The signs and symptoms of polyneuropathy include pain, accompanied by numbness, hypersensitivity and weakness in the affected arms and legs. In the majority of cases, there is development of tingling sensation in the affected area [7].

Sensory neuropathy occurs along with ataxia and hereditary polyneuropathy favors the development of high arches, hammer toes and scoliosis. In conditions when the autonomic nervous system is affected, there is onset of constipation accompanied by orthostatic hypotension and loss of control over bowel movements. Affected individuals also complain of skin turning pale, along with dryness and significant reduction in sweat production.

• Amyloidosis

  We herein report this first case of amyloid polyneuropathy and myocardial amyloidosis after DLT from hereditary ATTR amyloidosis with a transthyretin Ser50Arg mutation and discuss similar cases of other mutations. [ncbi.nlm.nih.gov]

  […] in the extremities. familial amyloid polyneuropathy autosomal dominant amyloid polyneuropathy occurring in hereditary amyloidosis; subtypes include Finnish type, Indiana type, Iowa type, and Portuguese type. [medical-dictionary.thefreedictionary.com]

  New drugs for TTR amyloidosis A number of new drugs for TTR amyloidosis are in various stages of development, around the world, offering hope for the near future to patients with TTR amyloidosis. [ttrstudy.com]

  amyloidosis E85.1 Neuropathic heredofamilial amyloidosis E85.2 Heredofamilial amyloidosis, unspecified E85.3 Secondary systemic amyloidosis E85.4 Organ-limited amyloidosis E85.8 Other amyloidosis E85.81 Light chain (AL) amyloidosis E85.82 Wild-type transthyretin-related [icd10data.com]

• Pallor

  Any symptom of anemia (shortness of breath, fatigue, palpitations) Pallor – conjuctival pallor is the best place to look but if the anemia is severe, pallor can be generalized Koilonychia (spoon-shaped nail) and platynychia (flat nails) – as seen above [stanfordmedicine25.stanford.edu]

  Symptoms resulting from anemia (weakness, pallor, fatigue, tachycardia) may dominate the clinical picture. Additional features are glossitis, angular cheilitis and koilonychia. Enlargement of the spleen and thyroid may also be observed. [orpha.net]

  There may be pallor and even tachycardia if anaemia is marked. There may be koilonychia (spoon-shaped nails), angular cheilitis and glossitis. Investigation FBC will show a microcytic, hypochromic anaemia. Ferritin is low. [patient.info]

  Symptoms resulting from anemia such as weakness, pallor, fatigue and tachycardia may dominate the clinical picture. Furthermore, it is characterized by glossitis, angular cheilitis and koilonychia (spoon-shaped finger nails). [ncbi.nlm.nih.gov]

• Epilepsy

  petit mal epilepsy, convulsion, facial palsy, polyneuropathy, areflexia more_vert ob naczyniowe, drgawki, upośledzenie świadomości, encefalopatia, neuropatia, polineuropatia Mononeuropatie, śpiączka§ Nieznana: Cerebrovascular haemorrhage, cerbrovascular [en.bab.la]

  Anti-Seizure Medications: Anti-seizure medications were originally developed with the goal of treating epilepsy, yet are sometimes used to relieve nerve pain. The side effects of these medications may include dizziness and drowsiness. [disabled-world.com]

  Anti-seizure medications - Drugs that were originally developed to treat epilepsy are sometimes used to relieve nerve pain. The side effects of these drugs can cause drowsiness and dizziness. [virginiamason.org]

  Neurologic manifestations can also occur, the most common being myelopathy, arterial stroke, myopathy, multiple sclerosis and epilepsy [ 2 - 4 ]. [bmcneurol.biomedcentral.com]

• Muscular Atrophy

  Despite the reduction of oral cyclosporine dose along with medical therapy for the cytomegalovirus infection and diabetes mellitus, his muscular weakness and atrophy did not improve. [jmedicalcasereports.biomedcentral.com]

  HMSN I: Charcot-Marie-Tooth disease HMSN II: Neuronal peroneal muscular atrophy HMSN III: Dejerine-Sottas disease HMSN IV: Refsum disease HMSN V: Hereditary spastic paraplegia HMSN VI: HMSN with optic atrophy HMSN VII: HMSN with retinitis pigmentosa Charcot-Marie-Tooth [lecturio.com]

