What helps with polyneuropathy?

What is polyneuropathy?

The technical term polyneuropathy describes nerve disorders that are located outside the brain and spinal cord regions, i.e. the central nervous system. Depending on the cause and stage, this clinical picture affects several nerves. In addition to the sensitized perception of touch, heat, cold or pain, the fine cords are also responsible for controlling muscle movements. In contrast, the autonomic nerve fibers regulate the vital functions of our organism and the width of the blood vessels. If these are restricted in their function or severity, polyneuropathy sufferers experience variable symptoms, the occurrence and causes of which are individual in nature.

What forms of polyneuropathy are there? 

The peripheral versus autonomic manifestation of polyneuropathy

Doctors currently distinguish between two forms of polyneuropathies, the peripheral and autonomic forms. The former affects the nerves that control the movements of our limbs. Diabetics in particular are affected by this variant. Initially, the sensitive nerves of the hands or feet are damaged, as they are located away from the center of the body. This results in everyday limitations such as pain, numbness or tingling, the causes of which are often not sufficiently taken into account in the early stages of polyneuropathy.

The autonomic form of polyneuropathy affects the autonomic nervous system. This autonomously regulates the heartbeat or digestion, for example. Autonomic polyneuropathy can damage any organ, depending on the nerve cords already affected. 

Symptoms of the two forms of polyneuropathy

• Peripheral polyneuropathy

Polyneuropathies that affect the nerve cords of the musculoskeletal system can be identified in particular by the typical numbness and tingling in the limbs. Burning or stabbing pains occur, particularly at rest or at night. Those affected also report muscle cramps or impaired coordination when walking or climbing stairs. The areas affected by the disease become less sensitive to stimuli, although the opposite, hypersensitivity of the nerves, can also occur. This manifests itself in a wide variety of situations and ranges from a massive reduction in the sense of touch to a greatly increased sensitivity to the slightest touch. 

• Autonomic polyneuropathy

Autonomic polyneuropathies and their symptoms are mainly influenced by the affected organs as the cause of the condition. Damage to the cardiovascular system, for example, is followed by an increased heartbeat, while blood pressure drops rapidly during movement. This results in a feeling of dizziness, which can severely impair everyday life. Other symptoms such as diarrhea, constipation, nausea or vomiting as well as difficulty swallowing or a feeling of fullness are not uncommon with this form of polyneuropathy, as the nerves of the gastrointestinal tract are considered to be the cause of the disease. If the urinary and reproductive organs are affected, there is also an increased risk of becoming incontinent. This is because the bladder filling goes unnoticed and is excreted uncontrollably. At the same time, some scientists attribute the onset of impotence to autonomic polyneuropathies. In addition, it is not unlikely that the autonomic manifestation of polyneuropathies causes hormonal imbalance. This manifests itself in sweating or inner restlessness, which are classic symptoms of hypoglycemia. Those affected should always take these symptoms seriously, as timely treatment is essential for survival.

Diabetic polyneuropathy

Diabetic polyneuropathy is the most common form of this disease and affects around half of all diabetics throughout their lives. It does not matter whether they suffer from type 1 or type 2. We divide the disease into the autonomic and sensorimotor variants, the symptoms of which usually occur gradually. In this case, a permanently elevated blood sugar level damages or destroys fine blood vessels in particular. 

Causes of diabetic polyneuropathy

The cause of nerve damage in the context of diabetic polyneuropathy is considered to be a permanently elevated blood glucose level. However, there are still different explanations that deal with its detailed effects on the nerves. Most doctors assume that the increased number of sugar molecules react with the body's own proteins. The resulting complexes attack the nerves, resulting in irreversible damage. In addition, poorly controlled diabetes results in too many inflammatory messengers in the blood, which have a negative impact on cell metabolism and therefore nerve function.

The diagnosis of polyneuropathy

Diagnosis begins with a clarifying consultation with the affected patient and their relatives. The doctor will inquire about any existing polyneuropathy symptoms as well as their progression and possible causes. They will also ask about known illnesses and their medication. This provides important information for the subsequent treatment.

Due to the almost infinite number of polyneuropathy triggers, an initial suspicion is always accompanied by a thorough clinical examination including detailed measurement of blood values. Targeted functional tests help to confirm or rule out the suspicion of diabetic polyneuropathy. If the clinical picture is severe or rare, a lumbar puncture and biopsy are performed in addition to the blood test. Genetic tests have also proven their worth in complex cases. Finally, the results obtained from the various tests help to identify the actual cause of the nerve damage. This is the only way to successfully treat polyneuropathies in the long term. 

