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Polyneuropathy — Clinical Guidelines

Overview

Polyneuropathy refers to disorders affecting multiple peripheral nerves, leading to sensory, motor, or autonomic dysfunction. It can result from various etiologies including toxic exposures, metabolic disorders, and genetic mutations 3 17.

Diagnosis

Clinical History: Detailed assessment for potential etiologies such as toxic exposures, systemic diseases, and recent infections 3 17.

Physical Examination: Focus on sensory loss, muscle strength, reflexes, and autonomic function 8.

Neurophysiological Tests: Nerve conduction studies and electromyography to assess axonal vs demyelinating patterns 4 22.

Laboratory Tests: Blood tests for diabetes, vitamin deficiencies, and autoimmune markers 17.

Imaging and Biopsy: Rarely needed but may include nerve biopsy in atypical cases 23.

Management

Address Underlying Cause: Treat or manage the primary condition (e.g., diabetes, vitamin deficiencies) 17.

Symptomatic Treatment:

- Pain Management: Use of anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., duloxetine) 8. - Physical Therapy: To maintain muscle strength and prevent contractures 8.

Adjunctive Therapies:

- Azathioprine: Considered in chronic relapsing idiopathic polyneuropathy with unclear response to other treatments 20. - Supportive Care: Including nutritional support in cases like nutritional sensory neuronopathy 18.

Special Populations

Elderly: Common causes include diabetes and neoplasms 17.

Pediatrics: Infantile cases may involve congenital defects or metabolic disorders 23.

Comorbidities: Presence of chronic diseases like diabetes significantly influences polyneuropathy presentation and management 17.

Key Recommendations

Identify and Treat Underlying Causes: Prioritize addressing systemic conditions like diabetes and vitamin deficiencies to manage polyneuropathy effectively (Evidence: Strong 17).

Utilize Neurophysiological Testing: Employ nerve conduction studies and electromyography for accurate diagnosis and differentiation of neuropathies (Evidence: Moderate 4 22).

Implement Symptomatic Pain Management: Incorporate anticonvulsants and antidepressants for neuropathic pain relief (Evidence: Moderate 8).

Consider Azathioprine in Chronic Cases: Evaluate azathioprine for patients with chronic relapsing idiopathic polyneuropathy unresponsive to other treatments (Evidence: Weak 20).

Supportive Care Tailored to Etiology: Provide specific supportive measures based on the underlying cause, such as enteral alimentation in nutritional sensory neuronopathy (Evidence: Expert opinion).

References

1 Kersebaum D, Sendel M, Fabig SC, Sachau J, Lassen J, Rehm S et al.. The pandemic's effect on a patient cohort with painful polyneuropathy in 2020: A longitudinal study on pain, mood, and everyday life. Medicine 2022. link 2 Menor Almagro R, Rodríguez Gutiérrez JF, Martín-Martínez MA, Rodríguez Valls MJ, Aranda Valera C, de la Iglesia Salgado JL. Association between antinuclear antibody titers and connective tissue diseases in a Rheumatology Department. Reumatologia clinica 2017. link 3 Karam C, Dyck PJ. Toxic Neuropathies. Seminars in neurology 2015. link 4 Hussain K, Abubaker J, Dar JA, Ahmed R. Acute peripheral polyneuropathy with multiorgan failure: a diagnostic dilemma. BMJ case reports 2014. link 5 Kojima K, Hiratsuka A, Suzuki H, Yano K, Ikebukuro K, Karube I. Electrochemical protein chip with arrayed immunosensors with antibodies immobilized in a plasma-polymerized film. Analytical chemistry 2003. link 6 Ando Y, Almeida M, Ohlsson PI, Ando E, Negi A, Suhr O et al.. Unusual self-association properties of transthyretin Y114C related to familial amyloidotic polyneuropathy: effects on detection and quantification. Biochemical and biophysical research communications 1999. link 7 Lukin YuV, Pavlova IS, Generalova AN, Zubov VP, Zhorov OV, Martsev SP. Immunoreagents based on polymer dispersions for immunochemical assays. Journal of molecular recognition : JMR 1998. link1099-1352(199812)11:1/6<185::AID-JMR419>3.0.CO;2-7) 8 Galer BS. Painful polyneuropathy. Neurologic clinics 1998. link70098-0) 9 Takaoka Y, Tashiro F, Yi S, Maeda S, Shimada K, Takahashi K et al.. Comparison of amyloid deposition in two lines of transgenic mouse that model familial amyloidotic polyneuropathy, type I. Transgenic research 1997. link 10 Perl-Treves D, Kessler N, Izhaky D, Addadi L. Monoclonal antibody recognition of cholesterol monohydrate crystal faces. Chemistry & biology 1996. link90148-9) 11 Román GC. An epidemic in Cuba of optic neuropathy, sensorineural deafness, peripheral sensory neuropathy and dorsolateral myeloneuropathy. Journal of the neurological sciences 1994. link90130-9) 12 Christensen ME, Banker N. Mapping of monoclonal antibody epitopes in the nucleolar protein fibrillarin (B-36) of Physarum polycephalum. Cell biology international reports 1992. link80038-4) 13 Joshi KS, Hoffmann LG, Butler JE. The immunochemistry of sandwich ELISAs--V. The capture antibody performance of polyclonal antibody-enriched fractions prepared by various methods. Molecular immunology 1992. link90136-l) 14 Caliceti P, Schiavon O, Veronese FM, Chaiken IM. Effects of monomethoxypoly(ethylene glycol) modification of ribonuclease on antibody recognition, substrate accessibility and conformational stability. Journal of molecular recognition : JMR 1990. link 15 Collignon A, Geniteau-Legendre M, Sandre C, Quero AM, Labarre C. Specific binding characteristics of high affinity monoclonal antidigitoxin antibodies. Hybridoma 1988. link 16 Geysen HM, Tainer JA, Rodda SJ, Mason TJ, Alexander H, Getzoff ED et al.. Chemistry of antibody binding to a protein. Science (New York, N.Y.) 1987. link 17 George J, Twomey JA. Causes of polyneuropathy in the elderly. Age and ageing 1986. link 18 May WE. Nutritional sensory neuronopathy. An emerging new syndrome. Archives of neurology 1984. link 19 Wilson JE, Smith AD. A gel electrophoresis method for epitope mapping studies with monoclonal antibodies. Analytical biochemistry 1984. link90574-8) 20 Pentland B. Azathioprine in chronic relapsing idiopathic polyneuropathy. Postgraduate medical journal 1980. link 21 Hart ZH, Hoffman W, Winbaum E. Polyneuropathy, alopecia areata, and chronic lymphocytic thyroiditis. Neurology 1979. link 22 Rosén I, Haeger-Aronsen B, Rehnström S, Welinder H. Neurophysiological observations after chronic styrene exposure. Scandinavian journal of work, environment & health 1978. link 23 Karch SB, Urich H. Infantile polyneuropathy with defective myelination: an autopsy study. Developmental medicine and child neurology 1975. link 24 Allen N, Mendell JR, Billmaier DJ, Fontaine RE, O'Neill J. Toxic polyneuropathy due to methyl n-butyl ketone. An industrial outbreak. Archives of neurology 1975. link

Polyneuropathy