Polyneuropathies

Polyneuropathies are functional disorders of the peripheral nerves in the context of a generalized or systemic disease.

There is a predominantly symmetrical distribution of symptoms and findings, with distal and leg emphasis. Depending on the cause, progression is slow to rapid.
Sensory disturbances may be present in a "sock and glove-like" distribution, as well as paraesthesia and possibly burning pain. In addition, there is an early loss of vibration sensation.

Motor deficits usually begin with weakness in lifting the foot. Muscle atrophy is first observed in the small muscles of the foot and hand, and later the lower leg and forearms are also affected. There is a premature loss of the Achilles tendon reflex.

Trophic disorders can be observed, for example, in the skin (trophically disturbed skin) and nails. Vegetative disorders, on the other hand, affect the skin (oedema, livid discoloration, disorders of sweat secretion) as well as disorders of sexual, bladder and rectal function and orthostatic hypotension.

To diagnose polyneuropathies, clinical examinations and neurological consultations must be carried out in addition to a medical history.

Laboratory: Basic program with blood sugar determination, ESR, blood count, TSH-basal, transaminases, creatinine, electrolytes, CK, serum electrophoresis (IgM-associated polyneuropathy is the most common paraproteinemia associated with polyneuropathy; formation of anti-MAG antibodies directed against a glycoprotein in the myelin sheaths of peripheral nerves), vitamin B12 and folic acid levels.

CSF diagnostics and lumbar puncture

Special neurological diagnostics: e.g. electrokyography, electroneurography, somatosensory and motor evoked potentials.

Nerve/muscle biopsy (in unclear cases)

Mulecular genetictests to clarify hereditary polyneuropathy.

Neuralgiform (polyneuropathic) pain can be treated symptomatically with carbamazepine, gabapentin or pregabalin, among others. Burning pains are treated with amitriptyline, duloxetine, and cramp-like pains with alternating foot baths with quinine sulphate. Other and therapy-resistant types of pain: clomipramine or amitriptyline if necessary