orange, yellow);
- the most preferred types of heat treatment of products are boiling, baking and steaming;
- It is recommended to wash vegetables and fruits in running water.
Food groups, each of which should be included in the daily diet, are:
- cereals, grains, legumes;
- vegetables;
- fruits and berries;
- dairy and fermented milk products;
- meat, fish, eggs.
To ensure the functionality of the immune system, an adult should consume 2 to 2.5 liters of fluid per day. To determine the exact volume, it is necessary to multiply the patient’s weight by 30 ( number of milliliters of water recommended per 1 kilogram of weight). The resulting figure is the daily fluid intake ( in milliliters). You can diversify your drink with fortified drinks and herbal teas.Recipes to strengthen your immune system
Drinks to improve the body's protective functions that can be prepared at home are:- chamomile tea– steam a spoonful of dried flowers with half a liter of boiling water and drink 3 times a day, one-third of a glass;
- ginger drink– grate 50 grams of ginger root, squeeze and mix the juice with lemon and honey; pour hot water and drink in the first half of the day a few hours before meals;
- pine needle infusion– Chop 2 tablespoons of pine needles and add hot water; after three hours, filter, add lemon juice and take half a glass twice a day after meals.
Hardening the body
Hardening is a systematic impact on the body of such factors as water, sun, air. As a result of hardening, a person develops endurance and increases the level of adaptability to changing environmental factors. Also, hardening activities have a positive effect on the nervous system, developing and strengthening resistance to stress.
The main rules of effective hardening are gradual and systematic. You should not start with long sessions and immediately use low temperatures of the influencing factors. Long pauses between hardening procedures reduce the acquired effect. Therefore, when hardening the body, you should adhere to a schedule and regularity.Methods of hardening the body are:
- walking barefoot– to activate biological points located on the feet, it is useful to walk barefoot on sand or grass;
- air baths (exposure to air on a partially or completely naked body) – for the first 3–4 days, procedures lasting no more than 5 minutes should be carried out in a room where the temperature varies from 15 to 17 degrees; further sessions can be carried out outdoors at a temperature of at least 20 - 22 degrees, gradually increasing the duration of the air baths;
- rubdown– rub the body with a towel or sponge soaked in cold water, starting from the top;
- dousing with cold water– for initial procedures, you should use water at room temperature, gradually lowering it by 1 – 2 degrees; people with weak immune systems should start by dousing their feet and hands; after completing the session, wipe dry and rub the skin with a terry towel;
- cold and hot shower– you need to start with cool and warm water, gradually increasing the temperature difference.
Stress management
One of the reasons that can trigger the development or relapse ( re-exacerbation) neuropathy is stress. An effective way to counter negative events is emotional and physical relaxation. Both methods of relaxation are closely related, because when the nervous system is excited, muscle tension occurs unconsciously and automatically. Therefore, to develop resistance to stress, you should train the ability to relax both mentally and emotionally.Muscle relaxation
To effectively master and use muscle relaxation techniques when performing exercises, you should follow a number of rules.The provisions that must be followed during relaxation are:
- regularity - in order to master the relaxation technique and use it when anxiety approaches, you should devote 5 to 10 minutes to training every day;
- You can practice relaxation in any position, but the best option for beginners is the “lying on your back” position;
- Exercises should be carried out in a secluded place, turning off the phone and other distractions;
- Light music will help increase the effectiveness of sessions.
This technique combines physical exercises and auto-training ( repeating certain commands out loud or silently).The steps of this muscle relaxation exercise are:
- You should lie on the floor or other horizontal surface, with your arms and legs slightly apart;
- lift your chin up, close your eyes;
- for 10 minutes, pronounce the phrase “I am relaxed and calm” according to the following scenario - while saying “I” you should inhale, on the word “relaxed” - exhale, “and” - inhale, and on the last word “calm” - exhale;
- You can increase the effectiveness of the exercise by simultaneously imagining how, as you inhale, the body is filled with bright light, and as you exhale, heat spreads throughout all parts of the body.
The principle of this set of exercises is to alternately tense and relax parts of the body. The method is based on the contrast between tense and relaxed muscles, which motivates the patient to get rid of tension faster. The presented method includes several stages intended for each part of the body. To begin relaxation, you need to lie down, spread your arms and legs to the sides, and close your eyes.Jacobson's relaxation stages are:
1. Relaxation of the muscles of the face and head:
- you should tense your forehead muscles and relax after 5 seconds;
- Next, you need to tightly close your eyes, close your lips and wrinkle your nose. After 5 seconds, release the tension.
