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{{Main|Somatosensory disorders}} |
{{Main|Somatosensory disorders}} |
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+ | {{SignSymptom infobox |
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+ | |Name = Paresthesia |
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+ | |ICD10 = {{ICD10|R|20|2|r|20}} |
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+ | |ICD9 = {{ICD9|782.0}}, {{ICD9|355.1}} |
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+ | |MeshID = D010292 |
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+ | }} |
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⚫ | '''Paresthesia''' ({{IPAc-en|ˌ|p|ær|ɨ|s|ˈ|θ|iː|z|i|ə}} or {{IPAc-en|ˌ|p|ær|ɨ|s|ˈ|θ|iː|ʒ|ə}}), spelled '''paraesthesia''' in British [[American and British English spelling differences|English]], is a sensation of tickling, tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep". The manifestation of paresthesia may be transient or chronic. |
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+ | ==Etymology== |
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+ | {{Wiktionary|paresthesia}} |
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− | Transient paresthesia is the temporary sensation of tingling, pricking, or numbness of the skin -- "pins and needles." It is usually felt in the extremities (hands, arms, legs, or feet), but can also occur in other parts of the body. This temporary sensation is usually caused by inadvertent pressure placed on a superficial [[nerve]]. The sensation gradually goes away once the pressure is relieved. |
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+ | [[Greek language|Greek]] ''para'' ("beside", ''i.e.'', abnormal) and ''aisthesia'' ("sensation"). |
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+ | ==Cause== |
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+ | Other common examples occur when sustained pressure has been applied over a [[nerve]], inhibiting/stimulating its function. Removing the pressure will typically result in gradual relief of these paresthesias.<ref name="NINDS">[http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm Paresthesia Information Page: National Institute of Neurological Disorders and Stroke. (NINDS)]</ref> |
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− | Irritation to the nerve can also come from [[inflammation]] to the surrounding tissue. Joint conditions such as [[rheumatoid arthritis]] and [[carpal tunnel syndrome]] are common sources of paresthesia. |
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⚫ | |||
⚫ | Another cause of paresthesia, however, may be direct damage to the nerves themselves, |
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+ | Chronic paresthesia indicates a problem with the functioning of [[neuron]]s. |
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⚫ | In older individuals, paresthesia is often the result of poor [[Circulation (physiology)|circulation]] in the limbs (such as in [[peripheral vascular disease]], also referred to by physicians as '''PVD''' or '''PAD'''), most often caused by [[atherosclerosis]], the build up of plaque within artery walls, over decades, with eventual [[vulnerable plaque|plaque ruptures]], internal clots over the ruptures and subsequent clot healing but leaving behind [[stenosis|narrowing of the artery openings]] or closure, both locally and in downstream smaller branches. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of [[vitamin deficiency]] and [[malnutrition]], as well as metabolic disorders like [[Diabetes mellitus|diabetes]], [[hypothyroidism]], and [[hypoparathyroidism]]. It can also be a symptom of [[mercury poisoning]]. |
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+ | Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as [[rheumatoid arthritis]], [[psoriatic arthritis]], and [[carpal tunnel syndrome]] are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress,{{Citation needed|date=January 2010}} [[bone disease]], poor posture, unsafe heavy-lifting practices or physical trauma such as [[Whiplash (medicine)|whiplash]]. Paresthesia can also be caused simply by putting pressure on a nerve by applying weight (or pressure) to the limb for extended periods of time. |
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− | Other known causes of paresthesia (aside from pressure on the affected area): |
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− | *[[Alcoholism]] |
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− | *[[Dehydration]] |
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− | *[[Fibromyalgia]] |
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− | *[[Hyperventilation]] |
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− | *Withdrawal from certain [[SSRI]]s, such as [[Paroxetine]] |
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− | *[[Vitamin B12]] deficiency |
