Neuropathy

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Clinical Description

Defective functioning of nerves, which may involve both peripheral, cranial and autonomic nerves (peripheral neuropathy) and cranial nerves. Different patterns are noted, i.e., polyneuropathy, mononeuritis multiplex and mononeuropathy, each of which may be caused by axonal degeneration or demyelination or a combination of the above.

 

Clinical Features

May be predominantly of a sensory, sensorimotor, autonomic, or motor nature. Important causes of neuropathy include:

  • Alcohol, diabetes, HIV infection, thiamine deficiency, acute inflammatory demyelinating polyradiculoneuropathy{Guillain-Barre}, and chronic inflammatory demyelinating polyradiculoneuropathy {CIDP}.

 

Treatment

General Measures

  • Observe rate of progression. If the disease is progressing fairly rapidly, i.e., deterioration noted over 5-7 days, admit patient and monitor ventilatory status carefully with spirometry, as intubation and ventilatory support may be required. Remove the cause where possible, i.e., drug- or alcohol-induced neuropathy, control diabetes mellitus, etc. Specialized nursing care and dedicated physiotherapy and occupational therapy must be indicated. If not referred early for medical rehabilitation services, may develop contractures, weakness affecting gait, develop chronic bedsores and become dependent on the guardians.
  • Most cases respond to management of the underlying disease process or removal of the etiological agent.
  • Neuropathic pain {i.e., pain due to a disease or injury of the central or peripheral nervous system}
    • Give Amitriptyline, oral, 25-75 mg q24h.
    • OR Give Carbamazepine, oral, 200-1200 mg daily in divided doses.

Isoniazid-induced polyneuropathy

  • Give Pyridoxine, oral 75 mg daily for 3 weeks. Follow with 25-50mg q24h.

Post-herpes zoster neuropathy {Note: Acyclovir is not beneficial in treating this condition}.

  • Give Amitriptyline, oral, 25-75 mg q24h.

 AND/OR

  • Give Carbamazepine, oral 200-1200 mg daily dose in divided doses. Beware of possible drug interactions in patients on ART.

 

BELLS' PALSY NOTE:

Exclude herpes zoster

Start within 4 days of onset of symptoms:

  • Give Prednisone, oral, 60 mg q24h for 7- 10 days

Referral

  • Electrophysiological studies may be needed in the diagnostic assessment, although many common causes do not warrant specialist investigations, e.g., polyneuropathies due to diabetes mellitus, HIV, isoniazid, hydralazine, dapsone, antiretrovirals {stavudine and didanosine}, amiodarone and alcohol. These cases may initially be managed locally, with referral of non-responding or atypical cases.
  • Gullain-Barre Syndrome: referral criteria are progressive, extensive paralysis with impending respiratory failure, bulbar palsy and swallowing problems, and aspiration, as well as for diagnostic confirmation.