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Types and Stages of Neuropathy

types and stages of neuropathy

Neuropathy is a disease characterised by damage to one or more nerves of the peripheral nervous system. It includes the cranial and spinal nerves, as well as the nerves and plexuses of the autonomic nervous system. Neuropathy appears as a sensitivity disorder, pain in the affected area, convulsions, muscle weakness and difficulty in movement. 

Presumably, the number of patients with the disease is greater becausе some of them do not go to the doctor in the beginning stages of neuropathy. The prevalence of neuropathy among the population is 2-7%. The risk of developing the disease increases with ageing: at 60, pathology occurs in 40% of cases.

If one nerve suffers, we are talking about mononeuropathy. If there are multiple symmetrical damages to peripheral nerves (for example, when the process covers both lower or upper limbs at once, etc.) – it is polyneuropathy. The pathological process can cover both cranial and peripheral nerves. Damage to the peripheral nerve trunks, which includes the nerve pinch due to inflammation and swelling in the muscle-bone tunnel, is called tunnel syndrome.

 

Different Types of Neuropathy

Varieties of neuropathy are determined depending on the number of affected nerves. They include:

    1. Mononeuropathy
    2. Ischemic neuropathy
    3. Polyneuropathy

Mononeuropathy. If only one nerve is involved in the pathological process, it reflects mononeuropathy. This type of neuropathy, compression-ischemic neuropathy, often occurs in large nerve trunks – the femoral, sciatic, trigeminal or radiocarpal nerves. This pathology is relatively easy to diagnose. Symptoms appear in the direction of the location of the nerve trunk in the tissues.

Ischemic neuropathy. Another neuropathy type is ischemic neuropathy, but it only affects the optic nerve. It is like a heart attack, leading to a drop in visual acuity, even to blindness. Post-traumatic neuropathy is distinguished separately due to a fracture, compression of a limb, sprain, or other injuries.

Polyneuropathy. With polyneuropathy, entire groups of peripheral nerves are affected. The disease can occur simultaneously in several limbs, often symmetrically on different body halves, and is accompanied by many symptoms.

different types of neuropathy

Depending on the causes, the following types of neuropathy are distinguished:

  • Metabolic – occur with metabolic disorders, they can be diabetic, uremic, or hepatic;
  • Infectious-toxic – develop with viral diseases (AIDS, leprosy, Lyme disease);
  • Toxic – nerve fibers are damaged by poisons, heavy metals, and alcohol; it is possible with an overdose of medicines;
  • Hereditary – it includes inherited genetic diseases and syndromes: Refsum’s disease, Roussy-Levy syndrome, Charcot-Marie-Tutta amyotrophy;
  • Alimentary – occurs in people with malnutrition and with a deficiency of specific vitamins;
  • Autoimmune – are formed when the immune system attacks its nerve fibres. These include Miller-Flescher syndrome, paraneoplastic neuropathies in oncological diseases, and paraproteinemic polyneuropathy.

Neuropathies are divided into different types of neuropathy, depending on the damage to the nerve trunk. They can be axonal when the inner part of the nerve is damaged and demyelinating, in which the sheath is destroyed, and the transmission of the nerve impulse is disrupted.

 

3 Stages of Neuropathy 

The 3 stages of neuropathy include:

  1. Subclinical Neuropathy
  2. Clinical Neuropathy
  3. Late complications of clinical neuropathy

Let’s look closer at its development.

Stage Characteristic
Stage 1

Subclinical Neuropathy

The beginning stages of neuropathy are characterized by:

• No symptoms or signs

• Subclinical neuropathy (stage 1)  be diagnosed in specialized neurophysiological departments

• It is clinically impossible to make a differential diagnosis between 0 and 1 stages

Stage 2

Clinical

Neuropathy

Chronic pain form

The second stage of peripheral neuropathy is characterized by:

• Presence of symptoms (aggravated at night): burning, sudden pain, stabbing pain

• Tingling 

• Absence or sensitivity disturbance and decreased or absent reflexes

Acute pain form • Poor diabetes control, weight loss

• Diffuse pain (trunk)

• It can also be hyperesthesia

• Minimal sensory disturbances or their absence during the peripheral neurological examination

Amyotrophy •  It usually occurs in older people with undiagnosed or poorly controlled type 2 diabetes. It presents with muscle weakness, usually affects the proximal muscles of the lower extremities, subacute onset

• It is usually accompanied by pain, especially at night, with minimal sensory disturbance

Painless form combined with complete/partial loss of sensation • Absence of symptoms or numbness of the feet, decreased temperature sensitivity, impaired pain sensitivity

• Signs of reduced or absent sensation with no reflexes

Stage 3

Late complications of clinical neuropathy

What is end-stage neuropathy characterized by?

