Neuropathy Definition - Treatment For Diabetic Neuropathy - Health Article

Neuropathy Definition - Treatment For Diabetic Neuropathy

What is neuropathy?


Neuropathy is a general term for many disorders of the peripheral nervous system, as it has come to be symptomatic, especially in the polyneuropathy. But even with central nervous system disorders such as in constitutionally anchored inclination to autonomic dysfunction, the term is used, inter alia, in pediatrics. Historically, this term was also customary for the neurosis and neurasthenia. Primary disorders of peripheral nerves are rare. However, neuropathies secondary to other diseases (eg. As diabetes mellitus) or neurotoxic substances (eg., Alcohol) are common.

Primary etiology of neuropathies


Primary, ie self emanating from the nerve, diseases are usually inherited. The following diseases fall under:

Hereditary motor and sensory neuropathies (HMSN I-VII)
Hereditary sensory neuropathies (HSN)
Hereditary sensory and autonomic neuropathies (HSAN IV)
Hereditary motor neuropathies (HMN I-V)
Hereditary motor neuropathies (HMN V-X)
Hereditary neuropathy with liability to pressure lesions (HNPP)
There are constitutionally related functional symptoms in pediatrics designated vegetative symptoms as neuropathies associated with drinking laziness, habitual vomiting, disorders of defecation, sweating, tendency to rise in temperature, etc.. This increased sensitivity to stimuli is assumed to be an excessive response to stimuli.

Etiology of secondary neuropathies


Secondary damage of the peripheral nerve is usually due to impairment of neuronal or axonal metabolic or inflammatory or autoimmune processes:

Inflammatory diseases
This group mainly includes pathogen-related diseases. It comes in infections caused by varicella, Mycobacterium leprae and Borrelia burgdorferi infection of the peripheral nerve or the neuron. The body's immune system tries to eliminate the pathogen, thereby destroying typically the neuron or the myelin sheath.

Autoimmune diseases
This group is mainly to call the Guillain-Barre syndrome. The autoimmune diseases it comes to immune system attack on the body's own constituents, here just the nerves or the myelin sheath. The cause is believed today that before the disease an infection has taken place by a pathogen, the immune system against the cross-reacting, ie also the body's own cells is attacking defensive substances. Specifically Campylobacter jejuni appears to induce with gangliosides of the myelin cross-reactive antibodies. Affected is usually only the myelin sheath, is that found in the Neurografien va a reduction in nerve conduction velocity. Clinically found in Guillain-Barré syndrome va limp paralysis, however, are reversible. Dangerous, however, that the disease supplying the diaphragm can affect nerves (phrenic nerve). In a Guillain-Barré syndrome va are the cranial nerves affected, so it is also called the Miller-Fisher syndrome.

Metabolic diseases
This group includes metabolic disturbances of the neuron or the myelin sheath (Schwann cells). The cause for this are, for example, bowel disease, diabetes mellitus, celiac disease and resulting vitamin deficiency states, such as a thiamine deficiency (beriberi), liver and kidney diseases, the Refsum disease and thyroid disorders in question. By far the most common one finds the diabetes mellitus (secondary) trigger or a companion neuropathy. Here are frequently distal polyneuropathy stressed, but also a painful mononeuritis multiplex. Often the autonomic nervous system is involved. This can result in autonomic disorders.

Neurotoxic substances
This group includes impairment of neuronal metabolism and the metabolism of myelin sheaths by so-called neurotoxins.:

-Cyclic hydrocarbons (eg., Benzene, phenol)
-Drugs (zB.Omeprazol)
-Chemotherapeutics
-Heavy metals
-Methanol
-Ethanol and much more.

Frequently one finds a neuropathy in long-term alcoholics. This is attributable to the ethanol on the often existing in alcoholics vitamin deficiency states.

Localization of damage


Axonopathy: You can find an axon destruction at first got nerve sheath. Reduced the number of neurons, is reduced so the total potential nerve. This type of damage found in hereditary, toxic and metabolic neuropathies.
Neuronopathy: Here the location of the damage is located in the cell body of the neuron (eg inherited metabolic diseases.). Neuronopathy counts not strictly to the peripheral neuropathies.
Demyelination: Here the injury is not in the neuron but in the myelin sheath. This reduces the nerve. Etiology are often found metabolic diseases and disorders in the synthesis of myelin.

