OVERVIEW
是由不同原因引起的多种末梢神经损害的总称
可出现肢体末端麻木、针刺、力量减退、皮肤苍白、发凉
发病与代谢紊乱、中毒、肿瘤、感染等因素有关
针对病因及症状治疗，药物治疗为主配合康复、中医治疗
Definition
Multiple peripheral neuritis is a variety of peripheral nerve endings damaged by different causes.
It mainly involves sensory, motor and autonomic functions of the distal extremities.
The main manifestations are numbness, pins and needles, loss of strength, and pale, cold skin at the ends of the limbs.
Multiple peripheral neuritis, also known as peripheral neuritis, peripheral neuritis, peripheral neuritis, peripheral peripheral neuritis, etc., are not part of the standardized medical name, and their nature are all multiple neuropathies.
Classification
Classification is mainly based on the cause of the disease.
Toxicity: due to poisoning by drugs, chemicals, heavy metals, etc.
Nutritional disorders: caused by disorders of vitamin intake, absorption, and metabolism.
Metabolic disorder: due to abnormal metabolism of iron ions, glucose, creatinine, urea and other substances in the blood.
Infectious-inflammatory: due to bacterial or viral infection or vaccine reaction.
Autoimmune: due to autoimmune diseases.
Tumor-associated: due to cancer, tumors.
Morbidity
The overall prevalence of polyneuropathy is about 1%, and the incidence is gradually increasing.
It can occur in all age groups, but is more prevalent in the elderly population at 7%.
Females are more likely to be affected than males.
Causes
Causes
Poisoning: common isoniazid, furan drugs, phenytoin sodium and other drug poisoning; organophosphorus pesticides, hexane and other chemicals; lead, arsenic, mercury and other heavy metal poisoning.
Nutritional disorders: common B vitamin deficiency, chronic alcoholism, chronic gastrointestinal diseases or after surgery.
Metabolic disorders: common in porphyria, diabetes, uremia, amyloidosis, gout, hypothyroidism, acromegaly and so on.
Infectious inflammatory diseases: common in Guillain-Barré syndrome, serum or post-vaccination.
Autoimmune diseases: common in lupus erythematosus, tuberculosis, polyarteritis nodosa and rheumatoid arthritis.
Tumors: common in lung cancer, lymphoma, and the emergence of paraneoplastic syndrome, POEMS syndrome and other related diseases.
Others: some of the multiple peripheral neuritis can not find the exact cause, called cryptogenic peripheral neuritis.
Predisposing factors
The disease can be triggered directly or indirectly by increased sensitivity of nerve tissue to external environmental factors.
Exposure to cold, cold.
Limb compression, ischemia.
Fatigue, strenuous exercise.
Decrease in body resistance.
High-risk groups
People working in chemical factories, shoe factories, mines, etc.
Elderly people.
Patients taking isoniazid, furans, phenytoin sodium and other drugs for a long time.
Patients with diabetes, uremia, rheumatoid arthritis, systemic lupus erythematosus, tumors and other diseases.
Those who have the habit of drinking alcohol for a long time and in large quantities.
Symptoms
Symptoms of polypoidal peripheral neuritis are mainly manifested in the distal extremities, such as hands and feet.
They may be characterized by sensory, motor and autonomic dysfunction. Symptoms may occur simultaneously or some symptoms may predominate.
Common symptoms
Sensory deficits
Hyperalgesia: the skin is insensitive to pinprick, cold and heat, or even disappears.
Sensory hypersensitivity: the skin is hypersensitive to touch, temperature and other stimuli, and even feels pain.
Sensory abnormality: numbness, hyperalgesia, ants sensation; burning and pinprick pain.
Some patients may have deep sensory disturbances, such as the appearance of unsteady standing and the feeling of feet stepping on cotton.
Movement disorder
Muscle weakness, flaccidity, atrophy, muscle bundle tremor, commonly found in the tiger’s mouth, the big and small fissure, and the outer side of the calf.
Appearance of deformity, limited joint movement, commonly drop wrist, drop foot.
Autonomic dysfunction
Pale skin, coldness, decreased skin temperature.
Skin roughness, thinning, no sweat.
Loss of normal luster of finger (toe) nails.
Complications
Swelling of the limbs
Associated with unfavorable movement and autonomic dysfunction.
