Peripheral neuropathy classification: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(One intermediate revision by the same user not shown)
Line 4: Line 4:
{{CMG}}; {{AE}} {{MMJ}}
{{CMG}}; {{AE}} {{MMJ}}
==Overview==
==Overview==
 
Peripheral neuropathy may be classified according to the number and distribution of nerves affected into three groups: [[Mononeuropathy]], [[Mononeuritis multiplex]] and [[Polyneuropathy]].It may also be classified according to the type of nerve fiber predominantly affected into three groups: [[Motor neuron|Motor]], [[Sensory neuropathy|sensory]] and [[Autonomic]]. peripheral neuropathy may also be classified according to the process affecting the nerves into three groups: [[Neuritis|Inflammatory neuritis]], compression [[neuropathy]] and[[chemotherapy]]-induced peripheral neuropathy.
Peripheral neuropathy may be classified according to the number and distribution of nerves affected (mononeuropathy, mononeuritis multiplex, or polyneuropathy), the type of nerve fiber predominantly affected (motor, sensory, autonomic), or the process affecting the nerves; e.g., inflammation (neuritis), compression (compression neuropathy), chemotherapy (chemotherapy-induced peripheral neuropathy).
 
=== Mononeuropathy ===
See also: Compression neuropathy and Ulnar neuropathy
 
'''Mononeuropathy''' is a type of neuropathy that only affects a single nerve. Diagnostically, it is important to distinguish it from polyneuropathy because when a single nerve is affected, it is more likely to be due to localized trauma or infection.
 
The most common cause of mononeuropathy is physical compression of the nerve, known as compression neuropathy. Carpal tunnel syndrome and axillary nerve palsy are examples. Direct injury to a nerve, interruption of its blood supply resulting in (ischemia), or inflammation also may cause mononeuropathy.
 
=== Polyneuropathy ===
Main article: Polyneuropathy
 
"''Polyneuropathy''" is a pattern of nerve damage that is quite different from mononeuropathy, often more serious and affecting more areas of the body. The term "peripheral neuropathy" sometimes is used loosely to refer to polyneuropathy. In cases of polyneuropathy, many nerve cells in various parts of the body are affected, without regard to the nerve through which they pass; not all nerve cells are affected in any particular case. In distal axonopathy, one common pattern is that the cell bodies of neurons remain intact, but the axons are affected in proportion to their length;  the longest axons are the most affected. Diabetic neuropathy is the most common cause of this pattern. In demyelinating polyneuropathies, the myelin sheath around axons is damaged, which affects the ability of the axons to conduct electrical impulses. The third and least common pattern affects the cell bodies of neurons directly. This usually picks out either the motor neurons (known as motor neuron disease) or the sensory neurons (known as ''sensory neuronopathy'' or ''dorsal root ganglionopathy'').
 
The effect of this is to cause symptoms in more than one part of the body, often symmetrically on left and right sides. As for any neuropathy, the chief symptoms include motor symptoms such as weakness or clumsiness of movement; and sensory symptoms such as unusual or unpleasant sensations such as tingling or burning; reduced ability to feel sensations such as texture or temperature, and impaired balance when standing or walking. In many polyneuropathies, these symptoms occur first and most severely in the feet. Autonomic symptoms also may occur, such as dizziness on standing up, erectile dysfunction, and difficulty controlling urination.
 
Polyneuropathies usually are caused by processes that affect the body as a whole. Diabetes and impaired glucose tolerance are the most common causes. Hyperglycemia-induced formation of advanced glycation end products (AGEs) is related to diabetic neuropathy. Other causes relate to the particular type of polyneuropathy, and there are many different causes of each type, including inflammatory diseases such as Lyme disease, vitamin deficiencies, blood disorders, and toxins (including alcohol and certain prescribed drugs).
 
Most types of polyneuropathy progress fairly slowly, over months or years, but rapidly progressive polyneuropathy also occurs. It is important to recognize that at one time it was thought that many of the cases of small fiber peripheral neuropathy with typical symptoms of tingling, pain, and loss of sensation in the feet and hands were due to glucose intolerance before a diagnosis of diabetes or pre-diabetes. However, in August 2015, the Mayo Clinic published a scientific study in the Journal of the Neurological Sciences showing "no significant increase in...symptoms...in the prediabetes group", and stated that "A search for alternate neuropathy causes is needed in patients with prediabetes."
 
