Wednesday, April 10, 2013

Peripheral neuropathy: a very common Lyme problem

In my practice, one of the most common set of symptoms, or a syndrome relate to peripheral neuropathy. Peripheral neuropathy is caused by nerve damage, which may be temporary, stable, progressive, mildly bothersome or disabling: Nerves are comprized of two parts which may be damaged: 1) axons, the body of the nerve and 2) myelin, the sheath around the axons of nerves. Nerves are then divided into sensory neurons ( associated with sensation) and motor neurons( associated with muscle activity). The nerves can come from different pathways: spinal nerve roots, the dorsal ganglia, peripheral nerve trunks and branches, autonomic nerves. Neuropathies can effect sensory nerves, motor nerves or more commonly both.

Differences between axonal and demylinating neuropathy can be seen with a routine exam:  large sensory fibers abnormalities may be associated with decreased sensation to pin prick, light touch and vibration. All that is needed is something sharp and a tuning fork. Small, unmylinated sensory fiber abnormalities associated with decreased temperature sensation.

Sensory symptoms of axonal small fiber neuropathy, may for exmple, inclde:   burning pain, radiating/lancinating/ electrical like sensations, pins and needles, increased sensation to light touch, numbness and reduced sensation.

Motor symptoms may include: weakness, muscle wasting, cramps, fasiculations, difficulty climbing stairs, decreased hand grip and restless leg syndrome.

Major characteristics of axonal vs demylelinating neurve damage can be seen with the EMG/NCV. Simply put: Axonal problems are seen with needle portion of the test and demyelinating problems are seen with the shocking part of the exam.

Some patients, with clear symptoms and abnormal physical examinations have negative EMGs. There is another test.

Patients may have small-fiber neuropathy not visable on an EMG.  This can be diagnosed with a biopsy of 2-3 areas of skin sent to a specialty lab.

The lab reports the "ENFD" - Epidermal Nerve Fiber Density. The test is fairly accurate.( I can perform this simple test in my office).

Most treatments for neuropathy are only symptomatic. The only therapy I have found to be curative is IViG. This therapy is extraordinarily expensive, costing $10,000 per dose given every 3-4 weeks. The FDA has approved IViGfor a limited number of conditions. It may be possible to get insurance coverage for some forms of neuropathy like CIDP which is discussed elswhere.

14 comments:

Summer said...

What are the symptomatic treatments used for neuropathy and do those prevent progression?

Do antibiotics reverse neuropathy once it has occurred or is it permanent?

T9im said...

Hi Summer:

It took a while but at least with our daughter the neuropathy disappeared. I credit the tindamax but she was also taking a mepron / zith combination.

Suppan-eblog said...

I've diagnosed with Cronic lyme. But my doctor is not treating it even i have it since insurance CDC wont recommend then inital doxy 28 days.
I do have all nuropatic symtoms mentioned in this post. Then why
so,e doctors are treating. Will u refer one in EASt coast. And which
anitbiotic works for these.
Anywasy After reasing so many suggestions on internet feel like
why cant they promply treat with antibiotics when you know the sympotoms and positive test results?

Monika Kucsera said...

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I have found your blog, which I really like it. Enjoyed to read your posts and get to know more about Lyme disease
I was wondering if you would be interested in sharing your posts and ideas on Glipho? It's a quite new social publishing platform for bloggers like you.

Gary said...

IVIG treatments are helping me so much. My feet are regaining feeling and the vertigo is GONE as in GONE! The added plus is that my energy level is greatly improved and my immune system seems to be on the mend. I havent had another MRSA outbreak since last year. Dr J thanks so much for putting on this treatment and getting me approved.

Connie said...

Headaches and stiff neck for days and days , migrainish, then easier headache. I've had it since last ivig treatment over 2 weeks ago. I have the steroid and drink water as it is suggested . Unrelated is the lymph nodes. Behind the ears that prior to the start of ivig 4weeks ago , is swollen and makes my ears hurt and refers pain down neck. Painful. Of course all this in addition to ever worsening muscle cramps, joint pain, nerve pain, body movements , tics and uncontrolled vocal utterances, twitches, involuntary stretching of muscles that even occurs in my sleep that weakens me, imbalance, add and memory issues/word recall, double vision, voice change, unable to be cooled episodes sometimes lasting 30 minutes and more, and periodically unable to move. Prob forgetting some, but this has been a progression with worst it seems over last yr with progressive polyneuropathy diagnosed via small fiber biopsy. One thing I didn't have is migraines. This week will slow the iv rate down even more. Ps. I've had 4 picc lines in 5 yrs . Have been antibiotic free for 8 months. Done the supplement thing, herbs and acupuncture short course, failed 15 wk strain/counter strain pt . 3 lyme docs and I have returned to no. 2 who bless him diagnosed the neuropathy and got me on ivig which I won't stop till it is clear I'm not responding. He also was able to identify the body movements and got my insurance to approve brain spect scan. Original scan in 2008 showed white matter changes. This 2nd one radiology report of either Lyme disease or white matter disease. Not looking good.

Connie said...

Dr number 2 is dr jaller of course. Thx for your care dr jaller.

daniell marco said...
This comment has been removed by the author.
daniell marco said...

does peripheral neuropathy gett worse in pregnancy times?
my wife thinks so, cause of the symptoms.. thanks


Peripheral neuropathy diagnosis

Juli Jonior said...

The underlying cause normally defines the course of Peripheral Neuropathy Treatment. The drugs that are recommended normally include acetaminophen, ibuprofen, asprin, antidepressents, anti-seizure drugs and duloxetine but all these drugs have several side effects. Repeton herbal medication by Herbs Solutions By Nature is the best treatment presently available for managing this problem. The product is made up of 100 % natural herbs hence no side effects are observed by its use.

Frank Sit said...

nice article… simple and useful :)

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docdan401 said...

May I ask who you saw for a doctor? I have the neuropathy and been in a lot of pain for many months without any relief. Any insight is greatly appreciated. Hope your daughter is wel.

Naturalherbs Solutions said...

Peripheral Neuropathy Treatment is usually directed at the underlying cause. On the off chance that the condition is because of a specific medication, the medication can be exchanged. On the off chance that the condition is brought about by a vitamin insufficiency, vitamin supplements may improve symptoms.

Herbs Solutions By Nature said...

In Peripheral Neuropathy, the junctions between muscles and the peripheral nerves. A lack of clinically relevant animal models is hampering the development of new Treatment for Peripheral Neuropathy.

http://www.herbs-solutions-by-nature.com/Peripheral-Neuropathy.php