• Foot ulcers

• Neuroosteoarthropathy

• Non-traumatic amputation

 

Symptoms of Neuropathy

symptoms of neuropathy

Although various reasons cause neuropathy, the main symptoms of the neuropathy progression are:

  • Movement disorders and muscle weakness. The patient has difficulty performing fine motor activities, for example, buttoning. There are problems with walking – the patient may fall due to weakness of the foot muscles.
  • Sensory disturbances – numbness, increased tactile sensitivity, sudden shooting pain, similar to an electric shock.
  • Decreased and lost tendon reflexes. Difficulties appear when performing daily activities, such as putting on clothes or moving objects.
  • Disorders of the cardiovascular system. It is expressed in blood pressure instability and decreases when standing up suddenly. It is also manifested by dizziness and the darkening of the eyes.
  • Disorders of the gastrointestinal tract – constipation and intestinal obstruction caused by a deterioration in the tone of the intestinal muscles.
  • Pain in hands and feet.
  • Impaired balance and coordination of movements.
  • Increased sweating.
  • Urinary retention.
  • Sexual dysfunction.

 

With neuropathy progression, not only the nerves of the limbs but also the cranial nerves can be affected:

  • Optic neuropathy (optic neuropathy) leads to blurred vision, impaired color perception, blindness;
  • Damage to the oculomotor nerve is manifested by drooping of the upper eyelid and paralysis of the eye muscles;
  • Abducens nerve pathology causes convergent strabismus, drooping of the upper eyelid, double vision;
  • Facial nerve – paralysis of facial muscles;
  • Vestibulocochlear (auditory nerve) – hearing loss;
  • Glossopharyngeal nerve – impaired mobility of the tongue;
  • Laryngeal nerve – respiratory problems.

 

Diagnostics of Different Types of Neuropathy

The diagnosis of pathology includes: consultations with specialists, taking an anamnesis,  different neurological examinations, tests, X-rays and MRI or CT etc.

 

diagnostics of different types of neuropathy

 

Neurological disorders characteristic of facial neuropathy can also occur with other diseases, particularly with a stroke. That is why, if any similar symptoms occur, it is urgent to contact a professional neurologist.

  • Consultations with specialists: therapist, otorhinolaryngologist, endocrinologist, infectious disease specialist.
  • Collection of complaints;
  • Taking an anamnesis, during which the doctor specifies the time and circumstances of the onset of symptoms, fixes past and chronic diseases, injuries and other important details;
  • Neurological type of neuropathy examination, during which the specialist checks skin sensitivity, motor function, muscle strength, the quality of reflexes, the functioning of the central nervous system, etc.;
  • Tests: a general blood and urine test, a biochemical blood test with a mandatory determination of the level of glucose, the antigens and antibodies to infectious diseases if their presence is suspected;
  • X-ray of the chest: allows you to diagnose tuberculosis, tumors;
  • MRI or CT of the brain: helps to visualize tumors, foci of acute ischemia, hemorrhages, the consequences of trauma and strokes;
  • CT scan of the temporal bone;
  • Electroneuromyography: assessment of the speed of impulse conduction along nerve fibers and muscles, allows you to determine the level of damage and the severity of the disease.

The list of exams may be adjusted depending on the specific clinical situation.

 

How Can You Stop the Progression of Neuropathy

You can stop the progression of this disease with the help of:

  • Vasoactive drugs and B vitamins
  • Complex therapy
  • Tricyclic antidepressants, anticonvulsants
  • Plasmapheresis

There is no point in looking for a cure for neuropathy on your own. It is a consequence, not a cause. It is necessary to treat the disease that caused it. In each case, its therapy is prescribed. Therefore, without the help of a doctor, one cannot do here.  

 

prevention of neuropathy

 

Vasoactive drugs and B vitamins will help maintain the condition, especially with alcohol or toxic damage. The mistake is to smooth the sensations with painkillers. They only relieve discomfort but do not cure it. And the disease that has become the root cause of the neuropathy progression remains unattended.

Complex therapy. For the treatment of polyneuropathy, complex methods of exposure are used. In some cases, it is necessary to observe a neurologist and several specialized specialists – for diabetes – an endocrinologist, for kidney pathology – a urologist, alcoholism – a narcologist.

Tricyclic antidepressants, anticonvulsants help reduce unpleasant pain, convulsive contractions and a burning sensation. With infectious causes of polyneuropathy, especially caused by HIV infection, it is impossible to recover from the pathology completely, but with the correct treatment of the underlying disease, neuropathy progression can be stopped.

Plasmapheresis. Some patients with autoimmune, toxic, or metabolic disorders are treated with plasmapheresis. Blood purification allows you to get rid of substances that cause damage to the nerve trunks. At the recovery stage, exercise therapy, and physiotherapy are used: electrophoresis, magnetotherapy, laser therapy, and acupuncture.

The treatment uses a combination of pharmacological and non-pharmacological methods.