  Inflammatory Neuropathies Demyelinating Acute - Guillain Barre Syndrome (GBS) CIDP - often associated with monoclonal gammopathies Hereditary Multifocal Motor Neuropathy Weakness and muscular atrophy & Responds to IVIg Infection Varicella Zoster ; Poliomyelitis [enotes.tripod.com]

  In general, neuropathies with extensive axonal loss, denervation and atrophy have a poor prognosis for full recovery. [now.aapmr.org]

  They include Immune-mediated disorders (eg, Guillain-Barré syndrome, multifocal motor neuropathy with conduction block) Lead toxicity Dapsone use Porphyria Spinal muscular atrophy (a motor neuron disorder that mimics motor polyneuropathy) Others affect [merckmanuals.com]

• Muscle Cramp

  If you have become severely impaired, you may need physical therapy to help retain strength and avoid muscle cramping and spasms. Surgical treatment may be recommended for people with nerve damage from injury or nerve compression. [webmd.com]

  cramps, predominantly at night Image : “The foot of a person with Charcot-Marie-Tooth. [lecturio.com]

  […] weakness but may also produce uncontrolled muscle twitches (fasciculations), painful muscle cramps, muscle atrophy with decreased reflexes similar to patients who are diagnosed with ALS, Motor Neuron Disease, Alzheimer and Parkinson’s disease. [stemcellthailand.org]

  […] loss Paresis, reduced muscle tone, muscle atrophy, reduced reflexes Muscle cramps, fasciculations Muscle cramps on strength testing, fasciculations Autonomic Dry skin Hypo- and anhidrosis Body hair loss, skin changes Trophic disorders Sensation of glare [ncbi.nlm.nih.gov]

  Needle electromyography (EMG) should include tibialis anterior, medial gastrocnemius, lumbar paraspinal muscles, possibly foot intrinsic muscles, and first dorsal interosseous (hand), followed by at least one contralateral muscle if any of the aforementioned [now.aapmr.org]

• Numbness of the Feet

  Because the longest nerve-fibers in the body are those that run from the lower back to the feet, in typical cases of polyneuropathy the first part of the body to become weak or numb is the feet. [cordingleyneurology.com]

  You might not feel temperature changes or pain on parts of your body that are numb. Infection. Your feet and other areas lacking sensation can become injured without your knowing. [mayoclinic.org]

• Sexual Dysfunction

  In a small minority of the patients, the autonomic nervous system may also be involved and the patients may experience persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction. [hopkinsmedicine.org]

  Sexual dysfunction and abnormally low blood pressure also can occur. Joints are particularly vulnerable to stress in people with polyneuropathy because they are often insensitive to pain. [powerofpain.org]

  Typical symptoms are constipation, sexual dysfunction, and fluctuating blood pressure—most notably a sudden fall in blood pressure when a person stands up ( orthostatic hypotension ). The skin may become pale and dry, and sweating may be reduced. [msdmanuals.com]

• Guillain-Barré Syndrome

  Differential diagnosis [ 2 ] Predominantly motor peripheral neuropathies include Guillain-Barré syndrome, Charcot-Marie-Tooth syndrome, porphyria, lead poisoning and diphtheria. [patient.info]

  In some patients, presentation can be acute and closely mimic Guillain-Barré syndrome (GBS) 2,4. CIPD is an acquired demyelinating disease of the peripheral nervous system. [radiopaedia.org]

  CIDP is similar to Guillain-Barré syndrome, which appears suddenly and generally improves spontaneously. Although CIDP was once called “chronic Guillain-Barré syndrome,” it is now regarded as a related, but distinct condition. [foundationforpn.org]

  In the axonal variant of Guillain-Barré syndrome, axonal degeneration often predominates. Severe Guillain-Barré syndrome is often associated with axonal degeneration as well, which results in wallerian degeneration. [emedicine.medscape.com]

• Mononeuropathy

  Polyneuropathy versus Mononeuropathy � Which type is it? Peripheral neuropathy can affect multiple nerves (polyneuropathy) or only one nerve or nerve group (mononeuropathy) at a time. [peripheralneuropathycenter.uchicago.edu]

  Blood tests may be done to identify a disorder causing multiple mononeuropathy. Treatment of multiple mononeuropathy depends on the cause. NOTE: This is the Consumer Version. [merckmanuals.com]

  In cases of mononeuropathy only the structures connected to that one nerve's fibers are affected. In contrast, "polyneuropathy" produces a pattern of weakness and numbness completely different from that seen in mononeuropathies. [cordingleyneurology.com]

