polyneuropathy
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Introduction
Also see peripheral nerve disease
Etiology
- diabetic polyneuropathy
- diabetes mellitus is the most frequent cause of polyneuropathy
- polyneuropathy is the most common complication of diabetes
- critical illness polyneuropathy
- alcoholic polyneuropathy
- vitamin B12 deficiency
Epidemiology
- prevalence: 2% in persons 50-60, 31% in persons > 80 years
- 31% with diabetes mellitus, 14% with vitamin B12 deficiency[3]
Pathology
- longest nerves are affected most severely
Clinical manifestations
- symptoms generally begin in the feet, then ascend up to legs
- later affects hands in stocking-glove distribution
- general signs & symptoms listed under peripheral nerve disease
Laboratory
- hemoglobin A1c in blood, serum glucose
- serum vitamin B12, serum methylmalonic acid, complete blood count for MCV
- serum protein electrophoresis[5]
Management
- management of underlying etiology
- treatment of neuropathic pain
- long-term opiates with unfavorable benefit/risk ratio[4]
More general terms
More specific terms
- botulism
- critical illness polyneuropathy
- diabetic polyneuropathy
- inflammatory demyelinating polyneuropathy
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1046-47
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
- ↑ 3.0 3.1 Hanewinckel R et al. Prevalence of polyneuropathy in the general middle-aged and elderly population. Neurology 2016 Nov 1; 87:1892 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27683845
- ↑ 4.0 4.1 Hoffman EM, Watson JC, St Sauver J et al Association of Long-term Opioid Therapy With Functional Status, Adverse Outcomes, and Mortality Among Patients With Polyneuropathy. JAMA Neurol 2017 Jul 1; 74:773. Published online May 22, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28531306 <Internet> http://jamanetwork.com/journals/jamaneurology/fullarticle/2626042
Volkow ND, Koroshetz W. Lack of Evidence for Benefit From Long-term Use of Opioid Analgesics for Patients With Neuropathy. JAMA Neurol. Published online May 22, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28531257 <Internet> http://jamanetwork.com/journals/jamaneurology/fullarticle/2626039 - ↑ 5.0 5.1 NEJM Knowledge+