The treatment of polyneuropathies is aimed firstly at eliminating or controlling the cause, secondly at maintaining muscle strength and physical function, and thirdly at controlling symptoms such as neuropathic pain.
 
=== Mononeuritis multiplex ===
'''Mononeuritis multiplex''', occasionally termed '''polyneuritis multiplex''', is simultaneous or sequential involvement of individual noncontiguous nerve trunks, either partially or completely, evolving over days to years and typically presenting with acute or subacute loss of sensory and motor function of individual nerves. The pattern of involvement is asymmetric, however, as the disease progresses, deficit(s) becomes more confluent and symmetrical, making it difficult to differentiate from polyneuropathy. Therefore, attention to the pattern of early symptoms is important.
 
Mononeuritis multiplex also may cause pain, which is characterized as deep, aching pain that is worse at night and frequently in the lower back, hip, or leg. In people with diabetes mellitus, mononeuritis multiplex typically is encountered as acute, unilateral, and severe thigh pain followed by anterior muscle weakness and loss of knee reflex.<sup>[''medical citation needed'']</sup>
 
Electrodiagnostic medicine studies will show multifocal sensory motor axonal neuropathy.
 
It is caused by, or associated with, several medical conditions:
* diabetes mellitus
* vasculitides: polyarteritis nodosa, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis
* immune-mediated diseases, such as rheumatoid arthritis, systemic lupus erythematosus (SLE)
* infections:  leprosy, lyme disease, Parvovirus B19, HIV
* sarcoidosis
* cryoglobulinemia
* reactions to exposure to chemical agents, including trichloroethylene and dapsone<sup>[''medical citation needed'']</sup>
* rarely, following the sting of certain jellyfish, such as the sea nettle<sup>[''medical citation needed'']</sup>
 
=== Autonomic neuropathy ===
'''Autonomic neuropathy'''  is a form of polyneuropathy that affects the non-voluntary, non-sensory nervous system (i.e., the autonomic nervous system), affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Autonomic nerve fibers form large collections in the thorax, abdomen, and pelvis outside the spinal cord. They have connections with the spinal cord and ultimately the brain, however. Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2. In most—but not all—cases, autonomic neuropathy occurs alongside other forms of neuropathy, such as sensory neuropathy.
 
Autonomic neuropathy is one cause of malfunction of the autonomic nervous system, but not the only one; some conditions affecting the brain or spinal cord also may cause autonomic dysfunction, such as multiple system atrophy, and therefore, may cause similar symptoms to autonomic neuropathy.
 
The signs and symptoms of autonomic neuropathy include the following:
* Urinary bladder conditions:  bladder incontinence or urine retention
* Gastrointestinal tract: dysphagia, abdominal pain, nausea, vomiting, malabsorption, fecal incontinence, gastroparesis, diarrhoea, constipation
* Cardiovascular system:  disturbances of heart rate (tachycardia, bradycardia), orthostatic hypotension, inadequate increase of heart rate on exertion
* Respiratory system: impairments in the signals associated with regulation of breathing and gas exchange (central sleep apnea, hypopnea, bradypnea).
* Other areas:  hypoglycemia unawareness, genital impotence, sweat disturbances
 
=== Neuritis ===
'''Neuritis''' is a general term for inflammation of a nerve or the general inflammation of the peripheral nervous system. Symptoms depend on the nerves involved, but may include pain, paresthesia (pins-and-needles), paresis (weakness),  hypoesthesia (numbness), anesthesia, paralysis, wasting, and disappearance of the reflexes.
 
