Polyneuropathy after chemotherapy - toxic damage to nerve cells occurs much more often than is paid attention to. A progressive neurological complication can disrupt treatment plans, and it will take many months to stop it, and during this time the tumor will continue to grow. That is why the doctor and the patient have to choose between a bad and a very bad option for the development of a clinical event, without focusing on mild and moderate neurological troubles.
- Polyneuropathy in oncology
- Causes of polyneuropathy
- Mechanism of occurrence
- Types and symptoms of polyneuropathy after chemotherapy
- Clinical phenomenology of chronic renal failure
- Treatment of polyneuropathy after chemotherapy
Types of polyneuropathy
There are more than 100 types of peripheral neuropathies, and most of them are polyneuropathies. Each type is classified according to the type of nerve damage. For example, diabetic neuropathy occurs in people with diabetes, while idiopathic neuropathy has no known cause.
There are three main types of polyneuropathy:
- Chronic symmetric peripheral neuropathy
- develops over many months. - Multiple mononeuropathy
is damage to several separate nerve areas. - Acute symmetric peripheral neuropathy
is rare. The most common cause is Guillain-Barré syndrome, a condition that can be fatal.
Some types of neuropathy may take years to develop, while others become severe within hours or days.
Causes and risk factors for the development of polyneuropathy
Diabetes
Diabetes
may be an important risk factor, especially if blood glucose levels are not controlled. It has been found that one in five people with type 2 diabetes suffer from diabetic neuropathy.
Alcohol abuse
Alcohol can damage nerve tissue, and alcohol abuse is often associated with nutritional deficiencies that contribute to the development of neuropathies.
Autoimmune diseases
The immune system attacks the body, causing damage to nerves and other areas. Conditions include Sjögren's syndrome, celiac disease, Guillain-Barre syndrome, rheumatoid arthritis, and lupus.
Bacterial or viral infections
Some infections can lead to neuropathy, including Lyme disease, shingles, hepatitis C and B, and HIV.
Bone marrow diseases
Examples include abnormal proteins in the blood, some forms of bone cancer, and lymphoma.
Exposure to toxins
Toxic neuropathy can be caused by exposure to industrial chemicals such as arsenic, lead, mercury and thallium. Drug or chemical dependence is also a risk factor.
Hereditary diseases
Certain diseases, such as Charcot-Marie-Tooth disease, are forms of hereditary neuropathy.
Hypothyroidism
May lead to polyneuropathy.
Kidney diseases
Uremic neuropathy is a form of polyneuropathy that affects 20-50% of people with kidney disease
.
Liver disease
Research shows that peripheral neuropathy is very common in people with cirrhosis.
Medications
Chemotherapy, along with some medications used to treat HIV/AIDS, can cause neuropathy.
Poor nutrition
Deficiencies in vitamins B1, B6, B12 and E can lead to polyneuropathy as they are vital for nerve health.
Physical trauma
Repetitive motion, accidents, or other trauma can damage peripheral nerves.
Some cases of polyneuropathy have no known cause. These are known as idiopathic neuropathy
.
Diagnosis of polyneuropathy of the lower extremities
In order to select adequate therapy for polyneuropathy of the lower extremities, neurologists diagnose the disease. During the interview, they find out what worries the patient, when the first signs of the disease appeared, and how they developed. A general examination allows you to suspect diseases of the internal organs, which can cause damage to the nerves of the lower extremities.
The diagnosis is clarified using laboratory research methods. Electroneuromyography allows doctors to identify the location and degree of damage to peripheral nerves, determine the speed of impulse behavior along nerve fibers, and determine the response of a muscle to irritation. If indicated, patients are consulted by an endocrinologist, toxicologist, or orthopedist. Doctors collectively decide on the choice of treatment tactics.
Symptoms of polyneuropathy
Polyneuropathy can cause different symptoms, depending on which nerves are affected. Symptoms associated with sensory or motor nerve damage may include:
- Tingling;
- Numbness;
- difficulty using your arms or legs;
- Increased pain (eg, burning, stabbing, freezing, or shooting pains);
- Trouble sleeping due to night pain;
- Inability to feel pain;
- Intense sensitivity to touch;
- Inability to sense changes in temperature;
- Lack of coordination;
- Increased incidence of falls;
- Changes in skin, hair, or nails;
- Ulcers on the feet;
- Skin and nail infections;
- Muscle weakness;
- Muscle twitching.