It is characterized by swelling and coldness of the limbs, depression and difficulty in rebounding when pressed, most obvious in the hands and feet.
Pressure Sore
When the limb is not moving well or when wearing a brace, the local skin is compressed for a long time, blood circulation is impaired, ischemia and necrosis occur.
Redness, swelling, skin breakage, and in severe cases, ulcers and secondary infections may occur at the place of pressure.
Consultation
Department of Medicine
Neurology
Prompt medical consultation is recommended when numbness, pins and needles, loss of strength, pale and cold skin at the end of the limb occur.
Due to the various causes of the disease, the patient’s first department may also be endocrinology, allergy and immunity, oncology, etc.
Preparation for medical treatment
Preparation for consultation: registration, preparation of documents, common problems
Tips for medical treatment
Try to keep a record of the symptoms you have experienced and how long they have lasted, so that you can give your doctor more information.
Patients with symptoms of limb weakness are at higher risk of falling, so it is recommended that family members accompany them to the doctor.
Preparation Checklist
症状清单
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Are there any symptoms of hand or foot weakness, muscle atrophy, numbness or pain?
When did the symptoms first appear and how long did they last?
Any aggravating or relieving factors?
Where did the symptoms first appear and have they progressed?
病史清单
Have there been any long-term medications, exposure to pesticides, chemicals, heavy metals, etc.?
Are there nutritional disorders, such as B vitamin deficiency, chronic alcoholism?
Are there metabolic diseases such as diabetes, uremia?
Are there infectious inflammatory diseases, such as Guillain-Barré syndrome?
Any recent serum use, vaccinations?
Any autoimmune diseases such as lupus erythematosus, tuberculosis?
Any tumors, such as lung cancer, lymphoma?
检查清单
Test results in the last 6 months to bring with you to your doctor’s appointment
Laboratory tests: blood glucose, tumor factor, rheumatoid factor, anti-nuclear antibody, double-stranded DNA antibody, liver and kidney function, serum vitamin B1 level.
Electrophysiologic examination: electromyography, somatosensory evoked potential examination.
用药清单
Medication used in the last 3 months, if available, bring the box or package with you to the doctor’s office
Immunomodulatory: dexamethasone, immunoglobulin.
Nutritional drugs: B vitamins, methylcobalamin, murine nerve growth factor.
Neurologic drugs: carbamazepine, phenytoin sodium, amitriptyline.
Glucose-lowering drugs: metformin, glimepiride, acarbose.
Diagnosis
Diagnosis is based on
Medical history
History of prolonged drug use, exposure to pesticides, chemicals, heavy metals, etc.
Has nutritional metabolic diseases, infectious inflammatory diseases, autoimmune diseases, tumors, etc.
Has recently used serums, vaccinated.
Clinical manifestations
症状
There are symptoms such as numbness, pins and needles in hands and feet, loss of strength, pale and cold skin.
体征
Doctors use physical examination to find out if there are any abnormalities in muscle strength, skin sensation, autonomic function and nerve reflexes.
Muscle strength examination: To determine muscle strength through movements such as lifting the hand, hooking the foot, and walking.
Skin sensation examination: To evaluate the sensitivity of skin sensation.
触觉：使用棉花或棉签轻触。
痛觉：使用叩诊锤的尖锐一侧或牙签触碰。
温度觉：通过冷或热的物体触碰。
注意事项：检查时患者需闭眼；需在正常/异常部位之间进行对比。
Skin autonomic function examination
医生用手指触摸四肢远端皮肤。
判断皮肤是否光滑、温度如何、有无汗液等。
Tendon reflex examination
观察敲击前臂、跟腱时手腕、小腿肌肉收缩情况。
本病通常会表现为肌肉收缩减弱或消失。
Laboratory examination
Purpose of examination: to clarify the cause of the disease and the general condition of the patient.
Common items: blood routine, blood glucose, tumor factor, rheumatoid factor, anti-nuclear antibody, double-stranded DNA antibody, liver and kidney function, immunofixation electrophoresis, serum vitamin B1 level, etc.
Precautions: Most of the items require fasting and need to be rechecked in the course of treatment.
Neurophysiologic examination
Including sensory/motor evoked potentials, electromyography, skin sympathetic response measurement.
