Treatments Focus

Neuropathy

Being unable to feel your feet or hand aside from the daily nagging pain can be frustrating and challenging to live with. But what if we say that this could be a sign of a serious nerve problem?
Neuropathy, or peripheral neuropathy, is one of the most common nerve disorders, affecting approximately 5 to 24 out of every 10,000 Indians and growing year by year. It occurs when a single or group of nerves fails to function normally and may even affect nerves in the whole body.
Peripheral neuropathy is a progressive degenerative disease that affects any single or all the extremities (hands, arms, legs, and feet), with symptoms advancing from mild to severe in stages. The condition can be continuous or episodic. Several types of peripheral neuropathies stem from myriad causes. And, if you know why you developed this condition, you can seek personalized treatment to lead a normal healthy life.

Symptoms of Neuropathy

Neuropathy can manifest in different ways, based on where, how, and what kind of peripheral nerves have been affected.

You may experience:

Dysfunction in organs and glands

Burning sensation

Sharp shooting or pin and needle-like pain

Extreme sensitivity to touch

Muscle cramping/ tightness

Falling and loss of coordination

Muscle weakness and difficulty in walking

Paralysis

Numbness, tingling, or prickling in the toes or fingers, spreading up to feet and hand

On occasion, the pain may worsen at night and can be felt throughout the body. For people with diabetes, numbness can often lead to wounds, infections, and gangrene.

Causes of Neuropathy

Peripheral nerve damage is often presented as a complication of  type-2 diabetes. But numerous other conditions impacting health can trigger the problem as well. These include:

  • Bone marrow disorder 
  • Chronic kidney or liver diseases
  • Genetic factors
  • Cancer
  • Infections or inflammatory diseases like HIV or Guillain-Barré syndrome
  • Vitamin B12 or folic acid deficiency
  • Autoimmune disorders such as rheumatoid arthritis
  • Excessive alcohol consumption
  • Underactive thyroid problems
  • Chemotherapy and radiation
  • Exposure to heavy metals, insecticides, and solvents
  • Poor blood flow to arms and legs

In some cases, nerve pain can also occur from unknown causes.

Diagnosis and Treatment

Your doctor is your partner in managing your pain. So, the information you give about your history and symptoms is generally important. A simultaneous physical examination and laboratory tests such as blood work, spinal fluid testing, and an MRI or CT scan can really tell your doctor what’s causing your pain and how to treat it.

Your doctor may also order nerve conduction studies, electromyography, skin biopsies, and genetic testing if they suspect nerve dysfunction or hereditary causes behind your neuropathy. 

Treatment is usually rooted in the cause. Depending on the type of neuropathy you may have, your doctor may prescribe

  • Over-the-counter (OTC) painkillers
  • Prescription medicines (such as anticonvulsants or antidepressants)
  • Physical therapy
  • Orthopedic devices like braces or splints
  • Implantable drug delivery devices
  • Lifestyle changes like exercise and a good diet

Finally, if all of the above options fail, surgery is considered to relieve pressure on the affected nerve.

FAQ's :

What is hereditary neuropathy?
This is a rare neurological disorder that is typically inherited from family members and begins to show symptoms in mid-life. However, they can’t be prevented. An early diagnosis and proper care can help manage the symptoms.
What genes are responsible for hereditary neuropathy?
More than 30 genes and their variants have been identified in neuropathy-related genetic diseases. The most common are CMT1X, CMT2G, HSAN1, HNPP, and HMN I-VII.
Are there any genetic tests for detecting heritable neuropathic pain?
Standard genetic testing is currently available for determining your chances of developing neuropathy-related genetic diseases. Most genetic panels analyze a set of single-gene variants (if known) associated with hereditary neuropathy, but some panels may involve a combination of multiple genes or even the entire genome.
What test results can I expect from genetic testing?
Three types of results you can expect:
 
  • Positive – Indicates the presence of variant in a gene associated with hereditary neuropathy. Help you and your doctor understand the prognosis for your condition and assist you in making treatment decisions.
  •  
  • Negative – Indicates the absence of a certain gene variant, but doesn’t mean you can’t develop hereditary neuropathy. Management in these cases is usually symptomatic and supportive
  • Variant of unknown significance (VUS): This means the results are inconclusive, and affected relatives may be tested to clarify further.
When is genetic testing for hereditary neuropathy appropriate?
Genetic testing is appropriate for anyone who has been diagnosed with neuropathy of unknown cause based on their personal or family history. If you have other family members with similar symptoms, it is advisable to do genetic testing on the affected family member first, followed by those at risk. Genetic sequencing in such people is particularly beneficial.

References:

  1. Trivedi, S., Pandit, A., Ganguly, G., & Das, S. K. (2017). Epidemiology of Peripheral Neuropathy: An Indian Perspective. Annals of Indian Academy of Neurology, 20(3), 173–184. https://doi.org/10.4103/aian.AIAN_470_16
  2. Peripheral neuropathy: Symptoms, Causes, and treatment. (2021, July 28). https://www.medicalnewstoday.com/articles/147963
  3. Neuropathy (Peripheral Neuropathy). Cleveland Clinic. Retrieved May 19, 2022, from https://my.clevelandclinic.org/health/diseases/14737-neuropathy
  4. Hereditary Neuropathy: Types, Risk Factors, Symptoms, and More. (2018, January 23). Healthline. https://www.healthline.com/health/hereditary-neuropathy
  5. Reilly, M. M. (2009). Classification and diagnosis of the inherited neuropathies. Annals of Indian Academy of Neurology, 12(2), 80–88. https://doi.org/10.4103/0972-2327.53075
  6. Genetic Testing: Is It for Me? | NeuropathyCommons. Retrieved May 19, 2022, from https://neuropathycommons.org/genetics/genetic-testing-it-me

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