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{{DiseaseDisorder infobox |
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{{Infobox disease
Name = Polyneuropathy |
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| Name = Polyneuropathy
ICD10 = G60-G64 |
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| Image =
ICD9 = {{ICD9|356.4}}, {{ICD9|357.1}}-{{ICD9|357.7}} |
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| Caption =
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| DiseasesDB =
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| ICD10 = {{ICD10|G|60||g|60}}-{{ICD10|G|64||g|60}}
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| ICD9 = {{ICD9|356.4}}, {{ICD9|357.1}}-{{ICD9|357.7}}
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| ICDO =
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| OMIM =
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| MedlinePlus =
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| eMedicineSubj =
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| eMedicineTopic =
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| MeshID = D011115
 
}}
 
}}
{{Boxbottom}}
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'''Polyneuropathy''' is a [[neurological disorder]] that occurs when many [[nerve]]s throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory involvement; some also involve dysfunction of the [[autonomic nervous system]]. These disorders are often symmetric and frequently affect the feet and hands, causing weakness, loss of sensation, pins-and-needle sensations or burning pain.<ref name=merck>[http://www.merckmanuals.com/home/brain_spinal_cord_and_nerve_disorders/peripheral_nerve_disorders/polyneuropathy.html Polyneuropathy], ''[[Merck Manual]]''</ref> There are numerous conditions that can cause polyneuropathy.
'''Polyneuropathy''' is a [[neurological disorder]] that occurs when many [[peripheral nerve]]s throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory involvement and some have autonomic dysfunction. These disorders are often symmetric and frequently involve distal extremities. There is a very large differential for polyneuropathy.
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==Classification==
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Polyneuropathies can be classified in different ways, such as by cause, by speed of progression, or by the parts of the body involved. Classes of polyneuropathy are also distinguished by which part of the nerve cell is mainly affected: the [[axon]], the [[myelin]] sheath, or the [[cell body]].
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* '''Distal axonopathy''', or "dying-back neuropathy", is the result of some metabolic or toxic derangement of [[neuron]]s. It is the most common response of neurons to metabolic or toxic disturbances, and may be caused by metabolic diseases such as [[Diabetic neuropathy|diabetes]], [[renal failure]], deficiency syndromes such as [[malnutrition]] and [[alcoholism]], or the effects of [[toxin]]s or [[pharmaceutical drug|drugs]] such as [[chemotherapy]]. They can be divided according to the type of axon affected: large-fiber, [[Small fiber peripheral neuropathy|small-fiber]], or both. The most distal portions of axons are usually the first to degenerate, and axonal atrophy advances slowly towards the nerve's cell body. If the cause is removed, regeneration is possible, though the prognosis depends on the duration and severity of the stimulus. People with distal axonopathies usually present with sensorimotor disturbances that have a symmetrical "stocking and glove" distribution. [[Deep tendon reflex]]es and [[autonomic nervous system]] functions are also lost or diminished in affected areas.
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* '''Myelinopathy''', or "demyelinating polyneuropathy", is due to a loss of myelin (or of the [[Schwann cells]] that make and contain it). This demyelination slows down or completely blocks the conduction of [[action potential]]s through the axon of the nerve cell. The most common cause is [[acute inflammatory demyelinating polyneuropathy]] (AIDP, the most common form of [[Guillain–Barré syndrome]]), though other causes include [[chronic inflammatory demyelinating polyneuropathy]] (CIDP), [[genetics|genetic]] metabolic disorders (''e.g.'', [[leukodystrophy]]), and toxins.
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* '''Neuronopathy''' is the result of destruction of [[peripheral nervous system]] (PNS) neurons. They may be caused by [[motor neurone disease]]s, sensory neuronopathies (''e.g.'', [[Herpes zoster]]), toxins or autonomic dysfunction. [[Neurotoxicity|Neurotoxins]] may cause neuronopathies, such as the [[chemotherapy]] agent [[vincristine]].
   