Fibromyalgia and polyneuropathy may have similar symptoms, but the cause of fibromyalgia is unknown. Similarities also exist between multiple sclerosis and peripheral neuropathy. There are many conditions associated with polyneuropathy:
- Amyloidosis;
- Celiac disease;
- Charcot-Marie-Tooth disease;
- Diabetes;
- Diphtheria;
- Guillain-Barre syndrome;
- Hepatitis B;
- Hepatitis C;
- HIV AIDS;
- Kidney disease;
- Hypothyroidism;
- Leprosy;
- Liver disease
- Lyme disease;
- Lymphoma;
- Osteosclerotic myeloma;
- Anemia (B12 deficiency anemia);
- Radiculopathy;
- Rheumatoid arthritis;
- Sjögren's syndrome.
Complications of polyneuropathies
Common complications associated with polyneuropathy include:
- Falls and Injuries
– Lack of balance and coordination, as well as muscle weakness, can lead to falls and injuries. - Burns and skin damage
. Numbness and the inability to feel pain or temperature changes can lead to accidental burns, cuts, and other skin injuries. - Infections
. Injuries, burns and cuts, especially on the legs and feet, can go undetected, increasing the risk of infection.
The simplest exercises
- You need to pull your toes with your hands and stretch them in this way for about ten seconds. Afterwards you need to twist your feet to the right and left, making rotational movements. Finally, massage the sole of your foot and slowly massage each toe.
- The exercise is more difficult because it is done while standing. Slowly rise on your toes, then roll from toe to heel and so on several times. Just do this carefully and sensitively, since with polyneuropathy of the lower extremities it is contraindicated to walk for a long time and running is generally prohibited. The load must be dosed.
- In a sitting position, focus on your hands, bend one leg at the knee and bend it left and right onto the floor and through the other leg. This is how a small massage of the limbs is done, especially the lower parts of the legs and feet. With polyneuropathy, even simple exercises are important.
- Do the same, but lifting your heel off the floor, this exercise improves blood circulation.
- Raise your leg and bend and extend your knee off the floor. But this exercise is more taxing, do it several times. Working out the knee joint improves blood flow and keeps muscles toned.
- Use a gymnastic ball to massage your feet, move them to the sides and rotate them; this exercise is relaxing, as it is performed in a lying position and your feet rest on the ball.
- Place one foot on the knee of the other and rotate your foot. This is a better position for self-massage, if you sit comfortably.
- If the stretch allows, move your feet together, hold them with your hands and move your knees up and down. This exercise is very good, but quite difficult to perform.
Diagnosis of polyneuropathies
Diagnosis is made based on medical history, clinical examination, and neurological evaluation. The doctor will conduct a detailed review of all symptoms, lifestyle factors, and family history. He will also check the patient's height, weight, pulse, blood pressure and temperature. The heart, lungs, and abdomen may also be tested to rule out alternative physiological causes.
Blood tests may be ordered to look for diabetes, thyroid function, immune function, nutritional deficiencies and other factors that may cause polyneuropathy.
Some simple tests may be done to check reflexes, muscle strength, sensitivity to temperature and other sensations, coordination and posture.
Other methods that can be used to diagnose polyneuropathy:
- MRI or CT scan
—can help detect tumors, herniated discs, or other abnormalities that may affect nerve function. - Electrodiagnostic tests
—measure electrical activity in muscles and nerves to help detect nerve damage. Examples are electromyography and nerve conduction velocity. - Biopsy
- The doctor may remove a small part of the nerve or a sample of skin to check for abnormalities in nerve function or nerve endings.
List of required examinations for ITU
Which disability groups are considered workers?
As with all other diseases, obtaining disability due to polyneuropathy requires passing a certain minimum of examinations, the forms of which must subsequently be submitted to the ITU.