3. Working the muscles of the neck and shoulders– this area is most subject to tension during stress, so sufficient attention should be paid to working with these parts of the body. You should raise your shoulders, trying to strain your back and neck as much as possible. After relaxing, repeat 3 times.
4. Relaxation of the chest– as you take a deep breath, you need to hold your breath, and as you exhale, you need to release the tension. Alternating inhalations and exhalations for 5 seconds, you should record a state of relaxation.
5. Abdominal exercise:
- you need to take a breath, hold your breath and tense your abs;
- During a long exhalation, the muscles should be relaxed and held in this state for 1 – 2 seconds.
- You should tense your gluteal muscles, then relax. Repeat 3 times;
- Next, you need to strain all the muscles of your legs, holding them in this position for several seconds. After relaxing, do the exercise several more times.
Alternative Relaxation Methods
In situations where muscle relaxation exercises are not available, other stress management techniques may be used. The effectiveness of the method depends on the individual characteristics of the patient and the situation that provoked the anxiety.- green tea– this drink has a beneficial effect on the functioning of the nervous system, improves the overall tone of the body and helps to resist negative emotions;
- dark chocolate– this product contains a substance that promotes the production of a hormone involved in the fight against depression;
- change of activity– anticipating anxiety, you should distract yourself from this state, turning your attention to household chores, pleasant memories, and doing what you love; an excellent way to not give in to anxiety is physical exercise or a walk in the fresh air;
- cold water– when feeling nervous, you need to dip your hands under a stream of cold running water; You should moisten your earlobes with water, and, if possible, wash your face;
- music– correctly selected musical compositions will help normalize the emotional background and cope with tension; According to experts, the most noticeable effect on the nervous system is exerted by the violin, piano, natural sounds, and classical music.
Wellness measures for neuropathy
Procedures such as massage or facial gymnastics, which the patient can perform independently, will help prevent this disease.Massage for neuralgia
Before starting a course of massages, you should consult your doctor. In some cases, a special device can be used instead of hands ( massager) with vibrating action.Massage techniques for the prevention of neuralgia are:
- rubbing ( shoulders, neck, forearms);
- stroking ( back of the head);
- circular movements ( in the area of cheekbones, cheeks);
- tapping with fingertips ( eyebrows, forehead, area around lips).
Gymnastics to prevent attacks of neuralgia
Performing a set of special exercises helps improve blood circulation and prevents muscle stagnation. To better control the process, gymnastics should be performed in front of a mirror.Facial gymnastics exercises are:
- bending and circular movements of the head;
- stretching the neck and head to the right and left;
- folding your lips into a tube, into a wide smile;
- swelling and retraction of the cheeks;
- opening and closing the eyes with strong eyelid tension;
- raising the eyebrows up while simultaneously pressing the fingers on the forehead.
Treatment of pathologies contributing to the development of neuropathy
To reduce the likelihood of development or recurrence of neuropathy, the causes that can provoke these processes should be promptly identified and eliminated.Factors that increase the risk of this disease include:
- diseases of the teeth and oral cavity;
- infectious processes of any localization;
- inflammation of the middle ear, parotid gland;
- colds;
- herpes and other viral diseases;
- disorders of the cardiovascular system.
Injury or illness can affect any part of the nerve fibers in our body. There is a classification of neuropathy, the creators of which were guided by the type and location of the damaged nerve.
Types of nervous disorder
- Peripheral neuropathy. Mechanical injury or disease affects the nerves of the peripheral nervous system, that is, that part of the nervous tissue that is located outside the brain and spinal cord. This type of neuropathy is localized to the tips of the fingers, toes, feet, and palms.
- Proximal neuropathy. The pathology is characterized by painful sensations concentrated in the thighs and buttocks.
- Cranial neuropathy. This type of pathology occurs due to dysfunction of one of the 12 pairs of cranial nerves that exit directly from the brain. Cranial neuropathy is divided into visual and auditory. Optic neuropathy occurs when the optic nerve is damaged, while auditory neuropathy occurs when the auditory nerve is damaged.
- Autonomic neuropathy occurs when the autonomic nervous system, which controls the heart muscle, blood flow, digestive activity, bladder function and intestinal motility, sweating and sexuality, is affected by injury or illness.
- Local neuropathy, the symptoms of which appear unexpectedly, usually develops in one specific area of the body.