 
==Evaluation==
 
==Evaluation==
Evaluation and classification of polyneuropathies begins with a history and physical exam in order to document what the pattern of the disease process is (arms, legs, distal, proximal, symmetric), when they started, how long they've lasted, if they fluctuate, and what deficits are involved. One also needs to know what disorders are already present within the family and what diseases the patient may currently have. This is vital in forming a differential diagnosis.
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Evaluation and classification of polyneuropathies begins with a history and physical exam in order to document what the pattern of the disease process is (arms, legs, distal, proximal, symmetric), when they started, how long they have lasted, if they fluctuate, and what deficits and pain are involved. If pain is a factor, and it often is, determining where and how long the pain has been present is important. One also needs to know what disorders are present within the family and what diseases the patient may have. This is vital in forming a [[differential diagnosis]].
   
==Diagnosis/testing==
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Although often diseases are suggested by the physical exam and history alone, testing is still a large part of the diagnosis. Tests which may be employed include electrodiagnostic testing using [[electromyography]], [[muscle biopsy]], serum [[creatine kinase]] (CK), and [[antibody]] testing. Nerve biopsy is not used much, but is helpful in determining [[Small fiber peripheral neuropathy|small fiber neuropathy]]. Other tests may be used, especially tests for specific disorders associated with polyneuropathies.
Although often diseases are suggested by the physical exam and history alone, testing is still a large part of the diagnosis. Tests which may be employed include: electrodiagnostic testing using [[electromyography]], [[repetitive nerve stimulation testing]], [[nerve conduction testing]], [[muscle biopsy]], serum [[creatine kinase]] (CK), [[antibody]] testing, . Nerve biopsy is not used much. Other tests may be used, especially tests for specific disorders associated with polyneuropathies.
 
   
==Differential==
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==Causes==
There is a large differential for polyneuropathies: [[vitamin deficiency]], [[cancer]], toxins, infections (ex. [[Guillain-Barré Syndrome]]), [[liver]] disease, [[endocrine]] disease (inc. [[diabetes]] with [[diabetic neuropathy]]), [[amyloidosis]], [[genetics|genetic]] disorders, motor neuron disorders, motor neuropathies, [[paraneoplastic]], [[polio]], [[porphyria]] (some types), [[spinal muscular atrophy]], [[catecholamine]] disorders, and many others. This is not a complete list.
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Acute polyneuropathy can have various causes, including [[infection]]s, [[autoimmune reaction]]s, toxins, certain drugs, and [[cancer]].
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Chronic polyneuropathy is often caused by [[diabetes mellitus]] or by the excessive use of [[alcoholic beverage|alcohol]] ([[alcoholic polyneuropathy]]), but a variety of other less common causes are known, including nutritional deficiencies, and [[liver]] or [[kidney]] failure.<ref name=merck/> [[Transthyretin]] amyloidogenesis is established to cause polyneuropathy in the case of inherited mutations and it could be that wild type transthyretin amyloidogenesis, which is established to cause cardiomyopathy, could also lead to peripheral neuropathy, as transthyretin amyloid diseases can present as either a prominent [[cardiomyopathy]], a peripheral neuropathy, or both.<ref>{{cite journal | author = Andrade C | year = 1952 | title = A peculiar form of peripheral neuropathy; familiar atypical generalized amyloidosis with special involvement of the peripheral nerves | url = | journal = Brain : a journal of neurology | volume = 75 | issue = | pages = 408–27 |pmid=12978172|doi=10.1093/brain/75.3.408}}</ref><ref>{{cite journal | author = Coelho T | year = 1996 | title = Familial amyloid polyneuropathy: new developments in genetics and treatment | url = | journal = Current opinion in neurology | volume = 9 | issue = 5| pages = 355–9 | doi = 10.1097/00019052-199610000-00007 | pmid = 8894411 }}</ref><ref>{{cite journal | author = Westermark P., Sletten K., Johansson B., Cornwell G. G. | year = 1990 | title = Fibril in senile systemic amyloidosis is derived from normal transthyretin | url = | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 87 | issue = 7| pages = 2843–5 |pmid=2320592 | pmc=53787 | doi = 10.1073/pnas.87.7.2843}}</ref><ref>{{cite journal | author = Jacobson D. R., Pastore R. D., Yaghoubian R., Kane I., Gallo G., Buck F. S., Buxbaum J. N. | year = 1997 | title = Variant-sequence transthyretin (isoleucine 122) in late-onset cardiac amyloidosis in black Americans | url = | journal = The New England Journal of Medicine | volume = 336 | issue = 7| pages = 466–73 | doi = 10.1056/NEJM199702133360703 | pmid = 9017939 }}</ref>
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One [[Denmark|Danish]] study in 2002 suggested a link between long term exposure to [[statins]] and increased risk of polyneuropathy,<ref name=twsOCT21>{{cite journal
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| title = Statins and risk of polyneuropathy – A case-control study
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| author = D. Gaist
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| author2 = U. Jeppesen
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| author3 = M. Andersen
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| author4 = L. A. García Rodríguez
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| author5 = J. Hallas
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| author6 = S. H. Sindrup
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| url = http://www.neurology.org/cgi/content/abstract/58/9/1333
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| journal = Neurology
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| publisher = American Academy of Neurology
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| date = 2002
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| volume=58
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| issue=9
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| pages = 1333–1337
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| accessdate = 2009-10-06
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| pmid=12011277
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| doi = 10.1212/WNL.58.9.1333
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}}</ref> although other studies have not confirmed this finding.
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==Treatment==
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If possible, treatment focuses on the underlying disease. Further, pain medications may be given and physical therapy is used to retain muscle function. Vyndaqel or [[Tafamidis]] is a European Medicines Agency approved drug for the treatment of familial amyloid polyneuropathy caused by transthyretin amyloisis.
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==Differential diagnosis==
  +
There is a large differential for polyneuropathies: [[vitamin deficiency]], cancer, toxins, infections (ex. Guillain–Barré syndrome, [[Lyme disease]]), liver disease, [[endocrine]] disease (including diabetes with [[diabetic neuropathy|diabetic and pre-diabetic neuropathy]]), [[amyloidosis]], genetic disorders, motor neuron disorders, motor neuropathies, [[kidney failure]],<ref>[http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm Chronic renal failure], ''Medline Plus''</ref> [[paraneoplastic]], [[polio]], [[porphyria]] (some types), [[spinal muscular atrophy]], [[catecholamine]] disorders, psychological disorders and many others.
   
