A disease or inflammation to the peripheral nerves, which connect the central nervous system (brain and spinal cord), to the muscle, glands, sense organs and internal organs(BMA 2002). It may affect a single nerve (mono-neuropathy) or be generalized disorder (polyneuropathy) symptoms will depend on whether motor, sensory or autonomic nerves are affected. Trauma or entrapment of a nerve is common cause of mono-neuropathy, pressure or stretching of a nerve occurring in various situations. Common causes of polyneuropathy include diabetes mellitus,Vitamin B deficiency (often alcohol associated) and some viral infection genetic and toxic neuropathies are also seen (Marcovitch 2010). The symptoms may become visible in days, months or years; it depends upon the cause of the nerve damage. It is a common condition that affects around 2% of the UK population (NHS 2010)
Understanding the neuropathy needs a good understanding of the basic nerve cells and nerves. Nerve cells are the basic structure of the nervous system. The neuron (nerve cell) made up of body axon and the myelin sheath that cover the axon. When the neuron is stimulated, the message carried along the axon in a form of electronic impulses , towards the central nervous system.
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In neuropathy the myelin sheath or the axon being affected, injured or destroyed, resulting in axonal degeneration mostly in the distal component of the nerve. (Bethlem & Knobbout 1987)
Leprosy (chronic disease caused by the bacterium mycobacterium leprae), effects the skin mucous membrane and nerves (Oxford 1994)) is the most frequent cause of neuropathy, that attacks the peripheral nerves of affected patient (olendorf &el 1999)
X linked recessive disorder located on the X chromosome resulting in deficiency in the HGPRT gene. The lack of HGPRT causes an increase of Phosphoribosyl pyrophosphate(prpp) the substrate for the enzyme amidophosphoribosyl transferase. This stimulates purine biosynthesis, resulting in an increasing in the level of uric acid. That increase of uric acid leads to severe neuropathy.
In general affects diabetes mellitus patient, the onset of the symptoms in diabetes patients happens between the age 60 and 60 years. About 20% of diabetic patents develop neuropathic symptoms, however 10% develop painful neuropathy (Young et al, 1993). Its frequency, estimated by Martin (1953), to be 30-40 % of diabetic patents.
Patients presents with sensory symptoms such as pain, sensory loss, ankle jerks are lost, ataxia and areflexia. Other symptoms such as paralysis and pupillart abnormalities are common (Blackwood & al 1971). In diabetes, it has been suggested that insulin deficiency and hyperglycemia cause demyelination and axonal degeneration if glucose levels, exceedingly above normal, could damage the peripheral nerves and their blood supplies (Peters, 2005). Nevertheless, blockage of small arteries resulting in nerve ischaemia may have an impact on neuropathy development. (Olendorf & al, 1999)
Patients with kidney failure have a 10-90% risk of developing neuropathy. The increasing level of lipids inside blood vessels can cut blood supply to certain nerves. The lack of nutrients and oxygen supply result in a slow death of the neurons cells and therefore the nerves. (Olendorf & al 1999)
Research shows that those who consume 3 liters of beer, or 300ml of liquor daily, for 3 years are more likely to suffer with neuropathy (Olendorf & al, 1999). Malnutrition associated with alcoholism, where alcoholics tend to have a diet rich in carbohydrate foods, such as bread, pasta and tinned soup, plays a role in patients effected with neuropathy.
Poor diet leads gradually to nutritional deficiency, thiamine in particular as well as other vitamins. Histopathology shows the myelin sheath and axons to be affected particularly in the distal parts of the nerves. (Bethlem & Knobbout 1987)
Vitamin B6 deficiency
Vitamin B6 play a role of co-factor in amino acid metabolism, in addition to the glycogen phosphorylase reaction. Furthermore, it is essential for synthesis of the neurotransmitter, noradrenalin and serotonin i . e. requirement of B6 vitamin increases with the protein intake (Baynes & Dominiczak, 2005). Vitamin B6 deficiency will lead to hyperpyruvaemia dilatation of the heart. An experiment by North and Sinclair(1956) showed degeneration in the distal parts of the sciatic and p.tibial nerves i .e. neuropathy.(Blackwood & al, 1971)
Placing excess pressure on the nerves, exceeding the threshold of the nerve capacity to stretch and obstruct the blood supplying the nerves with oxygen and nutrients, are a common injury associated with sport that result in neuropathy. These sorts of injuries result in numbness, tingling and pain along the leg which can cause severe sensory and motor loss. (Olendorf & al, 1999)
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An acute polyradical neuropathy appears after a respiratory trace infection or gastrointestinal disorder. The first symptom associated with this syndrome is numbness of the feet, in addition to muscle weakness. In severe cases, total paralysis of all limbs, respiratory insufficiency and facial palsy may develop.
Drugs, including Isoniazid,which is used to treat tuberculosis, leukaemia chemotherapy, cholesterol lowering medications and Metronidazole, an antibiotic. Many drugs which have shown association with peripheral neuropathy, have also shown involvement with neuropathy (Lorimer, 1993).
Industrial chemical and heavy metals, such as allyl chloride lead n-hexane, acrylamide, mercury solvent and glue-sniffing, have been shown to be toxic to nerves and evolve into Guillain-Barre syndrome, which effects the motor and sensory nerves (Olendorf & al, 1999).
Treatment of neuropathy includes daily self check of the feet for any signs of damage; checking that nothing in shoes has the potential damage, injure or irritate the feet such as tight fitting shoes; using moisturiser, especially when the skin is dry; exercising daily with massaging the feet and hand; reducing the caffeine intake and acupuncture, which is an effective treatment for painful diabetic neuropathy. Surgery intervention may be considered, but it depends upon individual circumstances (Bethlem & Knobbout, 1987)
Neuropathy affecting the lower limb is not exclusive to diabetes. Vitamin B deficiency, alcoholism, kidney failure, some viral infections, genetics and toxic agents are common causes of neuropathy. Neuropathy affects around 1 in 50 people in the UK (NHS 2010). Neuropathy caused by vitamin deficiency is rare, however, it seems that doctors are still prescribing B vitamins for patients with neuropathy (Bethlem & Knobbout, 1987)