  […] polyneupathy, 12% autonomic neuropathy, 8% mononeuropathy, 4% multiple mononeuropathy) of diabetes mellitus. • the patients had no neuropathy although they already had diabetes whichcan be related to the fact that they have diabetes for no more than [tishreen.edu.sy]

• Areflexia

  It often presents with symptoms that include tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. [ninds.nih.gov]

  /DM/amyloid  Large-fibre- predominantly posterior column- areflexia, ataxia, severe motor dysfunction, minor cutaneous sensory deficit 6. Diagnosis Nerve conduction studies Sural nerve (at ankle) biopsy, specially for mononeuritis multiplex 7. [slideshare.net]

  Patients typically present with a gradual and protracted (> 2 month) weakness of both proximal and distal musculature associated with areflexia and sensory changes 3. [radiopaedia.org]

• Seizure

  In addition to classic triad, seizure was recorded in seven patients. Dietary deprivation is a risk factor for non-alcoholic WE among elderly patients receiving gastrointestinal surgery. The prognosis is good after thiamine supplement therapy. [ncbi.nlm.nih.gov]

  […] more_vert Krwawienie naczyniowomózgowe *, niedokrwienie naczyniowomózgowe * encefalopatia *, polineuropatia * expand_more Seizure (convulsion)*, peripheral neuropathy* Cerebrovascular haemorrhage*, cerebrovascular ischaemia*, encephalopathy*, polyneuropathy [en.bab.la]

  In many instances, anti-seizure medications may also have to be employed. [symptoma.com]

  Treatment Treatment of idiopathic sensory-motor polyneuropathy depends on controlling neuropathic pain, which can be treated with anti-seizure medications, antidepressants, or analgesics including opiate drugs. [hopkinsmedicine.org]

• Neuralgia

  2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Neuritis (rheumatoid) M79.2 ICD-10-CM Diagnosis Code M79.2 Neuralgia [icd10data.com]

  Medicines used to treat this condition: Over-the-counter and prescription pain relievers to reduce stabbing pain ( neuralgia ) Anticonvulsants or antidepressants Lotions, creams, or medicated patches Use pain medicine only when necessary. [nlm.nih.gov]

  Medicines used to treat this condition: Over-the-counter and prescription pain relievers to reduce stabbing pain (neuralgia) Anticonvulsants or antidepressants Lotions, creams, or medicated patches Use pain medicine only when necessary. [medlineplus.gov]

  Types and causes of neuropathy Diabetic neuropathy Trigeminal neuralgia involves a nerve that brings sensation to the face, jaw, and eye area Inherited neuropathy (present from birth) Autonomic neuropathy (involving involuntary body functions, such as [doi.org]

A preliminary physical examination along with past medical history is taken initially. This is important for gathering information about the duration, severity and nature of symptoms that are being experienced by the individual. In many cases, physical examination is enough for arriving at a definite diagnosis. In cases when this isn’t enough, additional tests may be required [8].

Specialized nerve tests such as nerve conduction testing and electromyography are employed for further evaluation of the condition. Both these procedures are painful, wherein a needle is pricked into the muscles and electric shocks are given to understand the severity of condition. Quantitative sensory testing is another type of nerve test that is employed for diagnosing polyneuropathy. This test gives information about how well the patient is able to tolerate temperature changes and respond to vibration.

Treating the underlying cause and effective management of symptoms forms the basis of treatment. In many instances, it has been observed that with correction of the underlying disease condition (for example diabetes), neuropathy begin to show signs of improvement without any additional treatment [9].

Debilitating pain due to polyneuropathy needs to be controlled first. This is done using the following methods:

• Medications: For mild pain, over the counter pain medications may do the needful. In severe cases, corticosteroids may have to be employed for reducing the pain and associated inflammation. Anti-seizure medications have also shown to have a profound effect on nerve pain.
• Transcutaneous electrical nerve stimulation: This method employs administration of electrical impulses to specific affected areas. It can be given along with other treatment methods for relieving acute and severe forms of pain [10].
• Antidepressants: Antidepressants have also been found to be helpful in relieving the nerve pain. They work by blocking the chemical processes in the brain that get activated in response to pain.

The prognosis of the condition is favorable but depends on the extent of severity of symptoms and its underlying cause. Symptoms improve with initiation of treatment and if underlying etiology is effectively treated or managed. However, if initiation of treatment is delayed then various debilitating complications can set in.