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⚫ | Another cause of paresthesia, however, may be direct damage to the nerves themselves, ''i.e.'', [[neuropathy]], which itself can stem from [[nerve injury|injury]] or infection such as [[frostbite]] or [[Lyme disease]], or which may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies.<ref>{{cite web|url=http://www.cancer.gov/aboutnci/ncicancerbulletin/archive/2010/022310/page6|title=Chemotherapy-induced Peripheral Neuropathy|publisher=National Cancer Institute|accessdate=1 December 2011}}</ref> Benzodiazepine withdrawal may also cause paresthesia as the drug removal leaves the [[GABA receptors]] stripped bare and possibly malformed. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a [[transient ischemic attack]], or [[autoimmune disease]]s like [[multiple sclerosis]] or [[lupus erythematosus]]. |
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+ | The [[herpes zoster]] disease (shingles) can attack nerves causing numbness instead of pain commonly associated with shingles. A diagnostic evaluation by a medical doctor is necessary to rule these out.{{Clarify|date=December 2010|reason=rule what out? would seem to apply to everything in this section! and be redundant}} |
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+ | |||
+ | [[Demyelinating disease]]s may also cause cross-talk between adjacent axons and lead to paresthesia. During impulse conduction some aberrant current that escaped a demyelinated axon can circulate in the exterior and depolarize an adjacent demyelinated, hyperexcitable axon. This can generate impulses conducted in both directions along this axon since no part of the axon is in a [[refractory period (physiology)|refractory state]]. This becomes very serious in conditions such as multiple sclerosis and [[Guillain–Barré syndrome]]. |
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+ | |||
+ | ===Acroparesthesia=== |
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+ | Acroparesthesia is severe pain in the extremities, and may be caused by [[Fabry disease]], a type of [[Sphingolipidoses|sphingolipidosis]].<ref name=brschemi>{{cite book |author=Marks, Dawn B.;Swanson, Todd; Kim, Sandra I.;Glucksman, Marc |title=Biochemistry and Molecular biology |publisher=[[Wolters Kluwer Health]]/[[Lippincott Williams & Wilkins]] |location=Philadelphia |year=2007 |pages= |isbn=0-7817-8624-X |oclc= |doi= |accessdate=}}</ref> |
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+ | |||
+ | ===Other=== |
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+ | Other causes may include: |
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+ | {{multicol}} |
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+ | *[[anxiety]] and/or [[panic disorder]]<ref name=EvalPanicAttack>{{cite journal|last=Ietsugu|first=T|coauthors=Sukigara, M, Furukawa, TA|title=Evaluation of diagnostic criteria for panic attack using item response theory: findings from the National Comorbidity Survey in USA.|journal=Journal of Affective Disorders|year=2007|month=Dec|volume=104|issue=1-3|pages=197–201|pmid=17434598|url=http://www.ncbi.nlm.nih.gov/pubmed/17434598|doi=10.1016/j.jad.2007.03.005}}</ref> |
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+ | *[[carpal tunnel syndrome]] |
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+ | *[[chiari malformation]] |
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+ | *[[complex regional pain syndrome]] (CRPS), also known as reflex sympathetic dystrophy (RSD) |
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+ | *[[beta-alanine]] |
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+ | *[[beta blocker]] |
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+ | *[http://www.mayoclinic.com/health/celiac-disease/DS00319/ celiac disease] |
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+ | *[[decompression sickness]] |
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+ | *[[dehydration]] |
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+ | *[[dextromethorphan]] (recreational use) |
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+ | *[[Fabry disease]] |
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+ | *[[fibromyalgia]] |
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+ | *[[Fluoroquinolone Toxicity]] |
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+ | *[[Guillain–Barré syndrome]] (GBS) |
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+ | *[[hydroxy alpha sanshool]], a component of [[Sichuan pepper]]s |
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+ | *[[hyperglycemia]] (high [[blood sugar]]) |
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+ | *[[hyperkalemia]] |
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+ | *[[hyperventilation]] |
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+ | *[[hypoglycemia]] (low [[blood sugar]]) |
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+ | *[[Hypomagnesemia]], often as a result of long term [[Proton pump inhibitor|Proton-pump inhibitor]] use |
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+ | *[[hypothyroidism]] |
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+ | *[[immunodeficiency]], such as [[chronic inflammatory demyelinating polyneuropathy]] (CIDP) |
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+ | {{col-break}} |
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+ | *intravenous administrating of strong [[pharmaceutical drug]]s acting on the [[central nervous system]] (CNS), mainly [[opioid]]s, [[opiate]]s, [[narcotic]]s; especially in non-medical use ([[Substance abuse|drug abuse]]) |
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+ | *[[Lomotil]] |