Why does neuropathy occur?
The primary sources of pathology are numerous factors. Among them are various diseases, injuries, infectious lesions and even hypo- and. Let's list some of them:
- . Due to this systemic disease, peripheral damage to nerve fibers develops, which is also called diabetic neuropathy. In people with high blood sugar levels, the risk of experiencing this pathology increases with age and duration of the disease. People most often affected are those who have difficulty controlling diabetes, who have unsuccessfully tried to lose excess weight, and who have high levels of lipids in the blood and high blood pressure.
- Violation of the integrity of nerve fibers can be caused by a deficiency of vitamin B12 in the body.
- The onset of neuropathy is often rheumatoid arthritis, systemic lupus erythematosus and other diseases of an autoimmune nature.
- Nerve damage can be caused by certain infections. Among them are HIV and AIDS, syphilis, and Lyme disease.
- in especially severe cases it gives rise to postherpetic neuropathy.
- It’s not difficult to guess what could be the onset of alcoholic neuropathy.
- Pathological damage to nerves is caused by uremia, a disease in which large amounts of waste products accumulate in the body due to kidney failure.
- Neuropathy can be caused by toxic and poisonous substances. Gold compounds, arsenic, mercury, lead, synthetic solvents, nitric oxide, and phosphates pose a great danger to health.
- Some antibacterial agents and drugs used to treat cancer have a destructive effect on neurons.
- Mechanical trauma, prolonged compression of the nerve, or a tumor pinching the nerve fibers lead to the development of neuropathy.
- Sometimes the cause of nerve damage cannot be determined. This neuropathy is called idiopathic.
Signs of pathology
All types of neuropathy, regardless of the cause, have a number of common specific symptoms. The intensity of the manifestation of pathology in different people can vary markedly:
- with peripheral neuropathy, the area of the foot or palm becomes numb and loses sensitivity. Tingling and pain may spread from the leg/arm towards the torso. Numbness prevents the patient from determining the position of the joint, which causes falls. Sometimes high sensitivity to touch develops;
- Low sensitivity on the feet causes inattention to wounds and other injuries. This threatens the infection to penetrate into the deeper layers of the skin, and then into the soft tissues and bones. History has recorded cases of amputation of limbs due to untreated microtraumas;
- when the nerves responsible for motor functions are damaged, general weakness, loss of reflexes appear, thinness develops, and it happens;
- , vomiting, dyspepsia;
- genitourinary system disorder (urinary incontinence, sensation of incomplete emptying of the bladder);
- men's;
- fainting;
- constipation and diarrhea;
- blurred vision;
- poor heat tolerance.
Diagnosis of pathology
The necessary studies are prescribed based on the initial symptoms of neuropathy. To confirm a nervous system disorder, the following tests are performed:
- Electromyography. Using a thin needle with an electrode inserted into the muscle, it is determined how active the muscle fibers are.
- Test for the speed of impulse transmission along nerve fibers. Special sensors equipped with electrodes are attached to the skin of different parts of the body. Each of the sensors produces a weak electrical impulse that affects the nearest nerve. The electrical activity of the nerves indicates the speed of impulse transmission between the sensor electrodes.
In some cases, a nerve fiber biopsy is used: a small area of nerve fiber tissue is examined under a microscope. The subject of the study, as a rule, is part of the calf nerve fibers or nerve tissue on the wrist.
Drug therapy for pathology
Pathology therapy begins, first of all, with eliminating the root cause of the disease. For example, treatment of diabetes mellitus, infectious diseases, and vitamin deficiency can significantly improve the condition of a patient who is experiencing neuropathy.
Treatment of different types of neuropathy is symptomatic. Well-known painkillers of the type do not give the desired effect when it comes to damage to nervous tissue. Medicines that can alleviate the patient's suffering with neuropathy include:
- antidepressants (Amitriptyline, Paroxetine, etc.);
- anticonvulsants (Carbamazepine, Pregabalin);
- opiates (Tramadol, Oxycodone);
- topical medications (capsaicin cream, lidocaine patch).
Folk remedies for treating neuropathy
MirSovetov reminds that all traditional recipes must be discussed with the patient in advance with the attending physician.
This is a simple but very effective way to relieve pain from peripheral neuropathy. 3 times a day, bare feet trample on fresh nettle leaves for 15-20 minutes.