Peripheral neuropathy


-History: Patients report lack of perception (negative symptoms) or sensory disturbances such as tingling, pins and needles, burning (plus symptoms)
-Inspection: Striking dry skin can be with symmetrical involvement indicative of a neuropathy.
-Reflex examination of the patellar tendon and Achilles tendon reflex. In the absence of ASR is suspected polyneuropathy.
-Hot-cold distinction: the patient should be able to distinguish when touching the sole of the foot between a cold metal surface of about 1.5 cm diameter and an equally large plastic surface.
-Sensitivity testing with the Semmes-Weinstein monofilament after: it is a nylon thread, which exerts a pressure of 0.1 Newton defined by bending. The filament is placed eg on the ball of the foot between the first and the second metatarsophalangeal joint. The patient is first asked to close their eyes and indicate the location of the touch. At 5 contact points should be at least three correct.
-Investigation of vibration sense with the tuning fork after Rydel and Seiffer: The massive metal tuning fork after Rydel and Seiffer has a frequency of 128 Hz, which is reduced by 2 metal screw blocks to 68 Hz. On the metal blocks, there are two acute-angled triangles that overlap on the wings of fork and allow using a scale with 8 subdivisions, to determine the strength of the vibration to which the patient perceives the vibration. During the oscillation, a virtual triangles moves from 0/8 to 8/8. Normal is up to 50 years over 6/8, over the age of 50 to 5/8. At lower or absent awareness of the suspicion of polyneuropathy is.
-Electroneurography: measurement of the nerve and the nerve sum potential of subcutaneous nerves. Reduction of the nerve is found in diseases of the myelin sheath (demyelination). In axonal damage patterns on the other hand reduces the total potential nerve.
-Pathological diagnosis: removal of a piece of sural nerve. This is relatively superficially under the skin of the lower leg and has after removing only a small loss of sensitivity in the area of the lower leg. Studies are generally carried out on normal paraffin-section of semi-thin sections and by electron microscopy.

Diabetic Autonomic Neuropathy


The autonomic neuropathy typically occurs in diabetes mellitus, affecting the autonomic nervous system. You can affect nearly every organ system, and is characterized by a variety of symptoms. Severe symptoms are relatively rare. They often occur after long diabetes duration. Among the most important organs with associated symptoms include:
-Cardiovascular system: increased resting heart rate, dizziness and low blood pressure when standing up, without typical heart attack pain
-Esophagus, stomach: dysphagia, nausea, vomiting, bloating, early satiety after meals, blood sugar after meals (gastroparesis)
-Small intestine, large intestine: diarrhea, especially at night, constipation, gas, bloating
-Urinary and sexual organs: Delayed onset Harnddrang, bladder overfilling, weak urine stream, erectile dysfunction
-Hormones: reduced or absent awareness of hypoglycaemia (Hypoglykämiewahrnehmungsstörung)
-Sweat glands: dry, cracked skin on the foot / lower leg area, increased sweating during meals
-Foot: swelling of the lower leg (neuropathic edema), misalignment and loss of bone

Treatment for neuropathy


-The treatment of neuropathy depends on the underlying disease.
-In the congenital neuropathies (as) a causal therapy is often not possible.
-In a bacterial infection as the cause is treated with antibiotics.
-In a viral cause of a causal therapy of neuropathy is usually not possible.
-For toxic pollutant can cause the omission of (eg drugs alcohol) lead to a recovery of nerve function.
-In metabolic neuropathies such as. of diabetic polyneuropathy can lead a near-normal blood glucose control to a recovery of nerve function, but sometimes only a further deterioration can be prevented.
-In symptomatic neuropathy (burning, pain, etc.) where appropriate, is a therapy with medication is necessary (for example, alpha-lipoic acid, vitamins of the B group, opioids, opiates, amitriptyline, carbamazepine, gabapentin, pregabalin, etc.)
-About naturopathic, homeopathic and alternative methods such as acupuncture, magnetic therapy, or high tone, there are positive descriptions of individual cases.

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