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Overview of polyneuropathy

INTRODUCTION

The terms "polyneuropathy," "peripheral neuropathy," and "neuropathy" are frequently used interchangeably, but are distinct. Polyneuropathy is a specific term that refers to a generalized, relatively homogeneous process affecting many peripheral nerves, with the distal nerves usually affected most prominently. Peripheral neuropathy is a less precise term that is frequently used synonymously with polyneuropathy, but can also refer to any disorder of the peripheral nervous system including radiculopathies and mononeuropathies. Neuropathy, which again is frequently used synonymously with peripheral neuropathy and/or polyneuropathy, can refer even more generally to disorders of the central and peripheral nervous system.

Polyneuropathy is typically characterized by symmetric distal sensory loss, burning, or weakness. It often occurs as a side effect of medication or as a manifestation of systemic disease. The rate of progression of the polyneuropathy in conjunction with its character (axonal or demyelinating) can help identify its etiology (table 1A-C).

The polyneuropathies must be distinguished from other diseases of the peripheral nervous system, including the mononeuropathies and mononeuropathy multiplex (multifocal neuropathy), and from some disorders of the central nervous system.

  • Mononeuropathy refers to focal involvement of a single nerve, usually due to a local cause such as trauma, compression, or entrapment. Carpal tunnel syndrome is a common example of a mononeuropathy.
  • Mononeuropathy multiplex refers to simultaneous or sequential involvement of noncontiguous nerve trunks. Used loosely, this term can refer to multiple compressive mononeuropathies. However, in its more specific meaning, it identifies multiple nerve infarcts due to a systemic vasculitic process that affects the vasa nervorum. (See "Clinical manifestations of vasculitic neuropathy".)
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References Top
  1. Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation in two Italian regions. I. Prevalence and general characteristics of the sample. Italian General Practitioner Study Group (IGPSG). Neurology 1995; 45:1832.
  2. Bharucha, NE, Bharucha, AE, Bharucha, EP. Prevalence of peripheral neuropathy in the Parsi community of Bombay. Neurology 1991; 41:1315.
  3. Savettieri, G, Rocca, WA, Salemi, G, et al. Prevalence of diabetic neuropathy with somatic symptoms: A door-to-door survey in two Sicilian municipalities. Neurology 1993; 43:1115.
  4. Partanen, J, Niskanen, L, Lehtinen, J, et al. Natural history of peripheral neuropathy in patients with non-insulin dependent diabetes mellitus. N Engl J Med 1995; 333:89.
  5. Fuller, GN, Jacobs, JN, Guiloff, RJ. Nature and incidence of peripheral nerve syndromes in HIV infection. J Neurol Neurosurg Psychiatry 1993; 56:372.
  6. Radhakrishnan, K, el-Mangoush, MA, Gerryo, SE. Descriptive epidemiology of selected neuromuscular disorders in Benghazi, Libya. Acta Neurol Scand 1987; 75:95.
  7. Skre, H. Genetic and clinical aspects of Charcot-Marie-Tooth disease. Clin Genet 1974; 6:98.
  8. Benson, MD, Kincaid, JC. The molecular biology and clinical features of amyloid neuropathy. Muscle Nerve 2007; 36:411.
  9. Holmgren, G, Costa, PM, Andersson, C, et al. Geographical distribution of TTR met30 carriers in northern Sweden: Discrepancy between carrier frequency and prevalence rate. J Med Genet 1994; 31:351.
  10. Alter, M. The epidemiology of Guillain-Barre syndrome. Ann Neurol 1990; 27 Suppl:S7.
  11. Kuwabara, S, Kai, MR, Nagase, H, Hattori, T. n-Hexane neuropathy caused by addictive inhalation: clinical and electrophysiological features. Eur Neurol 1999; 41:163.
  12. Hafer-Macko, C, Hsieh, ST, Li, CY, et al. Acute motor axonal neuropathy: an antibody-mediated attack on axolemma. Ann Neurol 1996; 40:635.
  13. Ozge, A, Atis, S, Sevim, S. Subclinical peripheral neuropathy associated with chronic obstructive pulmonary disease. Electromyogr Clin Neurophysiol 2001; 41:185.
  14. Dyck, PJ, Dyck, JB, Grant, IA, Fealey, RD. Ten steps in characterizing and diagnosing patients with peripheral neuropathy. Neurology 1996; 47:10.
  15. England, JD, Gronseth, GS, Franklin, G, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64:199.
  16. England, JD, Gronseth, GS, Franklin, G, et al. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of laboratory and genetic testing (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 2009; 72:185.
  17. England, JD, Asbury, AK. Peripheral neuropathy. Lancet 2004; 363:2151.
  18. England, JD, Gronseth, GS, Franklin, G, et al. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 2009; 72:177.
  19. Lauria, G. Small fibre neuropathies. Curr Opin Neurol 2005; 18:591.
  20. Sommer, C, Lauria, G. Skin biopsy in the management of peripheral neuropathy. Lancet Neurol 2007; 6:632.
  21. Vlckova-Moravcova, E, Bednarik, J, Dusek, L, et al. Diagnostic validity of epidermal nerve fiber densities in painful sensory neuropathies. Muscle Nerve 2008; 37:50.
  22. McCarthy, BG, Hsieh, ST, Stocks, A, et al. Cutaneous innervation in sensory neuropathies: Evaluation by skin biopsy. Neurology 1995; 45:1848.
  23. McArthur, JC, Stocks, EA, Hauer, P, et al. Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol 1998; 55:1513.
  24. Dyck, PJ, Low, PA, Windebank, AJ, et al. Plasma exchange in polyneuropathy associated with monoclonal gammopathy of undetermined significance. N Engl J Med 1991; 325:1482.
  25. Guay, DR. Update on gabapentin therapy of neuropathic pain. Consult Pharm 2003; 18:158.
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