Make a mixture of leaves, motherwort and oregano. Take 100 g of each herb and pour 3 liters of boiling water over the raw material, leave for an hour. Then immerse the affected part of the body in this bath for 15-20 minutes.
Even if you don’t have the necessary herbs at home, you can simply soak your sore feet in warm water, and then smear your feet with a cream that contains bee venom.
Lemon peel soaked in olive oil perfectly relieves pain in the feet. Tape the “medicine” to your feet, put on warm socks and leave it on overnight.
Is it possible to prevent neuropathy?
If possible, complications of diseases that can cause the development of neuropathy should be avoided. With diabetes, for example, you need to regularly monitor the level, preventing it from reaching a critical level. This will help prevent the onset of diabetic neuropathy. The same applies to a nervous disorder that develops due to improper or insufficient nutrition and alcohol abuse. Unfortunately, genetic and hereditary disorders of the nervous system cannot be prevented.
Neuropathy is a pathological condition in which the function of a particular nerve is impaired. The cause of the disease can be traumatic injury or illness.
The name of the disease is usually related to the location of the damage and the cause of its occurrence (examples include radial neuropathy or diabetic neuropathy).
The disease has many varieties...
For ease of diagnosis, neuropathy is divided into the following types:
- Peripheral. In this case, damage occurs to nerves that do not belong to the central nervous system. With this disorder, the function of the limbs is affected, with proximal neuropathy affecting the thighs and buttocks, and distal neuropathy affecting the feet, hands, fingers, or toes.
- Cranial. This term refers to changes in the functioning of any of the 12 pairs of cranial nerves. There are subtypes of this pathology - visual and auditory, with disorders of the corresponding nerves.
- Autonomous. Refer to disorders of the autonomic innervation of internal organs, including disorders of blood pressure, cardiac muscle function, digestive organs and urine excretion.
Causes of nerve dysfunction
The causes of neuropathy can be a variety of conditions and disorders:
- most often, neuropathy develops against the background of long-term diabetes mellitus;
- lack of vitamins. Most often these are folic acid and B vitamins;
- autoimmune diseases;
- herpes virus;
- long-term alcohol abuse;
- congenital or hereditary diseases;
- amyloidosis;
- uremia in renal failure;
- toxic damage;
- taking certain medications;
- injury or bruise;
- tumors of any origin.
If the cause of the disease cannot be identified, then such neuropathy is called idiopathic.
Symptoms depending on the location of the lesion
The symptoms of neuropathy appear depending on which nerve is damaged in this case. Most often, in the peripheral and cranial form of the disease, the functioning of various nerves is disrupted.
Facial nerve
Signs of damage include the development of acute paralysis or paresis of facial muscles. Most often, there is a unilateral disruption of innervation.
In the first stages of the disease, mild pain in the ear area may appear. But a couple of days before the onset of the movement disorder, the pain becomes unbearable.
In case of disturbances at the level of the bone canal, there is a lack of secretion of tear fluid and drying of the ocular cornea. Sometimes the opposite phenomenon may occur - uncontrollable lacrimation.
Ulnar nerve
Violation of innervation manifests itself in the form of weakness in the hand when trying to perform any action. The sensitivity of the little finger and the associated edge of the palm, as well as partially the ring finger, changes.
There is pain in the elbow joint, which radiates to the hand along the left side of the forearm. Symptoms intensify in the morning.
Peroneal nerve
If the innervation in the area of the common trunk is disrupted, there is an inability to flex the foot and turn it inward. The patient develops a gait that is characteristic of such a deviation - when moving, he strongly bends his leg at the knee so that the toe does not touch the floor. Standing or walking on your heels becomes impossible. 
Pain develops on the outside of the lower leg, which intensifies when trying to squat. A long course of neuropathy leads to impaired skin sensitivity and atrophic changes in muscle fibers in the innervation zone.
Radial nerve
If the nerve is damaged at the level of the armpit, it leads to the inability to extend the hand and forearm, and the thumb cannot be moved to the side.
Sensory disturbance occurs, most often in the form of numbness in the area of the first, second and partially third fingers.
Sciatic nerve
A very characteristic sign of neuropathy of this nerve is severe pain along its innervation, which is called sciatica.
The pain is so severe that many patients compare it to an electric shock or a dagger. At the same time, it is pain that does not allow a person to move freely. Paresthesia is noted in the same area.
The leg is constantly kept with the knee joint extended, since due to muscle atrophy the work of antagonists begins to predominate. The patient can move only with a straight leg, without bending the knee.