 

Drugs for Neuropathy

As a rule, doctors prescribe drugs from these groups:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): meloxicam, nimesulide, diclofenac and other drugs. They are necessary to relieve pain and inflammation and eliminate edema. They are used for preventing the progression of neuropathy of mild and moderate severity;
  • Glucocorticosteroids: prednisolone, hydrocortisone, dexamethasone. They have an anti-inflammatory effect, relieving swelling. They are used in severe forms of the disease, as well as in the ineffectiveness of NSAIDs;
  • Diuretics: furosemide, lasix; necessary to eliminate tissue edema;
  • Vascular preparations: pentoxifylline, nicotinic acid, cavinton; stimulate active blood flow in the affected area, improve tissue nutrition;
  • Metabolic means: actovegin; necessary to stimulate metabolism and regenerate damaged structures;
  • Antiviral and antibacterial agents for the infectious nature of the pathology;
  • Anticholinesterase drugs: neuromidin improves the transmission of excitation from the nerve to the muscle, help get rid of paralysis of mimic muscles quickly;
  • B vitamins: milgamma, combilipen; stimulate nerve regeneration and improve impulse conduction.

It is not worth postponing a visit to a neurologist. It is better to choose an adequate treatment as early as possible, get rid of unpleasant symptoms and prevent further adverse effects on the body.

 

Prevention of Neuropathy

It is difficult to prevent the progression of some forms of neuropathy. It is possible to predict the formation of a hereditary disease only when examined by a geneticist. But it is also possible to influence the development of pathologies associated with lifestyle.

 

  • It is necessary to reduce alcohol consumption to avoid the disease, and if you are prone to alcoholism, you need to undergo special treatment.

 

  • Often neuropathy is a consequence of diabetes mellitus. But with good glucose control, keeping it within physiological limits with diet or insulin injections, complications can be avoided.

 

  • It is necessary to avoid injuries, and use high-quality protection and insurance when doing extreme sports to prevent neuropathy.

 

  • Proper preconception preparation, the use of a multivitamin complex before conception, and the treatment of chronic diseases help pregnant women reduce the likelihood of pathology.

 

Bottom Line 

Consequences of Neuropathy disease are very dangerous. This disease does not go away on its own, and it can lead to serious consequences. Muscle weakness rather quickly leads to a decrease in muscle tone and muscle atrophy, which is fraught with the occurrence of ulcers. Can you stop the progression of neuropathy? Only timely full-fledged treatment helps to reverse the process and restore the normal functioning of nerve fibres. 

Our Lone Star Neurology clinic deals with the treatment of neurological diseases. Go to our website and view the complete list of diseases that are within our clinical practice. Also, you can read our interesting and useful articles about different kinds of diseases and their treatment. Contact our experts if you need help. 

 

FAQs 

  • Can you cure neuropathy?

Unfortunately, there is no cure for neuropathy. Treatment of neuropathy is aimed at improving the general condition. It includes, first of all, the treatment of the underlying diseases. 

  • How fast does neuropathy progress?

According to the speed of development, there are:

  • acute polyneuropathy (development within < 4 weeks): the most common cause is Guillain-Barré syndrome;
  • subacute polyneuropathy (development within 4-8 weeks);
  • chronic polyneuropathy (development for > 8 weeks): common causes are diabetes mellitus, alcohol abuse, lack of B vitamins, chronic inflammatory demyelinating polyneuropathy, hereditary causes, etc.
  • How serious is neuropathy in feet?

Damage to the nerves of the lower extremities provokes persistent pain and a decrease in sensitivity along with the movement of the fibers, vegetative disorders and open wounds heal for a long time. As a result, the risks of attaching a secondary infection increase, which contributes to the death of nerve endings and tissues.

  • What is the most painful neuropathy?

The term proximal neuropathy is used to describe damage to the nerve fibers that causes pain in the hips and buttocks. The disease can cause severe pain and difficulty moving. It is considered the most painful type of neuropathy.

  • How do I know what type of neuropathy I have?

An experienced doctor will be able to determine the symptoms and conduct a qualitative type to establish the correct diagnosis. Diagnosis of any type of neuropathy should begin with general blood tests with ESR and urine, as well as glucose measurements before and after meals. 

  • What is the difference between neuropathy and peripheral neuropathy?

Neuropathy is a general term used to describe nerve damage, while peripheral neuropathy occurs when peripheral nerves are damaged.

  • How does neuropathy affect walking?

People suffering from neuropathy most often have a staggering walk and loss of balance. It occurs due to muscle weakness, which is a consequence of the disease. That is why people suffering from neuropathy are advised to wear orthopedic shoes.

  • What are the final stages of neuropathy?

Muscle weakness is a significant sign of leg neuropathy, but it is characteristic of the later stages of the disease. Initially, the weakening of the muscles is transient, and then it becomes permanent. In the final stages, it can lead to:

  • decrease in limb activity;
  • difficulty moving without support;
  • thinning of muscles, and their atrophy.

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Lone Star Neurology
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Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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