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多發性神經病變 (Multiple Neuropathy)
syndrome可以治療的，也可以治癒的，預後是好的。因為本疾患有先行感染後才發生，尤其是發生在上呼吸道感染，腹瀉等腸胃道的感染多見，而腸胃道的感染以幽門桿菌多見。其發生機轉是在神經系統有Ganglioside，因而產生抗體。剛才提到的Campylobacter Pylori，這是幽門螺旋桿菌(Helicobacter pylori)是一種微嗜氧的格蘭氏陰性菌，而我們身上也有類似(Mimicry)的胞體因而產生自體抗體。其症狀的出現，因為神經很長，從最遠的部位開始發病，也就是從最弱的部位開始發病。至於談到較慢性，如糖尿病，最初是深部的感覺，有振動感覺發生障礙，最初病患沒有甚麼感覺，慢慢的發生發麻，而後發生感覺障礙。這是很普遍的疾病，如果能夠把糖尿病好好控制，可以使病情進行較慢，同時改善病情。
Longer nerve fibers are affected to a greater degree than shorter ones, because nerve conduction velocity is slowed in proportion to a nerve's length. In this syndrome, decreased sensation and loss of reflexes occurs first in the toes on each foot, then extends upward. It is usually described as glove-stocking distribution of numbness, sensory loss, dysesthesia and night time pain. The pain can feel like burning, pricking sensation, achy or dull. Pins and needles sensation is common. Loss of proprioception, the sense of where a limb is in space, is affected early. These patients cannot feel when they are stepping on a foreign body, like a splinter, or when they are developing a callous from an ill-fitting shoe. Consequently, they are at risk of developing ulcers and infections on the feet and legs, which can lead to amputation. Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint. Loss of motor function results in dorsiflexion, contractures of the toes, loss of the interosseous muscle function and leads to contraction of the digits, so called hammer toes. These contractures occur not only in the foot but also in the hand where the loss of the musculature makes the hand appear gaunt and skeletal. The loss of muscular function is progressive.
Sensorimotor polyneuropathy causes a decreased ability to move or feel (sensation) due to nerve damage.
Neuropathy means a disease of, or damage to nerves. When it occurs outside of the brain or spinal cord, it is called a peripheral neuropathy. Mononeuropathy means one nerve is involved. Polyneuropathy means that many nerves in different parts of the body are involved.
Neuropathy can affect nerves that provide feeling (sensory neuropathy) or cause movement (motor neuropathy). It can also affect both, in which case it is called a sensorimotor neuropathy.
Sensorimotor polyneuropathy is a body-wide (systemic) process that damages nerve cells, nerve fibers (axons), and nerve coverings (myelin sheath). Damage to the covering of the nerve cell causes nerve signals to slow down. Damage to the nerve fiber or entire nerve cell can make the nerve stop working.
Nerve damage can be caused by:
● Autoimmune (body-wide) disorders
● Conditions that put pressure on nerves
● Decreased blood flow to the nerve
● Diseases that destroy the glue (connective tissue) that holds cells and tissues together
● Swelling (inflammation) of the nerves
Some diseases lead to polyneuropathy that is mainly sensory or mainly motor.
Possible causes of sensorimotor polyneuropathy include:
● Alcoholic neuropathy
● Cancer (called a paraneoplastic neuropathy)
● Chronic inflammatory neuropathy
● Diabetic neuropathy
● Drug-related neuropathy
● Guillain-Barre syndrome
● Hereditary neuropathy
● Vitamin deficiency (vitamins B12, B1, and E)
● Decreased feeling in any area of the body
● Difficulty swallowing
● Difficulty using the arms or hands
● Difficulty using the legs or feet
● Difficulty walking
● Pain, burning, tingling, or abnormal feeling in any area of the body (called neuralgia)
● Weakness of the face, arms, or legs, or any area of the body
Symptoms may develop quickly (as in Guillain-Barre syndrome) or slowly over weeks to years. Symptoms usually occur on both sides of the body. Most often, they start at the ends of the toes first.
Exams and Tests
An exam may show:
● Decreased feeling (may affect touch, pain, vibration, or position sensation)
● Diminished reflexes (ankle most commonly)
● Muscle atrophy
● Muscle twitches (fasciculations)
● Muscle weakness
Tests may include:
● Blood tests
● Electrical test of the muscles (EMG)
● Electrical test of nerve conduction
● X-rays or other imaging tests
The goals of treatment include:
● Finding the cause
● Controlling the symptoms
● Promoting a patient's self-care and independence
Depending on the cause, treatment may include:
● Changing medications, if they are causing the problem
● Controlling blood sugar levels
● Not drinking alcohol
● Taking daily nutritional supplements
PROMOTING SELF-CARE AND INDEPENDENCE
● Exercises and retraining to maximize function of the damaged nerves
● Job (vocational) therapy
● Occupational therapy
● Orthopedic treatments
● Physical therapy
● Wheelchairs, braces, or splints
CONTROL OF SYMPTOMS
Safety is an important consideration for people with neuropathy. Lack of muscle control and decreased sensation may increase the risk of falls or other injuries.
If you have movement difficulties, consider the following safety measures:
● Leave lights on.
● Remove obstacles (such as loose rugs that may slip on the floor).
● Test water temperature before bathing.
● Use railings.
● Wear protective shoes (such as those with closed toes and low heels).
● Wear shoes that have non-slippery soles.
Other tips include:
● Check your feet (or other affected area) daily for bruises, open skin areas, or other injuries, which you may not notice and can become infected.
● Check the inside of shoes often for grit or rough spots that may injure your feet.
● Visit a foot doctor (podiatrist) to assess and reduce the risk of injury to your feet.
● Avoid leaning on your elbows, crossing your knees, or being in other positions that put prolonged pressure on certain body areas.
Medications used to treat this condition:
● Over-the-counter and prescription pain relievers to reduce stabbing pain (neuralgia)
● Anticonvulsants (gabapentin, carbamazepine, phenytoin, pregabalin)
● Antidepressants (duloxetine, amitriptyline, desimpramine, nortriptyline, venlafaxine)
● Lotions, creams, or medicated patches
Avoid pain medication whenever possible, or use it only when necessary.
Keeping your body in the proper position or keeping bed linens off a tender body part may help control pain.
For additional information and support, see: www.neuropathy.org.
You can fully recover from peripheral neuropathy if your health care provider can find the cause and successfully treat it, and if the damage does not affect the entire nerve cell.
The amount of disability varies. Some people have no disability, while others have a partial or complete loss of movement, function, or feeling. Nerve pain may be uncomfortable and may last for a long time.
Occasionally sensorimotor polyneuropathy causes severe, life-threatening symptoms.
● Injury to feet (caused by bad shoes or hot water when stepping into the bathtub)
● Trouble walking
When to Contact a Medical Professional
Call your health care provider if you have loss of movement or feeling in a part of your body. Early diagnosis and treatment increase the chance of controlling the symptoms.
Polyneuropathy - sensorimotor
Update Date: 2/16/2012