During the examination, some types of reflexes are absent - Achilles and plantar. In some cases, the disease is accompanied by vasomotor and trophic abnormalities.
Median nerve
Neuropathy of this nerve signals itself with severe pain. It is burning in nature and covers the inner surface of the hand and 1-3 fingers.
With this pathological condition, vegetative and trophic changes are very pronounced. The patient cannot form a fist with his fingers or move his thumb away. Hyperesthesia is sometimes noted. 
Tibial nerve
If there are violations at the level of the popliteal fossa, there is a violation of the flexion of the foot and the ability to move the fingers. Such a patient is unable to stand on his toes.
A very typical sign is walking with a heel strike. The back of the muscle fibers in the area of the leg and foot atrophy.
The Achilles tendon reflex is reduced. Tactile and pain sensitivity changes. Edema and autonomic abnormalities develop. With prolonged movement or walking, pain occurs in the area of the plantar part of the foot. This syndrome occurs especially often in athletes - runners.
The disorder occurs in middle-aged and older women who often wear heels and are overweight.
Sometimes damage to the lower branches of the tibial nerve is provoked by jumping from a height and landing on the heels, or prolonged use of shoes with no heels.
Femoral neuropathy
Flexion and supination with femoral nerve neuropathy are practically not impaired, since there are alternative innervation options for these types of movements in the leg.
The extension function of the knee joint is difficult.
The patient has difficulty running and walking on level ground, but it is especially difficult to climb stairs. There is a change in gait, and during examination there is no knee reflex. 
When lying on your stomach, trying to lift your leg straight causes severe pain. The same thing happens when the lower limb is flexed at the knee joint.
What to do with neuropathy?
- The stages of care for neuropathy consist of symptomatic treatment and taking measures to eliminate the cause of the pathology. In the latter case, the following is carried out:
- normalization and control of sugar levels in diabetes;
- treatment of autoimmune pathologies;
- prevention and antibacterial therapy for infectious processes;
- replenishment of deficiencies of vitamins and other essential substances;
surgical intervention for injuries, and decompression of nerve fibers.
- Symptomatic treatment may be as follows:
- For acute disorders and severe pain, anti-inflammatory, analgesic and decongestant drugs are used. You can use NSAIDs that have all the necessary effects (indomethacin).
- Antispasmodics and vascular drugs (complamin and nicotinic acid) play a significant role in restoring local blood circulation and metabolism.
- Severe inflammation is controlled with hormonal therapy, this avoids the development of muscle contractures. Sometimes local blockades are used, which include glucocorticoids and anesthetics (lidocaine or novocaine).
- Physiotherapy is used to restore damaged fibers and normalize conductivity. Most often, paraffin applications, mud treatment, and UHF are recommended. Ultrasound therapy with hydrocortisone and electrical myostimulation are sometimes used. B vitamins and substances that affect metabolic processes in tissues are prescribed.
- After the acute condition is relieved, special therapeutic exercises, massage and acupuncture are recommended.
For mild peripheral disorders, treatment of neuropathy is possible at home. But in case of severe pain that is not relieved by conventional means or deviations that cause difficulties in self-care, you should go to the hospital until the condition improves.
Neuropathy is a disease characterized by degenerative-dystrophic damage to nerve fibers. With this disease, not only peripheral nerves are affected, but also cranial nerves. Often there is inflammation of a single nerve; in such cases, this disorder is called mononeuropathy, and when several nerves are affected simultaneously, it is called polyneuropathy. The frequency of manifestation depends on the causes of occurrence.
Diabetic neuropathy is considered the most common, as it occurs in more than half of cases. In second place in importance is alcoholic neuropathy - its characteristic feature is that it develops without symptoms. Other types of neuropathy occur equally, but the rarest type of disease is facial nerve neuropathy.
Any type of disease is diagnosed using a hardware examination of the patient, for example, ultrasound or CT, and is also determined based on the results of an examination by a neurologist. The main principles of treatment are the use of physiotherapy and the prescription of medications.
Etiology
There are quite a few reasons for the manifestation of the disease, so they are divided into two large groups - external and internal. The reasons that arose in the body itself include:
- – against the background of this disease, in most cases, peripheral neuropathy develops, i.e., damage occurs to the nerves transmitting signals from the spinal cord or brain;
- pathologies of the endocrine system;
- lack of vitamins in the body, especially those included in group B, since they are important in the metabolic processes of nervous tissues. Quite often it causes the expression of neuropathy of the facial nerve;
- autoimmune disorders such as Guillain-Barré syndrome;
- diseases that have a negative effect on the nerve sheath - myelin. They manifest themselves with symptoms such as increased weakness and gait disturbance. Without timely treatment, they can lead to paralysis;
- . It can be either an independent disorder or a consequence of, which also leads to neuropathy.