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+ | *[[menopause]] |
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+ | *[[nitrous oxide]], long-term exposure <ref>[http://www.osha.gov/SLTC/healthguidelines/nitrousoxide/recognition.html#healthhazard Nitrous Oxide<!-- Bot generated title -->]</ref> |
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+ | *[[obdormition]] |
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+ | *[[pyrethrum]] and [[pyrethroid]] ([[pesticide]]) |
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+ | *[[rabies]] |
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+ | *[[radiation poisoning]] |
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+ | *[[sarcoidosis]] |
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+ | *[[spinal disc herniation]] or injury |
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+ | *[[stinging nettle]]s |
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+ | *[[syringomyelia]] |
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+ | *[[transverse myelitis]] |
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+ | *[[Pantothenic acid|vitamin B<sub>5</sub>]] deficiency]] |
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+ | *[[vitamin B12 deficiency|vitamin B<sub>12</sub> deficiency]] |
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+ | *withdrawal from certain [[selective serotonin reuptake inhibitor]]s (or serotonin-specific reuptake inhibitors) (SSRIs), such as [[paroxetine]] and [[venlafaxine]] |
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+ | {{col-end}} |
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+ | |||
+ | ==Diagnostic approach== |
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+ | The nerve conduction study usually provides useful information for making diagnosis. A [[CT scan]] is sometimes used to rule out some causes from the central nervous system. |
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==Treatment== |
==Treatment== |
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+ | Medications offered can include the [[immunosuppressant]] [[prednisone]], intravenous [[gamma globulin]] (IVIG), [[anticonvulsant]]s such as [[gabapentin]] or [[Tiagabine|Gabitril]] and [[Antiviral drug|antiviral]] medication, among others, according to the underlying cause. |
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− | In some cases, rocking the head from side to side will painlessly remove the "pins and needles" sensation in less than a minute. A tingly hand or arm is often the result of compression in the bundle of nerves in the neck. Loosening the neck muscles releases the pressure. Compressed nerves lower in the body govern the feet, and standing up and walking around will typically relieve the sensation. <ref>http://health.msn.com/menshealth/articlepage.aspx?cp-documentid=100119940>1=7538</ref> |
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+ | |||
+ | In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such as [[lidocaine]] or [[prilocaine]]. Care must be take to apply only the necessary amount, as excess can contribute to the condition. Otherwise, these products offer extremely effective, but short-lasting, relief from the condition. |
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+ | Paresthesia caused by shingles is treated with appropriate antiviral medication. |
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− | An arm that has "fallen asleep" may also be "awoken" more quickly by clenching and unclenching the fist several times; the muscle movement increases blood flow and helps the limb return to normal. |
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==See also== |
==See also== |
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*[http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm National Institute of Neurological Disorders and Stroke: Paresthesia Information Page] |
*[http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm National Institute of Neurological Disorders and Stroke: Paresthesia Information Page] |
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− | [[Category: |
+ | [[Category:Neurological disorders]] |
[[Category:Somatosensory disorders]] |
[[Category:Somatosensory disorders]] |
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[[Category:Symptoms]] |
[[Category:Symptoms]] |
Latest revision as of 11:58, 5 October 2013
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ICD-10 | R20.2 | |
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ICD-9 | 782.0, 355.1 | |
OMIM | {{{OMIM}}} | |
DiseasesDB | {{{DiseasesDB}}} | |
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eMedicine | {{{eMedicineSubj}}}/{{{eMedicineTopic}}} | |
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- Main article: Somatosensory disorders
[[Image:{{{Image}}}|190px|center|]] | |
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ICD-9 | 782.0, 355.1 |
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MedlinePlus | {{{MedlinePlus}}} |
eMedicine | {{{eMedicineSubj}}}/{{{eMedicineTopic}}} |
DiseasesDB | {{{DiseasesDB}}} |
Paresthesia (/ˌpærɨsˈθiːziə/ or /ˌpærɨsˈθiːʒə/), spelled paraesthesia in British English, is a sensation of tickling, tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep". The manifestation of paresthesia may be transient or chronic.