Purpose: To discover the type and extent of damage to peripheral nerves.
Results: slowing down of nerve signal conduction and decrease in wave amplitude can be seen; disappearance or delayed appearance of muscle response to stimulus emergence, suggesting the presence of myelin and axonal lesions in peripheral nerves.
Precautions for examination
检查前应按医生要求清洁皮肤，配合放松。
避免皮肤污垢、精神紧张影响检查结果。
Other tests
Mainly to clarify the specific type of the disease, such as confirming the diagnosis of Guillain-Barré syndrome.
Cerebrospinal fluid examination: to check for abnormalities in the cerebrospinal fluid such as proteins, cell types, and antibodies.
Peroneal nerve biopsy: To detect the presence of damage to the myelin sheath or axons of the nerve fibers.
Differential Diagnosis
Erythematous limb pain
Similarities: both may present with limb pain and localized sweating of the skin.
Differences
红斑性肢痛症以双下肢多见。
在发作时将患肢浸泡在冷水中可以减少或缓解疼痛。
Raynaud’s disease
Similarities: both may present with pale, cold skin on the hands.
Differences
雷诺病可出现皮肤苍白、发凉、青紫，继而皮肤发红、皮肤温度上升。
无肌肉力量下降、萎缩、感觉减退等表现。
Hysterical numbness of the limbs
Similarities: both may present with numbness of the limbs.
Differences
癔症性肢体麻木的发病多与情绪、心理因素有关。
麻木的范围、表现、程度、过程多变，且可不符合神经分布区域。
Hypokalemic periodic paralysis
Similarities: both may present with decreased muscle strength and muscle flaccidity.
Differences
低钾性周期性瘫痪常在暴饮、暴食、受凉、疲劳等诱因下发病。
肢体无力由下肢开始，逐渐向躯干和全身蔓延，血清钾离子浓度降低。
Treatment
Aim of treatment: Remove or alleviate the cause of the disease, improve symptoms, control the progression of the disease, and prevent and minimize complications.
Treatment Principle: Treating the cause and symptoms of the disease, with medication as the main treatment together with rehabilitation therapy.
Cause treatment
Those who are poisoned by chemicals and heavy metals should immediately detach themselves from the poisoned environment and rapidly apply relevant antidotes to expel the poison.
Drug-induced patients need to stop and change drugs as soon as possible under the guidance of doctors.
Diabetic patients should pay attention to blood sugar control.
Patients with uremia should undergo hemodialysis or kidney transplantation.
Chronic alcoholics need to regulate alcohol withdrawal.
Patients with autoimmune diseases and tumors should actively treat the original disease.
Symptomatic treatment
Neurotrophic drugs
Therapeutic purpose: improve nerve nutrition and promote the recovery of nerve function.
Indications: Applicable to the protection of nerves in the acute stage, post-surgery auxiliary support and non-surgical treatment.
Commonly used drugs: vitamin B6, vitamin B12, methylcobalamin, rat nerve growth factor, ganglioside.
Adverse reactions: nausea, vomiting, skin rash may occur.
Other drugs
Immunosuppression and modulation: e.g. dexamethasone, prednisone, immunoglobulin.
Relief of neuralgia: e.g. carbamazepine, pregabalin, gabapentin, amitriptyline, etc.
Rehabilitation therapy
Limb function training
Passive training: move the upper and lower limbs with the assistance of the therapist to the extent that it can be tolerated, which can prevent muscle atrophy, maintain the mobility of the joints and prevent joint stiffness.
Active training: utilize elastic band, grip and other tools to exert force to the palm side and dorsal side of the wrist joint, finger grasping and stretching training; ankle upward and downward dorsiflexion and extension, standing up and walking training.
Pay attention to safety and moderation of labor and leisure during training, avoid falling or overwork, otherwise it will easily lead to aggravation or relapse of the disease.
Sensory training
Superficial sensory training: to apply tactile stimulation to the skin, such as pain, touch, ice – warm water alternating temperature stimulation, touch screening of physical objects, and so on.
Deep sensory training: Sensory training must be combined with motor training, such as squeezing and weight bearing on the joints during training, to obtain the correct motor experience in the process of completing the movement.