External causes causing the appearance of this disorder include:
- alcohol abuse. Alcoholism pathologically affects the entire human body, including internal organs and systems. It is natural that its long-term use causes harm to the nerves. For this reason, neuropathy of the lower extremities most often appears;
- a wide range of injuries - even a strong blow can negatively affect the nerve, leading to its damage. Often this is the main factor in the occurrence of neuropathy of the sciatic and ulnar nerve and upper extremities;
- body with various chemical elements. Typically, toxic substances have a direct effect on the nerves;
- infectious processes - one or another type of neuropathy is expressed against the background of a previous infection, for example, or.
Often the cause of this disorder is a hereditary factor. In this case, the disease develops independently, without any pathogenic effects.
Varieties
Depending on what was the factor for the manifestation of the disease and the location of its localization, the disease is divided into several types:
Depending on the spread of the pathological process and the number of affected nerves, the disorder is called:
- mononeuropathy– only one nerve is affected, for example, facial, ulnar, etc.;
- polyneuropathy– pathology affects several nerves;
- peripheral neuropathy– only those nerves that are responsible for transmitting signals from the brain or spinal cord are involved in the pathogenic process.
Symptoms
Since there are quite a few types of the disease, they will manifest themselves in different symptoms. Thus, the signs of compression-ischemic neuropathy are:
- paralysis of the muscles of one side of the face. For unknown reasons, the nerves on the right side are most often affected;
- pronounced facial asymmetry;
- the appearance of pain in the ears;
- decreased hearing acuity;
- increased tearfulness or, conversely, dry eyes;
- change in taste preferences;
- when you close your eyes, the one on the affected side of your face does not close;
- leakage of fluid from the oral cavity;
- inability to make chewing movements;
- curvature of the upper and lower lips.
Symptoms of diabetic neuropathy are:
- numbness and burning of the skin throughout the body, which leads to sensitivity disorders;
- unsteadiness of gait;
- rapidly developing weakness of the body;
- increased sweating while eating or sleeping;
- dysfunction of the gastrointestinal tract - diarrhea, constipation, nausea and vomiting, bloating and flatulence;
- sexual disorders – lack of erection and vaginal dryness;
- pain and discomfort when rotating the eyeballs.
Alcoholic neuropathy will manifest itself as:
- sudden onset of pain in the lower extremities, which also suddenly stops;
- numbness of arms and legs;
- the occurrence of cramps in the calves at night;
- swelling;
- redness of the skin of the legs;
- difficulty or inability to perform motor functions;
- speech impairment.
Neuropathy of the lower extremities is manifested by the following symptoms:
- burning and numbness;
- severe swelling;
- seizures at any time of the day;
- partial paralysis;
- difficulty walking.
Characteristic signs of sciatic nerve neuropathy are:
- localization of pain in the buttocks, spreading to the thighs. Sometimes the pain is so intense that a person cannot move independently;
- muscle weakness;
- decreased sensitivity in the lower legs and feet;
- coldness of the tips of the toes.
The main symptoms of ulnar nerve neuropathy:
- weakness of the hand, sometimes developing to such an extent that a person cannot perform simple functions, for example, holding cutlery;
- complete numbness of the little finger and partial numbness of the ring finger;
- soreness in the area from the hand to the elbow.
Manifestations of radial nerve neuropathy:
- localization of pain and discomfort in the armpits, often moving to the shoulder and shoulder blades;
- violations of the flexion functions of the hand and fingers;
- numbness of the little finger, ring and middle fingers.
Symptoms of median nerve neuropathy include:
- pronounced pain starting from the forearm and ending with the fingers of the affected upper limb;
- inability to join fingers into a fist;
- muscle weakness;
- numbness of the hand.
Peroneal nerve neuropathy is expressed by the following symptoms:
- impaired extension of the foot and toes. This is noticeable because when walking a person bends his legs strongly at the knee so as not to catch the surface with his toe;
- sensory disturbance;
- pain in the lower leg and foot;
- inability to shift supports to the heels.
The main manifestations of peripheral neuropathy are symptoms such as pain and weakness of the muscles of the upper and lower extremities.