Causes of neuritis include:
* Physical injury
* Infection
** Diphtheria
** Herpes zoster (shingles)
** Leprosy
** Lyme disease
* Chemical injury such as chemotherapy
* Radiation therapy
Types of neuritis include:
* Brachial neuritis
* Cranial neuritis such as Bell's palsy
* Optic neuritis
* Vestibular neuritis
* Wartenberg's migratory sensory neuropathy
* Underlying conditions including:                                            :
** Alcoholism
** Autoimmune disease, especially multiple sclerosis and Guillain–Barré syndrome
** Beriberi (vitamin B1 deficiency)
** Cancer
** Celiac disease
** Diabetes mellitus (Diabetic neuropathy)
** Hypothyroidism
** Porphyria
** Vitamin B12 deficiency
** Vitamin B6 excess


==Classification==
==Classification==
* Peripheral neuropathy may be classified according to the number and distribution of nerves affected into three groups:
* Peripheral neuropathy may be classified according to the number and distribution of nerves affected into three groups:<ref name="pmid19893645">{{cite journal| author=Misra UK, Kalita J, Nair PP| title=Diagnostic approach to peripheral neuropathy. | journal=Ann Indian Acad Neurol | year= 2008 | volume= 11 | issue= 2 | pages= 89-97 | pmid=19893645 | doi=10.4103/0972-2327.41875 | pmc=2771953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19893645  }} </ref><ref name="pmid23020902">{{cite journal| author=Brito-Zerón P, Akasbi M, Bosch X, Bové A, Pérez-De-Lis M, Diaz-Lagares C et al.| title=Classification and characterisation of peripheral neuropathies in 102 patients with primary Sjögren's syndrome. | journal=Clin Exp Rheumatol | year= 2013 | volume= 31 | issue= 1 | pages= 103-10 | pmid=23020902 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23020902  }} </ref>
** [[Mononeuropathy]]  
** [[Mononeuropathy]]  
** [[Mononeuritis multiplex]]  
** [[Mononeuritis multiplex]]  
** [[Polyneuropathy]]  
** [[Polyneuropathy]]  


* Peripheral neuropathy may be classified according to the type of nerve fiber predominantly affected into three groups:  
* Peripheral neuropathy may also be classified according to the type of nerve fiber predominantly affected into three groups:<ref name="pmid23642713">{{cite journal| author=Barohn RJ, Amato AA| title=Pattern-recognition approach to neuropathy and neuronopathy. | journal=Neurol Clin | year= 2013 | volume= 31 | issue= 2 | pages= 343-61 | pmid=23642713 | doi=10.1016/j.ncl.2013.02.001 | pmc=3922643 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23642713  }} </ref><ref name="pmid24210312">{{cite journal| author=Chung T, Prasad K, Lloyd TE| title=Peripheral neuropathy: clinical and electrophysiological considerations. | journal=Neuroimaging Clin N Am | year= 2014 | volume= 24 | issue= 1 | pages= 49-65 | pmid=24210312 | doi=10.1016/j.nic.2013.03.023 | pmc=4329247 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24210312  }} </ref>
** h
** [[Motor neuron|Motor]]
** [[Sensory neuropathy|Sensory]]  
** [[Sensory neuropathy|Sensory]]  
** [[Autonomic]]  
** [[Autonomic]]  
or the process affecting the nerves; e.g., inflammation (neuritis), compression (compression neuropathy), chemotherapy (chemotherapy-induced peripheral neuropathy).
[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
*[Group1]
*[Group2]
*[Group3]
*[Group4]
OR
[Disease name] may be classified into [large number > 6] subtypes based on:
*[Classification method 1]
*[Classification method 2]
*[Classification method 3]
[Disease name] may be classified into several subtypes based on:
*[Classification method 1]
*[Classification method 2]
*[Classification method 3]
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
'''If the staging system involves specific and characteristic findings and features:'''
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR


There is no established system for the staging of [malignancy name].
* Peripheral neuropathy may also be classified according to the process affecting the nerves into three groups:<ref name="pmid26437251">{{cite journal| author=Callaghan BC, Price RS, Chen KS, Feldman EL| title=The Importance of Rare Subtypes in Diagnosis and Treatment of Peripheral Neuropathy: A Review. | journal=JAMA Neurol | year= 2015 | volume= 72 | issue= 12 | pages= 1510-8 | pmid=26437251 | doi=10.1001/jamaneurol.2015.2347 | pmc=5087804 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26437251  }} </ref><ref name="pmid21286866">{{cite journal| author=Hovaguimian A, Gibbons CH| title=Diagnosis and treatment of pain in small-fiber neuropathy. | journal=Curr Pain Headache Rep | year= 2011 | volume= 15 | issue= 3 | pages= 193-200 | pmid=21286866 | doi=10.1007/s11916-011-0181-7 | pmc=3086960 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21286866  }} </ref><ref name="pmid19400724">{{cite journal| author=Costigan M, Scholz J, Woolf CJ| title=Neuropathic pain: a maladaptive response of the nervous system to damage. | journal=Annu Rev Neurosci | year= 2009 | volume= 32 | issue=  | pages= 1-32 | pmid=19400724 | doi=10.1146/annurev.neuro.051508.135531 | pmc=2768555 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19400724  }} </ref>
** [[Neuritis|Inflammatory neuritis]]
** Compression [[neuropathy]]
** [[Chemotherapy]]-induced peripheral neuropathy


==References==
==References==

Latest revision as of 14:26, 17 August 2018

Peripheral neuropathy Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating peripheral neuropathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Peripheral neuropathy classification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Peripheral neuropathy classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Peripheral neuropathy classification

CDC on Peripheral neuropathy classification

Peripheral neuropathy classification in the news

Blogs on Peripheral neuropathy classification

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Peripheral neuropathy classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Peripheral neuropathy may be classified according to the number and distribution of nerves affected into three groups: Mononeuropathy, Mononeuritis multiplex and Polyneuropathy.It may also be classified according to the type of nerve fiber predominantly affected into three groups: Motor, sensory and Autonomic. peripheral neuropathy may also be classified according to the process affecting the nerves into three groups: Inflammatory neuritis, compression neuropathy andchemotherapy-induced peripheral neuropathy.

Classification

  • Peripheral neuropathy may also be classified according to the type of nerve fiber predominantly affected into three groups:[3][4]

References

  1. ↑ Misra UK, Kalita J, Nair PP (2008). "Diagnostic approach to peripheral neuropathy". Ann Indian Acad Neurol. 11 (2): 89–97. doi:10.4103/0972-2327.41875. PMC 2771953. PMID 19893645.
  2. ↑ Brito-Zerón P, Akasbi M, Bosch X, Bové A, Pérez-De-Lis M, Diaz-Lagares C; et al. (2013). "Classification and characterisation of peripheral neuropathies in 102 patients with primary Sjögren's syndrome". Clin Exp Rheumatol. 31 (1): 103–10. PMID 23020902.
  3. ↑ Barohn RJ, Amato AA (2013). "Pattern-recognition approach to neuropathy and neuronopathy". Neurol Clin. 31 (2): 343–61. doi:10.1016/j.ncl.2013.02.001. PMC 3922643. PMID 23642713.
  4. ↑ Chung T, Prasad K, Lloyd TE (2014). "Peripheral neuropathy: clinical and electrophysiological considerations". Neuroimaging Clin N Am. 24 (1): 49–65. doi:10.1016/j.nic.2013.03.023. PMC 4329247. PMID 24210312.
  5. ↑ Callaghan BC, Price RS, Chen KS, Feldman EL (2015). "The Importance of Rare Subtypes in Diagnosis and Treatment of Peripheral Neuropathy: A Review". JAMA Neurol. 72 (12): 1510–8. doi:10.1001/jamaneurol.2015.2347. PMC 5087804. PMID 26437251.
  6. ↑ Hovaguimian A, Gibbons CH (2011). "Diagnosis and treatment of pain in small-fiber neuropathy". Curr Pain Headache Rep. 15 (3): 193–200. doi:10.1007/s11916-011-0181-7. PMC 3086960. PMID 21286866.
  7. ↑ Costigan M, Scholz J, Woolf CJ (2009). "Neuropathic pain: a maladaptive response of the nervous system to damage". Annu Rev Neurosci. 32: 1–32. doi:10.1146/annurev.neuro.051508.135531. PMC 2768555. PMID 19400724.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Peripheral_neuropathy_classification&oldid=1490892"