Occupational therapy
Daily life movement training, such as dressing and undressing, eating, knitting, typing, carpentry, etc., to improve independent living function.
Orthotics and assistive devices
Maintain the joints of the injured area in proper position and keep them in functional position to prevent injury.
Such as wrist support, shoulder sling, brace, splint, etc.
Physical factor therapy
Through microwave diathermy, infrared rays and low-energy laser irradiation, etc., the treatment can promote nerve repair, relieve pain and prevent joint adhesion.
Transcutaneous electrical nerve stimulation and neuromuscular electrical stimulation therapy can be used to promote the regeneration and functional recovery of peripheral nerves.
Chinese medicine treatment
Chinese medicine treatment mainly focuses on regulating the spleen and stomach, benefiting qi and blood circulation, resolving blood stasis and opening up collaterals.
The treatment methods include soups, acupuncture, herbal fumigation, acupoint compresses, bloodletting at acupoints and so on.
Commonly used prescriptions: Astragalus and Gui Zhi Five Substances Soup, Tonic Yang Returning Five Substances Soup, Yang He Soup, Tao Hong Four Substances Soup.
Commonly used acupoints: Baihui, Si Shencong, Fengfu, Fengchi, Quchi, Hegu, Ashigaru, and Jiaoji points.
Prognosis
Cure
The prognosis of this disease mainly depends on the primary disease and the duration of the disease.
Early peripheral nerve injury caused by poisoning, vitamin B deficiency, infection, partial or complete recovery of nerve function after removal of the cause.
Irreversible neurological dysfunction often occurs with tumor-related diseases or long-term autoimmune diseases, hereditary diseases, or metabolic disorders.
Harmfulness
Patients with foot weakness are prone to fall and stumble, causing trauma and fracture.
Numbness and pain in the limbs can affect mood and sleep, leading to decreased quality of life.
Skin sensation is reduced or disappeared, which is easy to have accidents such as skin breakage, burns, scalds and so on.
Long-term unfavorable limb movement and sensory impairment can cause psychological stress, resulting in anxiety and depression.
Daily
Daily Management
Diet management
Balanced diet, increase nutrition and ensure adequate nutrition.
Foods that are high in protein, calories and easy to digest, such as cheese, eggs and lean meat.
Fruits and vegetables rich in B vitamins and fiber, such as kiwi, strawberries and celery.
Diabetics avoid high sugar foods to ensure stable blood sugar.
Do not smoke or drink alcohol
Exercise management
Choose suitable exercise methods under doctor’s advice, such as Baduanjin, Taiji, paper-cutting, clay modeling and hydrotherapy exercise.
Family members should accompany you when exercising to prevent falls and bone fracture accidents.
Exercise environment should be safe, avoid sharp objects and debris to obstruct the route.
Exercise intensity should be appropriate, avoid overdoing, and should be gradual.
Life Management
Pay attention to rest and avoid exertion.
If the brace is used for a long time, it should not be fixed too tightly and should be unfastened regularly to observe the skin condition and avoid skin injury.
The lesion area may appear to manifest as pale, cold, pay attention to limb warmth, but prohibit the use of hot water bags, warm babies and other localized high heat items to avoid burns.
Psychological support
Pay attention to their own physical and mental state, timely relief of pressure, avoid excessive anxiety, depression.
Family members should pay attention to the patient’s psychological changes, actively listen, and give support and encouragement.
Disease monitoring
Monitor muscle strength, sensory function, and skin changes daily.
If there are any changes such as skin redness, blisters, turning purple, etc., attention should be paid.
Follow-up
Follow the doctor’s instructions for regular review, usually once every 1 to 3 months, in order to adjust the treatment program.
Follow-up examinations include laboratory tests and electromyography.
Prevention
People working in chemical plants, shoe factories, mines, etc. need to take proper occupational protection.
Patients taking isoniazid, furans, phenytoin sodium and other drugs for a long period of time should standardize the follow-up examination, and should not adjust the dosage of drugs privately.
Actively treat diabetes, rheumatoid arthritis, systemic lupus erythematosus, tumors and other diseases.
Do not drink alcohol, and quit drinking as soon as possible if you have the habit of drinking alcohol.
Patients with uremia should follow the doctor’s recommendation to regulate hemodialysis or kidney transplantation.
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