Diagnostics
The main diagnostic measure for neuropathy of any type is a neurological examination. Additionally, tests and hardware tests are prescribed.
Neurological examination consists of:
- questioning the patient about possible causes, previous diseases, as well as the time of onset of the first symptoms;
- direct examination, during which a specialist determines the degree of the disease, based on the patient’s inability to perform one or another action;
- blood test - carried out to identify autoimmune diseases, as well as inflammatory or infectious processes that could contribute to the occurrence of the disease;
- Ultrasound and CT scan of the whole body or affected part;
- radiography using a contrast agent;
- electromyography - for this, small electrodes are inserted into the affected nerve. This is done to record muscle activity.
After receiving all the examination results, the specialist prescribes an individual and most effective treatment strategy.
Treatment
The main goal of therapy is to eliminate the pain and discomfort of the disease, as well as to eliminate the ailments that caused it. Drug treatment includes the following:
- corticosteroids that relieve inflammation;
- antiviral drugs;
- medications that relieve painful spasms;
- sedatives;
- drugs aimed at improving nerve patency;
- vitamin injections.
But the main result in the treatment of neuropathies comes from physiotherapy, which includes:
- therapeutic massage courses;
- warming up;
- electrophoresis;
- exercise therapy exercises;
- treatment with current and magnetic field;
- acupuncture;
- hydrotherapy.
To treat diabetic neuropathy, you need to keep your blood sugar levels under control for the rest of your life. There are no other ways to eliminate this type of disorder. In the alcoholic form, it is necessary to completely abstain from alcoholic beverages, and to restore the body, it is recommended to diversify the diet.
Surgical operations are used extremely rarely, only in cases where it is necessary to stitch a damaged nerve.
Prevention
Preventive measures for neuropathy include:
- enrichment of the diet with vitamins and nutrients;
- strengthening immunity;
- maintaining a healthy lifestyle;
- exercise regularly;
- walking;
- restriction from stressful situations;
- taking courses in therapeutic massage and gymnastics;
- preventive examinations at the clinic several times a year.
In addition, it is necessary to promptly treat diseases that can cause this disorder.
Is everything in the article correct from a medical point of view?
Answer only if you have proven medical knowledge
Neuropathy is a disease that affects the peripheral nervous system (PNS). The PNS controls the motor, sensory, and automatic (such as blood pressure and sweating) functions of the body. When nerves are damaged, a variety of symptoms can occur, depending on which nerves are affected. Foot neuropathy affects 2.4% of all people, including 8% over 55 years of age. Although diabetes is the main cause, neuropathy can be hereditary or develop due to infection, other illnesses, or injury, so you should see a doctor to treat the condition.
Steps
Part 1
Change your lifestyle- If you're having trouble finding free time to exercise, remember that taking small steps is all it takes. For example, you can clean the house, play with the dog, or wash your car yourself. All of these activities promote blood circulation.
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Do foot baths. Fill a small container (such as a basin) with warm water and add 1 cup (about 420 grams) of Epsom salts for every liter of water. Make sure that the water temperature does not exceed 40 degrees. After this, lower your feet into the water. Warm water will help you relax and relieve foot pain. Among other things, Epsom salts contain magnesium, which helps relax muscles.
Reduce your consumption of alcoholic beverages or stop drinking them altogether. Alcohol is toxic to nerves, especially if they are already damaged. It is necessary to limit alcohol consumption to 4 servings (one serving is about 40 milliliters of strong drink, 120 milliliters of wine or 250 milliliters of beer), consumed evenly throughout the week. Some types of neuropathy develop due to alcoholism, so if you have neuropathy, you should abstain from alcohol. Avoiding alcohol will help alleviate symptoms and prevent further nerve damage.
- If you have a history of alcoholism in your family, you may need to stop drinking alcohol completely. Consider giving up alcohol completely - it will help you stay healthy.
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Take evening primrose oil. This natural oil is extracted from the flowers of wild plants and is available in tablet form. Ask your doctor to recommend the appropriate dosage of a dietary supplement that contains evening primrose oil. Studies have shown that the fatty acids contained in this oil can alleviate the symptoms of neuropathy. These fatty acids improve nerve function.
- The beneficial fatty acid GLA (gamma-linolenic acid) is also found in borage oil and blackcurrant oil.
