現在位置 : 醫療2 > 多發性 感覺運動神經病變 - Sensorimotor Polyneuropathy
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多發性神經病變 (Multiple Neuropathy)
多發性神經病變(Multiple－neuropathy)是在我們身體上發生的末梢神經障礙的意思，多發性的意思就是發生手足或者左右，身體全部發生障礙的意思。雖然其發生為全身，但還是有先後的順序。因為末梢神經是細長，會從最前端發生障礙，是常說的手套、襪子型，先從手足慢慢向上發展的特徵。基本上可以說從腳的前端開始發病，可能是腳比手神經還要長有關。末梢神經包括運動神經、感覺神經及自主神經。自主神經如果發生障礙時不易感覺出來，如果運動神經發生障礙時手腳會沒有力氣，即發生運動麻痺。如果是感覺神經發生障礙時則會感覺遲鈍。 通常症狀的表現會運動神經和感覺神經兩種神經同時出現，也會因疾病的種類不同，有的運動神經表現得比較明顯，有的感覺神經會比較明顯。總之兩者同時出現症狀的多見。也有單一邊發生，這種情形就要分為運動神經病變及感覺神經病變。 檢查本病時要注意，手腳的最前端發生運動和感覺神經的障礙，同時發生反射消失，如腱反射消失，或不容易發生等特徵。如果能檢查到上述程度大概就可以瞭解由於是多發性，因此是對稱性或者是一側性。其病情的進行程度有快速的，也有比較慢的。由於許多疾病包括在裡頭，重要的有急性進行的，如Guillain-Barré syndrome，這是人的名字，是一種很有名的疾病，由氣管或消化道的感染引起，不久就發生自體免疫機轉後導致手腳的感覺及運動的麻痺。本病進行得很快，不僅發生在手腳，也會造成吞嚥及講話等腦神經的障礙，甚至影響到呼吸器。如果不小心，有時還會致死，此點有必要注意。嚴重的時候早晨手腳發麻，但是到了傍晚就發生由腳到腰部的麻痺而發生不能走路。因此對此類病患初診時要小心診斷，因為Guillain-Barré 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。 通常多發性神經病變，是一種神經性細胞，如果障礙發生很嚴重，是會比較難恢復，如果是初期就比較容易恢復。除了糖尿病的代謝疾病外，就是維他命缺乏症。本病常與酒精中毒合併在一起，B1的缺乏，或者與腸胃病有關的B12及葉酸缺乏的糖尿病，都會引起高度的多發性神經變性病。因此檢查病患時，應詳細詢問病歷，如果有大量喝酒的習慣，那就要減量或禁酒，同時補充維他命。 在檢查方面主要是使用「末梢神經傳導檢查」，可以分辨脫髓鞘性或者軸索性，同時可查出嚴重與否。如果檢查時發現有多發性神經變性病時應轉介到神經內科專科醫師處理。 |
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糖尿病多發性神經病變 (下載)
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(多發感覺運動神經病變)
Sensorimotor Polyneuropathy 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. |
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Sensorimotor Polyneuropathy
Sensorimotor polyneuropathy causes a decreased ability to move or feel (sensation) due to nerve damage. Causes 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) Symptoms ● 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 ● Paralysis Tests may include: ● Biopsy ● Blood tests ● Electrical test of the muscles (EMG) ● Electrical test of nerve conduction ● X-rays or other imaging tests Treatment 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. Support Groups For additional information and support, see: www.neuropathy.org. Outlook (Prognosis) 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. Possible Complications ● Deformity ● Injury to feet (caused by bad shoes or hot water when stepping into the bathtub) ● Numbness ● Pain ● Trouble walking ● Weakness 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. Alternative Names Polyneuropathy - sensorimotor Update Date: 2/16/2012 |