Acute polyneuropathy is caused due to infections, exposure to toxins, HIV/AIDS, various drugs, autoimmune reactions and diseases such as cancer. When the cause of polyneuropathy cannot be determined, it is known as idiopathic polyneuropathy. Drug induced polyneuropathy is a result of cancer chemotherapy drugs. Autoimmune reactions can cause the body’s own immune system to mistakenly attack the peripheral nerves giving rise to Guillan-Barre syndrome; also known as acquired polyneuropathy [2].

Chronic form of polyneuropathy occurs as a secondary complication of various conditions and factors such as diabetes mellitus, alcohol consumption, impaired tolerance to glucose and connective tissue diseases characterized by degeneration of the nerves. In rare cases, nutritional deficiencies, kidney or liver failure and Lyme disease can also cause polyneuropathy [3].

Polyneuropathy is estimated to affect about 80 per 1000 individuals [4]. Many scientific research trials have suggested that peripheral polyneuropathy frequently affects individuals above 55 years of age.

Anatomically, the peripheral nerves pass through the spinal cord and reach the skin, muscles, glands and internal organs. In polyneuropathy, malfunctioning of nerves may be noticed simultaneously in several regions of the body. The basic phenomenon that induces polyneuropathy is injury to the peripheral nerves that eventually disrupt the blood supply to the body part, interfering with oxygen and nutrient supply that are required for appropriate nerve functioning, ultimately giving rise to several debilitating symptoms [5].

Polyneuropathy is classified into 3 distinct categories based on the type of nerve cell that is affected. These include distal axonopathy, myelinopathy and neuronopathy. Distal axonopathy primarily occurs due to metabolic derangement of neurons. Myelinopathy develops as a result of loss of myelin sheath. Neuronopathy occurs due to destruction of peripheral nervous system [6].

Effective management of conditions that can increase the risk of developing polyneuropathy should be done. Individuals are advised to remain healthy, lead an active lifestyle and adopt healthy dietary practices. It is also necessary to avoid the factors that can lead to nerve damage.

Polyneuropathy is a disease affecting the peripheral nerves and is therefore, also known as peripheral polyneuropathy. The condition can be both acute or chronic in nature. In the preliminary stages, the condition strikes the feet and hands and then eventually affects the arms and legs. As the disease progresses to the advanced stages, it can also significantly affect the autonomic nervous system. Polyneuropathy affects almost the same areas on both sides of body. In such a type of condition, many body parts are affected at almost the same time [1].

Polyneuropathy occurs due to damage of the peripheral nerves which eventually leads to development of debilitating signs and symptoms. The condition can significantly affect both the sides of body. Various factors such as diabetes, HIV/AIDS, inherited disease, alcoholism, autoimmune diseases, vitamin deficiencies and trauma or injury to nerve can predispose an individual to develop polyneuropathy. Symptoms of polyneuropathy include pain and numbness in the affected limb, along with reduced tolerance to heat and a decreased production of sweat. Affected individuals also lose control over bowel movements and there is development of dizziness and /or lightheadedness. Treatment is geared towards pain management and correction of the underlying cause. Various medications are administered to relieve the debilitating pain and inflammations. In many instances, anti-seizure medications may also have to be employed.

1. Hughes R. Investigation of peripheral neuropathy. BMJ 2010; 341:c6100.
2. Kumar S, Alexander M, Markandeyulu V. Guillain-Barre syndrome presenting in the anti-HIV seroconversion period. Neurol India. Dec 2003;51(4):559.
3. Morrison B, Chaudhry V. Medication, toxic, and vitamin-related neuropathies. Continuum (Minneap Minn) 2012; 18:139.
4. Bharucha NE, Bharucha AE, Bharucha EP. Prevalence of peripheral neuropathy in the Parsi community of Bombay. Neurology 1991; 41:1315.
5. England JD, Gronseth GS, Franklin G, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64:199.
6. Hafer-Macko C, Hsieh ST, Li CY, et al. Acute motor axonal neuropathy: an antibody-mediated attack on axolemma. Ann Neurol 1996; 40:635.
7. England JD, Asbury AK. Peripheral neuropathy. Lancet 2004; 363:2151.
8. England JD, Gronseth GS, Franklin G, et al. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 2009; 72:177.
9. Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol 1995; 38:869.
10. Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010; 74:173.