Search
polyneuropathy
Also see peripheral nerve disease
Etiology:
1) diabetic polyneuropathy
a) diabetes mellitus is the most frequent cause of polyneuropathy
b) polyneuropathy is the most common complication of diabetes
2) critical illness polyneuropathy
3) alcoholic polyneuropathy
4) 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]
Interactions
disease interactions
Specific
botulism
critical illness polyneuropathy
diabetic polyneuropathy
inflammatory demyelinating polyneuropathy
General
peripheral nerve disease; peripheral neuropathy
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
- Hanewinckel R et al.
Prevalence of polyneuropathy in the general middle-aged
and elderly population.
Neurology 2016 Nov 1; 87:1892
PMID: 27683845
- 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
PMID: 28531306
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
PMID: 28531257
http://jamanetwork.com/journals/jamaneurology/fullarticle/2626039
- NEJM Knowledge+