About multiple peripheral neuritis
What is multiple peripheral neuritis?
Peripheral neuropathy is an umbrella term that denotes a disorder of, or damage to, the peripheral nervous system. The peripheral nervous system consists of all the motor and sensory nerves that connect the brain and spinal cord to the rest of the body (i.e., the nerves outside the central nervous system). The symptoms and physical findings associated with peripheral neuropathies vary greatly from case to case and may be extremely complex.
More than 100 different peripheral neuropathies are recognized, each with a distinguishing set of symptoms, development path, and prognosis. Disorders affecting only one nerve are described as a mononeuropathies while disorders affecting more than one nerve are called polyneuropathies. If two nerves affecting different parts of the body are involved, the disorder is described as a mononeuritis multiplex.
In some cases, symptoms emerge abruptly, progress rapidly, and are slow to subside. Some chronic forms emerge only gradually and progress slowly. Some chronic forms appear to be resolved but are subject to relapses. Most often, symptoms such as pain, tingling, and/or muscle weakness start in both of the feet (bilateral) and progress up the legs. This is usually followed by symptoms in the hands that progress up the arms.
What are the symptoms for multiple peripheral neuritis?
Signs and symptoms of peripheral neuropathy might include:
- Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
- Sharp, jabbing, throbbing or Burning pain
- Extreme sensitivity to touch
- Pain during activities that shouldn't cause pain, such as Pain in your feet when putting weight on them or when they're under a blanket
- Lack of coordination and falling
- Muscle weakness
- Feeling as if you're wearing gloves or socks when you're not
- Paralysis if motor nerves are affected
If autonomic nerves are affected, signs and symptoms might include:
- Heat intolerance
- Excessive Sweating or not being able to sweat
- Bowel, bladder or digestive problems
- Drops in blood pressure, causing Dizziness or lightheadedness
Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy), or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.
What are the causes for multiple peripheral neuritis?
Peripheral neuropathy is nerve damage caused by a number of different conditions. Health conditions that can cause peripheral neuropathy include:
- Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
- Diabetes. This is the most common cause. Among people with diabetes, more than halfwill develop some type of neuropathy.
- Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV.
- Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
- Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press on nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.
- Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.
- Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).
Other causes of neuropathies include:
- Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.
- Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.
- Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
- Injury or pressure on the nerve. Injuries, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.
- Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.
In a number of cases, no cause can be identified (idiopathic).
What are the treatments for multiple peripheral neuritis?
Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms. If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves.
Besides medications used to treat conditions associated with peripheral neuropathy, medications used to relieve peripheral neuropathy signs and symptoms include:
Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.
Medications containing opioids, such as tramadol (Conzip, Ultram, others) or oxycodone (Oxycontin, Roxicodone, others), can lead to dependence and addiction, so these drugs generally are not prescribed unless all other treatments fail.
- Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness.
Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it.
Lidocaine patches are another treatment you apply to your skin that might offer pain relief. Side effects can include drowsiness, dizziness and numbness at the site of the patch.
Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin (Silenor, Zonalon) and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.
The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta, Drizalma Sprinkle) and the extended-release antidepressants venlafaxine (Effexor XR) abd desvenlafaxine (Pristiq) also might ease the pain of peripheral neuropathy caused by diabetes.
Side effects of antidepressants may include dry mouth, nausea, drowsiness, dizziness, changes in appetite, weight gain and constipation.
Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy.
- Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month.
Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions.
Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins).
- Physical therapy. If you have muscle weakness, physical therapy can help improve your movements. You may also need hand or foot braces, a cane, a walker, or a wheelchair.
- Surgery. If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you might need surgery to reduce the pressure.
What are the risk factors for multiple peripheral neuritis?
Peripheral neuropathy risk factors include:
- Diabetes, especially if your sugar levels are poorly controlled
- Alcohol misuse
- Vitamin deficiencies, particularly B vitamins
- Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV
- Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system attacks your own tissues
- Kidney, liver or thyroid disorders
- Exposure to toxins
- Repetitive motion, such as those performed for certain jobs
- Family history of neuropathy
Is there a cure/medications for multiple peripheral neuritis?
If your neuropathy is due to an underlying, treatable condition, you may be able to stop your peripheral neuropathy by treating the larger problem.
However, if this isn’t the case for you, you can successfully manage the symptoms of your peripheral neuropathy. Speak with your doctor to determine the best medical treatment for you, and explore complementary and self-care options that can supplement your medical care.