 
==See also==
 
==See also==
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* [[Neuropathy]]
 
* [[Mononeuropathy]]
 
* [[Mononeuropathy]]
*[[Polyneuropathy in dogs and cats]]
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* [[Polyradiculoneuropathy]]
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* [[Polyneuropathy in dogs and cats]]
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* [[Neuritis]]
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==References==
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{{reflist}}
   
 
==External links==
 
==External links==
*[http://www.merck.com/mrkshared/mmanual_home2/sec06/ch095/ch095h.jsp Merck Manual overview]
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*[http://neuromuscular.wustl.edu/naltbrain.html Wash U. Neuro website, very complete]
*[http://www.neuroland.com/nm/pn_evaluate.htm Diagram Diagnosis page]
 
*[http://www.neuro.wustl.edu/neuromuscular/naltbrain.html Wash U. Neuro website, very complete]
 
 
*[http://www.familydoctor.org Discussion of diabetic polyneuropathy with Spanish translation]
 
*[http://www.familydoctor.org Discussion of diabetic polyneuropathy with Spanish translation]
   
[[Category:Neurological disorders]]
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{{PNS diseases of the nervous system}}
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[[Category:Neuropathology]]
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[[Category:Peripheral nervous system disorders]]
   
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Latest revision as of 13:16, October 3, 2012

Polyneuropathy
Classification and external resources
ICD-10 G60-G64
ICD-9 356.4, 357.1-357.7
MeSH D011115

Polyneuropathy is a neurological disorder that occurs when many nerves throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory involvement; some also involve dysfunction of the autonomic nervous system. These disorders are often symmetric and frequently affect the feet and hands, causing weakness, loss of sensation, pins-and-needle sensations or burning pain.[1] There are numerous conditions that can cause polyneuropathy.