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Try acupuncture. Acupuncture is a traditional Chinese medicine technique that involves inserting thin needles into specific points on the body. Stimulation of these active, or acupuncture, points results in the release of endorphins, which relieve pain. The acupuncturist will insert four to ten needles into the acupuncture points and leave them there for about half an hour. It will take 6-12 sessions over three months.
- Before contacting an acupuncturist, check their reputation. Find out if he has the necessary equipment and sterile needles to avoid possible infections.
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Consider complementary and alternative treatments. In addition to acupuncture, symptoms of neuropathy can be relieved with medications and low-intensity electrical stimulation. Electromyostimulation uses probes charged from a set of small batteries that are placed on the skin around the areas where pain is felt. As a result, a closed electrical circuit is formed, and an electric current passes through the diseased areas, which stimulates them. Electromyostimulation has been shown to be effective in treating certain types of neuropathic pain, although more research is needed.
Part 2
Drug treatment-
Take medications prescribed by your doctor. There are many different medications available to treat neuropathy. Your doctor will pay special attention to the disease or disorder that is underlying the neuropathy, which will help alleviate symptoms and improve the functioning of the nerves in your legs. Your doctor may prescribe the following medications:
Take opioids as prescribed by your doctor. To reduce the pain of neuropathy, your doctor may prescribe long-acting opioids. As a rule, this requires an individual approach, since side effects such as dependence, addiction (the effect of the drug decreases over time) and headaches are possible.
- To treat chronic neuropathy (dysimmune neuropathy), your doctor may prescribe immunosuppressive medications (such as cyclophosphamide) if other medications do not help.
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Talk to your doctor about surgery. Depending on the cause of the neuropathy, your doctor may recommend decompression surgery. This operation will release pinched nerves, which will help them function properly. Decompression surgery is often used to treat carpal tunnel syndrome. In addition, certain types of hereditary neuropathy that involve foot and ankle problems may benefit from such surgeries.
Part 3
Improve your health-
Include more vitamins in your diet. Unless you have diabetes or other obvious systemic diseases, neuropathy can be caused by a deficiency of vitamins E, B1, B6 and B12. Be sure to consult your doctor before taking vitamin supplements. Before recommending nutritional supplements or other treatments, your doctor must determine the cause of the neuropathy.
- To get more vitamins from healthy foods, eat enough green leafy vegetables, egg yolks and liver.
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Control your diabetes. Neuropathy usually develops many years after diabetes is diagnosed. Proper control of diabetes helps prevent neuropathy or slow its progression. However, neuropathy usually cannot be completely cured once it has already begun to develop. Your doctor will focus on controlling your diabetes and relieving pain caused by neuropathy.
- It is necessary to monitor blood glucose levels. On an empty stomach, this level should be 70-130 mg/dL (3.9-7.2 mmol/L), and two hours after breakfast it should not exceed 180 mg/dL (10 mmol/L). You should also monitor your blood pressure.
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Prevent injury and ulceration. Neuropathy can lead to decreased sensation in the feet, which increases the likelihood of injuries such as cuts, punctures and scrapes. Be sure to wear socks and shoes both at home and outside. Repeated injuries to the feet can lead to the formation of ulcers that do not heal well. Also, during regular visits to your doctor, ask him to examine your feet.
- Wear loose-fitting shoes, such as mules, but avoid shoes, sandals, or flip-flops that don't provide enough support. Shoes that are too tight can interfere with proper blood circulation in the feet, increasing the risk of ulcers.
- Make sure your toenails are the appropriate length. This will prevent the formation of ingrown toenails. Be careful when cutting your nails. Do not use blades to avoid accidental cuts.
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Make sure that existing ulcers are clean. Rinse affected areas with warm water and salt. To do this, take a sterile bandage and soak it in salted water, then remove dead tissue from the ulcers. Then cover the sores with a dry, sterile bandage. Change the dressing once or twice a day, or more often if it becomes wet. If the sore has a foul odor, see your doctor immediately, as this may indicate a fairly serious infection.
- If sores appear, tell your doctor immediately. If the ulcers are small, they can be treated with dressings and antibiotics. However, large ulcers are often difficult to treat and can even lead to amputation of fingers or feet.
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Walk regularly. Try to get out of the house at least three times a week or do safe exercise that suits you. You can also ask your doctor to recommend an appropriate exercise regimen for you. Exercise will improve blood flow and nutrition to damaged nerves. Walking lowers your overall blood sugar levels and helps you better control your diabetes. If you can control your diabetes, you may be able to reduce neuropathy.