Etymology
Look up this page on
Wiktionary:
paresthesia
Greek para ("beside", i.e., abnormal) and aisthesia ("sensation").
Cause
Transient
Paresthesias of the hands and feet are common, transient symptoms of the related conditions of hyperventilation syndrome, often open mouth, and panic attacks.
Other common examples occur when sustained pressure has been applied over a nerve, inhibiting/stimulating its function. Removing the pressure will typically result in gradual relief of these paresthesias.[1]
Chronic
Chronic paresthesia indicates a problem with the functioning of neurons.
In older individuals, paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease, also referred to by physicians as PVD or PAD), most often caused by atherosclerosis, the build up of plaque within artery walls, over decades, with eventual plaque ruptures, internal clots over the ruptures and subsequent clot healing but leaving behind narrowing of the artery openings or closure, both locally and in downstream smaller branches. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of vitamin deficiency and malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, and hypoparathyroidism. It can also be a symptom of mercury poisoning.
Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as rheumatoid arthritis, psoriatic arthritis, and carpal tunnel syndrome are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress,[citation needed] bone disease, poor posture, unsafe heavy-lifting practices or physical trauma such as whiplash. Paresthesia can also be caused simply by putting pressure on a nerve by applying weight (or pressure) to the limb for extended periods of time.
Another cause of paresthesia, however, may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury or infection such as frostbite or Lyme disease, or which may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies.[2] Benzodiazepine withdrawal may also cause paresthesia as the drug removal leaves the GABA receptors stripped bare and possibly malformed. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack, or autoimmune diseases like multiple sclerosis or lupus erythematosus.
The herpes zoster disease (shingles) can attack nerves causing numbness instead of pain commonly associated with shingles. A diagnostic evaluation by a medical doctor is necessary to rule these out.
Demyelinating diseases may also cause cross-talk between adjacent axons and lead to paresthesia. During impulse conduction some aberrant current that escaped a demyelinated axon can circulate in the exterior and depolarize an adjacent demyelinated, hyperexcitable axon. This can generate impulses conducted in both directions along this axon since no part of the axon is in a refractory state. This becomes very serious in conditions such as multiple sclerosis and Guillain–Barré syndrome.
Acroparesthesia
Acroparesthesia is severe pain in the extremities, and may be caused by Fabry disease, a type of sphingolipidosis.[3]
Other
Other causes may include:
Diagnostic approach
The nerve conduction study usually provides useful information for making diagnosis. A CT scan is sometimes used to rule out some causes from the central nervous system.
Treatment
Medications offered can include the immunosuppressant prednisone, intravenous gamma globulin (IVIG), anticonvulsants such as gabapentin or Gabitril and antiviral medication, among others, according to the underlying cause.
In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such as lidocaine or prilocaine. Care must be take to apply only the necessary amount, as excess can contribute to the condition. Otherwise, these products offer extremely effective, but short-lasting, relief from the condition.
Paresthesia caused by shingles is treated with appropriate antiviral medication.
See also
References
- ↑ Paresthesia Information Page: National Institute of Neurological Disorders and Stroke. (NINDS)
- ↑ Chemotherapy-induced Peripheral Neuropathy. National Cancer Institute. URL accessed on 1 December 2011.
- ↑ Marks, Dawn B.;Swanson, Todd; Kim, Sandra I.;Glucksman, Marc (2007). Biochemistry and Molecular biology, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
- ↑ Ietsugu, T, Sukigara, M, Furukawa, TA (Dec 2007). Evaluation of diagnostic criteria for panic attack using item response theory: findings from the National Comorbidity Survey in USA.. Journal of Affective Disorders 104 (1-3): 197–201.
- ↑ Nitrous Oxide
External links
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