ClassificationEdit

Polyneuropathies can be classified in different ways, such as by cause, by speed of progression, or by the parts of the body involved. Classes of polyneuropathy are also distinguished by which part of the nerve cell is mainly affected: the axon, the myelin sheath, or the cell body.

EvaluationEdit

Evaluation and classification of polyneuropathies begins with a history and physical exam in order to document what the pattern of the disease process is (arms, legs, distal, proximal, symmetric), when they started, how long they have lasted, if they fluctuate, and what deficits and pain are involved. If pain is a factor, and it often is, determining where and how long the pain has been present is important. One also needs to know what disorders are present within the family and what diseases the patient may have. This is vital in forming a differential diagnosis.

Although often diseases are suggested by the physical exam and history alone, testing is still a large part of the diagnosis. Tests which may be employed include electrodiagnostic testing using electromyography, muscle biopsy, serum creatine kinase (CK), and antibody testing. Nerve biopsy is not used much, but is helpful in determining small fiber neuropathy. Other tests may be used, especially tests for specific disorders associated with polyneuropathies.

CausesEdit

Acute polyneuropathy can have various causes, including infections, autoimmune reactions, toxins, certain drugs, and cancer.

Chronic polyneuropathy is often caused by diabetes mellitus or by the excessive use of alcohol (alcoholic polyneuropathy), but a variety of other less common causes are known, including nutritional deficiencies, and liver or kidney failure.[1] Transthyretin amyloidogenesis is established to cause polyneuropathy in the case of inherited mutations and it could be that wild type transthyretin amyloidogenesis, which is established to cause cardiomyopathy, could also lead to peripheral neuropathy, as transthyretin amyloid diseases can present as either a prominent cardiomyopathy, a peripheral neuropathy, or both.[2][3][4][5]

One Danish study in 2002 suggested a link between long term exposure to statins and increased risk of polyneuropathy,[6] although other studies have not confirmed this finding.

TreatmentEdit

If possible, treatment focuses on the underlying disease. Further, pain medications may be given and physical therapy is used to retain muscle function. Vyndaqel or Tafamidis is a European Medicines Agency approved drug for the treatment of familial amyloid polyneuropathy caused by transthyretin amyloisis.

Differential diagnosisEdit

There is a large differential for polyneuropathies: vitamin deficiency, cancer, toxins, infections (ex. Guillain–Barré syndrome, Lyme disease), liver disease, endocrine disease (including diabetes with diabetic and pre-diabetic neuropathy), amyloidosis, genetic disorders, motor neuron disorders, motor neuropathies, kidney failure,[7] paraneoplastic, polio, porphyria (some types), spinal muscular atrophy, catecholamine disorders, psychological disorders and many others.

See alsoEdit

ReferencesEdit

  1. 1.0 1.1 Polyneuropathy, Merck Manual
  2. Andrade C (1952). A peculiar form of peripheral neuropathy; familiar atypical generalized amyloidosis with special involvement of the peripheral nerves. Brain : a journal of neurology 75: 408–27.
  3. Coelho T (1996). Familial amyloid polyneuropathy: new developments in genetics and treatment. Current opinion in neurology 9 (5): 355–9.
  4. Westermark P., Sletten K., Johansson B., Cornwell G. G. (1990). Fibril in senile systemic amyloidosis is derived from normal transthyretin. Proceedings of the National Academy of Sciences of the United States of America 87 (7): 2843–5.
  5. Jacobson D. R., Pastore R. D., Yaghoubian R., Kane I., Gallo G., Buck F. S., Buxbaum J. N. (1997). Variant-sequence transthyretin (isoleucine 122) in late-onset cardiac amyloidosis in black Americans. The New England Journal of Medicine 336 (7): 466–73.
  6. D. Gaist (2002). Statins and risk of polyneuropathy – A case-control study. Neurology 58 (9): 1333–1337.
  7. Chronic renal failure, Medline Plus

External linksEdit


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