Neuropathy

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Neuropathy

  1. 1. Presented By: Kevin Sirman Robin CarlsonA Neuropathy Association Support Group
  2. 2. Hahnemann Chapter 4/11/2012 2
  3. 3.  The information on this power point presentation or guidance provided is intended to be educational and informative and not medically prescriptive or diagnostic. All patients are encouraged to consult with their own medical doctor when considering any information contained on our support group presentation. 4/11/2012 3
  4. 4.  Neuropathy is a disorder resulting from injury to the peripheral nerves – the motor, sensory and autonomic nerves. The main function of the peripheral nervous system is to connect the central nervous system (CNS) to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood brain barrier, leaving it exposed to toxins and mechanical injuries. 4/11/2012 4
  5. 5.  The deterioration of the peripheral nerves disrupts the body’s ability to communicate with its muscles, organs and tissues. Neuropathy is like the body’s wiring system going haywire, causing unusual or unpleasant irritations including tingling, burning, itchiness, crawling sensation, dizziness, clumsiness and many many more! If ignored, as this is done often these symptoms can lead to numbness at one extreme to unremitting pain at the other. It can come and go, slowly progress over many years or become severe and debilitating. 4/11/2012 5
  6. 6.  Rare not at all! It is estimated that up to 20 million Americans have it. The full extent of and importance of it have not been recognized. Often it is misdiagnosed or thought of merely as a side effect of another disease such as diabetes or cancer or even kidney failure. It can occur at any age however it is more common among older adults. 4/11/2012 6
  7. 7.  At first you might feel numbness or stabbing or burning in your feet. Sock Sensation – Your feet feel like they have socks on but they are bare. It gradually spreads to your legs and hands. You find it harder to walk, your legs feel heavy and you have to drag yourself up the stairs! You lose your balance and stumble on things. As for your hands you think your keys are gripped tight and you drop them! 4/11/2012 7
  8. 8. 4/11/2012 8
  9. 9.  Electrodiagnositic Tests1. Nerve Conduction Studies - evaluates how the nerves transmit electrical stimuli.2. Electromyography – (EMG) measures the electrical activity of muscles in response to nerve stimulation. Skin Biopsy – Small Fiber Neuropathy cannot be diagnosed with EMG and nerve conduction studies that only measure the large fibers. 4/11/2012 9
  10. 10.  Autonomic Tests – The Quantitative Sudomotor Axon Reflex Test (QSART) measures the autonomic nerve fibers that stimulate sweating. This is a tilt table test which measures your changes in blood pressure and pulse from prone to vertical positions. It also detects autonomic nerve involvement. Nerve Biopsy – A Nerve Biopsy provides tissue for pathological examination. It will show if vasculitis or inflammation of the blood vessels as well as deymyelination that is missed by electrodiagnostic studies. Vasculitis can decrease the oxygen supply to the peripheral nerves and will quickly cause damage to nerve tissues. 4/11/2012 10
  11. 11.  In addition to procedures, your neurologist may order a number of blood and urine tests as well as radiologic tests in order to help find the cause of your neuropathy. These include tests for: Diabetes Autoimmunity Infections Nutritional Deficiencies Toxins Hereditary Conditions Certain Cancer and Cancer Treatments 4/11/2012 11
  12. 12. Peripheral neuropathy (or neuropathy) hasreached epidemic proportions, impacting over20 million Americans. According to theNational Institute of Neurological Disorders andStroke, “More than 100 types of neuropathyhave been identified, each with its owncharacteristic set of symptoms, pattern ofdevelopment, and prognosis.” And, althoughthere are more questions about the variousneuropathies than there are answers, we arelearning more and more about this devastatingdisease every day. 4/11/2012 12
  13. 13.  Autonomic Neuropathy Cancer-Related Neuropathies Compressive Neuropathies Diabetic Neuropathy Drug-Induced and Toxic Neuropathy G.I. and Nutrition-Related Neuropathies Hereditary Neuropathies Immune-Mediated and CIDP Infectious Diseases and Neuropathy Neuropathic Pain Chemotherapy Induced Neuropathy 4/11/2012 13
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  15. 15.  Tacrolimus has been often described to induce neuropathy in liver-, pancreas-, and renal-transplanted patients. There is a report the first case of a 56-year-old woman who developed a progressive symmetric demyelinating sensorimotor polyneuropathy in the distal muscles of the lower limbs after therapy with tacrolimus because of heart transplantation. This condition suddenly reverted after the tacrolimus was stopped. 4/11/2012 15
  16. 16.  Heartdisease and high blood pressure are sometimes treated with drugs that can induce peripheral neuropathy, such as amiodarone, hydralazine, perhexiline and indapamide, which is sold as Lozol. Statins such as Zocor, Crestor, Lipitor have been linked to Neuropathy 4/11/2012 16
  17. 17. Deficiencies in Vitamins! Especially B-12! But, B-6 in high doses can damage nerves!Foot Care – You need podiatrist for foot checkups andadditional foot care. Autonomic Neuropathy causes dryskin which can crack. There are many other reasons fora podiatrist checkup and we will discuss this later.Diabetic Neuropathy – Glycemic Control is mostimportant. Gender may be a differential factordepending upon the type of neuropathy. 4/11/2012 17
  18. 18.  Thefollowing list are standard medications prescribed for those with NeuropathyIn addition to these Gabapentin Oxycodone,medications there are Metanx Hydrocodone andointments and creams Cymbalta as well as otherused by patients. opiates are oftenBiofreeze, Capsaicin, Lyrica prescribed forZostrix along with RX Amitriptyline neuropathy pain.Compounding Creams Patients have described getting relief from rebuilders, acupuncture, reflexology and anodyne light therapy. In more severe cases of Neuropathy patients have turned to Plasmapheresis. 4/11/2012 18
  19. 19. Awareness: Increase public awareness of the nature and extent of peripheral neuropathy.Education: Educate the public andhealthcare providers on the need for earlyintervention. Support: Support patients by providing platforms for exchanging information and experiencesAdvocacy: Urge legislators, government agencies and medicalproviders to deliver proper coverage, care and treatment forpeople with peripheral neuropathy Research: Encourage the funding if research to understand peripheral neuropathy’s causes, develop more effective therapies, and ultimately find cures for neuropathy. 4/11/2012 19
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  21. 21. Parts of this Powerpoint have been taken from information providedby The Neuropathy Association. 4/11/2012 21

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