What to do with polyneuropathy? Therapy and holistic measures

In congenital forms of polyneuropathy, the focus is on the long-term treatment of symptoms - there are currently no causal therapeutic measures. If a specific hereditary disease is present, known as acute intermittent porphyria, medication and active substances tailored to the individual patient are used. Appropriate medication is not limited to the intermittent variant of polyneuropathies, but rather supports the attenuation of polyneuropathy symptoms in general.

The active ingredient R-alpha lipoic acid in particular has proven its worth in the treatment of polyneuropathy. As an endogenous substance, the acid is already present in the body. There it helps to shape the sugar metabolism. In contrast to people without the disease, however, diabetics have lower levels of alpha lipoic acid in their bodies. When administered as a high-dose infusion, for example, the active ingredient can help to relieve pain and alleviate the cause of sensitivity disorders.

In the case of acquired polyneuropathy, which includes diabetic polyneuropathy, precise control of blood glucose levels is crucial. This prevents the progression of the disease and thus alleviates any polyneuropathy symptoms that may occur later. Those affected should also learn how to keep their values stable in the long term. Special training courses or specialist literature sponsored by the health insurance company provide the necessary knowledge.

In addition to the proven R-alpha lipoic acid (alpha lipoic acid) treatment method, high-frequency therapy, in which electrodes attached to the feet and upper body transmit very high sound frequencies through the body, has also proven effective in alleviating polyneuropathy symptoms.

Diabetics should also pay particular attention to thorough foot care in order to prevent small injuries from becoming infected. At the same time, supportive measures such as exercise therapy, lifestyle adjustments and a change in diet have shown good results in the treatment of polyneuropathic diseases. The former promotes impaired motor function, reduces circulatory disorders and helps to maintain individual mobility for as long as possible. This form of therapeutic support can be divided into physiotherapy, direct current treatments or massages. Treatment with alternating or movement baths is also possible, as is the application of heat.

• Diet and important nutrients for polyneuropathy

When it comes to nutrition, it is essential to compensate for potential deficiencies at the beginning. If patients are proven to be deficient in certain nutrients such as vitamin B12, folic acid or vitamin B, their daily mineral intake must be adjusted. This can be achieved by changing eating habits, using certified nutritional supplements or administering adapted injections.

Therapeutic approaches to alleviating the symptoms of polyneuropathy are currently increasingly based on the targeted use of nutrients such as vitamin D, magnesium, R-alpha lipoic acid or vitamin B to improve the performance of the nerves, a healthy diet in combination with sporting activity, individually tailored drug treatments, supported by physiotherapeutic measures. If the cause of the polyneuropathy is alcohol, we also recommend detoxification of the organism as well as expert cleansing of the liver and intestinal rehabilitation.

• Body and mind in harmony with polyneuropathy

Despite all treatment options, one key factor that significantly influences the severity of polyneuropathy is often ignored: the patient's psyche. As this disease of the nerves severely restricts everyday life, especially as it progresses, it is important to take individualized measures to alleviate symptoms. Long walks in the fresh air are ideal for replenishing the body's vitamin D 12 stores. Its deficiency is responsible for so-called winter depression, for example.

Patients also benefit from regular physical activity that is adapted to their personal preferences. Swimming, walking or moderate muscle training are popular in this respect, as they place relatively little strain on the body. In addition, these activities cause the brain to release a number of neurotransmitters such as adrenaline or serotonin, which convey a feeling of happiness. A sporting hobby practiced in a club or with loved ones strengthens self-confidence and conveys the aspect of normality. It goes without saying that active leisure activities are fun, keep you healthy and reduce listlessness.

Exchanging ideas with other sufferers is another option for psychological relief. Specialized online forums or talking directly about the illness in self-help groups are particularly suitable for this. These offers are gratefully accepted not only by those affected themselves, but also by their relatives.

It can also be useful to read specialist literature on the subject and put the tips it contains into practice. The drive inspired by this provides new energy and conveys the important prospect of a pain-free future.

When it comes to polyneuropathy therapy, not only is expert treatment by an experienced doctor absolutely essential, but also a solution-oriented approach to this long-invisible disease.

 

Sources (in English):

Ziegler, D., Strom, A., Lobmann, R., Reiners, K., Rett, K. & Schnell, O. (2015). High prevalence of diagnosed and undiagnosed polyneruopathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study). Journal of Diabetes and its Complications, 29(8):998-1002, doi: 10.1016/j.jdiacomp.2015.09.008

Smith A. G. & Singleton, J. R. (2012, February). Diabetic neuropathy.  Continuum (Minneapolis, Minn.), 18(1):60-84, doi: 10.1212/01.CON.0000411568.34085.3e