The treatment of polyneuropathy

Research output: Contribution to journalArticle

Abstract

The treatment of diseases of the peripheral nervous system may be divided into general and specific. General therapeutic measures include physiotherapy, maintenance of nutrition and morale, the fitting of splints, and the supply of appliances. Specific treatment aims at curing the underlying diseases. Unfortunately, there is no known drug which cures peripheral nerve diseases in general. It is impossible in a short article to consider all features necessary to make an accurate diagnosis. The most common type of peripheral nerve involvement is diabetes and this is usually a polyneuropathy. Approximately 5% of diabetics have symptoms of this complication. The basis is undoubtedly vascular with multiple nerve infarcts. Treatment depends upon attempts to improve the control of the diabetes. The author discusses liver disease; such individuals have a predominantly demyelinating distal mixed sensorimotor polyneuropathy. However, the important feature is central nervous system damage. The cause is probably the circulating endogenous toxins. Polyneuropathy may occur with chronic renal failure and is usually seen when the creatinine clearance is less than 5 ml/min and the blood urea is greater than 200 mg/100m. The cause of nerve damage is probably circulating endogenous toxins. Nitrofurantoin aggravates polyneuropathy in these patients. A successful renal transplant will usually clear the polyneuropathy fairly quickly. Acute intermittent porphyria is the result of abnormality of the metabolism of porphyrins. The neuropathy is usually proximal causing limb girdle weakness. Pyridoxine is sometimes suggested although it is usually not effective. Many agents may cause toxic peripheral neuropathy with chronic distal symmetrical sensorimotor polyneuropathy. A high degree of suspicion is necessary to make this diagnosis. A number of vitamins, including the B group, are required for the function of the peripheral nervous system and their deficiency or malabsorption may result in neuropathies. However, even if all vitamins which are potentially lacking are replaced the patient usually does not achieve complete recovery. The Guillain Barre Syndrome is preceded by an infection in 50% of patients and is believed to be viral in nature. The important element in treatment of this syndrome is maintaining respiration. Prednisone, 100 milligrams each d for one wk is recommended. If this does not help, azathioprine, 2.5 mg/kg-bw/day, should be tried. The prognosis is usually fairly good. Vascular neuropathies may produce a disseminated neuropathy. The characteristic picture is of mononeuritis multiplex with infarcts involving different nerves at different times. The prognosis is usually poor. An underlying neoplasm may cause paraneoplastic neuropathy particularly in older patients. The author briefly discusses unusual conditions such as leprosy, hereditary neuropathies, the entrapment syndrome and idiopathic polyneuropathy. Finally, the author discusses general therapy to assist the individual to overcome his nerve deficit. (De Saussure - Memphis, Tenn.)

Original languageEnglish
Pages (from-to)452-460
Number of pages9
JournalPractitioner
Volume215
Issue number1288
StatePublished - Dec 1 1975
Externally publishedYes

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Polyneuropathies
Peripheral Nervous System Diseases
Therapeutics
Blood Vessels
Paraneoplastic Polyneuropathy
Mononeuropathies
Nerve Compression Syndromes
Acute Intermittent Porphyria
Morale
Nitrofurantoin
Vitamin B Complex
Pyridoxine
Guillain-Barre Syndrome
Splints
Poisons
Porphyrins
Azathioprine
Peripheral Nervous System
Leprosy
Prednisone

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The treatment of polyneuropathy. / Bradley, Walter G.

In: Practitioner, Vol. 215, No. 1288, 01.12.1975, p. 452-460.

Research output: Contribution to journalArticle

Bradley, WG 1975, 'The treatment of polyneuropathy', Practitioner, vol. 215, no. 1288, pp. 452-460.
Bradley, Walter G. / The treatment of polyneuropathy. In: Practitioner. 1975 ; Vol. 215, No. 1288. pp. 452-460.
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