This list includes:
- General (clinical) blood and urine tests.
- Diagnosis of cerebrospinal fluid (necessary for patients suffering from infectious polyneuropathies, as well as autoimmune ones).
- Ophthalmological, somatic types of diagnostics, determined by the origin of the disease.
- EMG (electromyography), ENMG (electroneuromyography) (procedures are recommended in dynamics).
- Virological, bacteriological studies, based on the peculiarities of the occurrence of polyneuropathy.
- RVG (rheovasography - study of blood supply to the extremities), thermal imaging.
- Biochemical diagnostics of blood and urine (necessary for toxic, somatic polyneuropathies, as well as for the porphyritic form of the disease).
In addition, in the opinion of the attending physician, additional types of research may be required, which is determined by the peculiarities of the etiology of polyneuropathy, the nature, and the severity of its course.
Polyneuropathy - treatment
Doctors recommend that treatment for peripheral neuropathy should target the factor that led to the condition, correct nutritional deficiencies, and aim to relieve symptoms.
Available treatment methods include medications and various manipulations.
Several different medications are available to treat neuropathy and its symptoms. These include:
Drugs for associated conditions—this includes insulin to treat diabetes and thyroid hormones to treat hypothyroidism.
Painkillers - These are prescribed to patients with mild to moderate pain.
Corticosteroid injections may be used for mononeuropathy.
Prescription drugs. Certain antidepressants (including amitriptylene or nortriptyline).
Medical manipulations
- Electrical nerve stimulation
—electrodes are placed on the skin and send a small electrical current. This may help with pain and sensitivity. - Plasmapheresis
– People with inflammatory and autoimmune conditions may benefit from this therapy. Blood is drawn from the patient, antibodies and other proteins are separated, and the blood is then infused back. - Immune Globulin Therapy
– Patients with inflammatory and autoimmune conditions are given high levels of proteins as antibodies, which helps with immune function. - Exercise therapy
– This is prescribed for people with muscle weakness or coordination problems. - Orthotics and other devices
—braces, canes, splints, walkers, and wheelchairs—can provide support and pain relief for people with neuropathy in the arms and legs.
If the neuropathy is caused by pressure on a nerve, surgery may be recommended.
Foot massage
Basic movements for neuropathy, massage of the lower extremities
- Rub your palms over the ribs of your feet.
- Press the middle of the foot with your fist and help with your palm on the other side.
- Rub the base of your feet with your palms.
- Rotate your foot left and right while holding your heel.
- Rotate the limb left and right
- Use your thumb to massage the sole, pressing with your fingers on the upper side.
- Circular movements of the fingers on the heels.
- We move our thumbs from the heel to the toes along the sole.
- Circular movements of the toes at the top of the foot.
Please note that the massage should be done for about five minutes, and the exercises should be done in short, smooth approaches several times a day.
Prevention of polyneuropathies
Preventing polyneuropathy involves limiting risk factors. A person may not be able to avoid all risk factors, but making some lifestyle changes can reduce the risk. This:
- Avoid drinking alcohol;
- Avoid exposure to toxins, including cigarette smoke;
- Limit factors that contribute to physical injury;
- Adequate sleep and physical activity will support immune function;
- Eat a balanced diet rich in vitamins and minerals;
- Consider vitamin B12 supplements.
For some people, treating the underlying cause may lead to improvements. For others, the damage will be permanent. In some cases, symptoms may worsen.
Improved blood supply
With polyneuropathy of the lower extremities, you need to pay attention to gymnastic exercises that restore muscle function and improve blood circulation. To improve nutrition of the limbs, you need to rotate the joints, bend and straighten your legs. Of course, at first you need help if your legs are not in good shape, but over time the so-called active phase will begin and the patient will be able to monitor the movement of the limbs himself.
Massage of the limbs plays an important role, especially at the initial stage. Of course, a professional massage therapist will not be able to constantly monitor the recovery process, so you need to remember his movements and repeat them with the help of loved ones, as well as do self-massage. Only in this way, by acting on the affected legs, can one expect a favorable prognosis, and, as a result, recovery.
