PERIPHERAL NEUROPATHY-THE LEADING CAUSE FOR GENERAL WEAKNESSHTML Full Text
PERIPHERAL NEUROPATHY-THE LEADING CAUSE FOR GENERAL WEAKNESS
Sumala Vineela and J. R. Tulasi *
Sir CR Reddy College of Pharmaceutical Sciences, Andhra University, Eluru, Andhra Pradesh, India.
ABSTRACT: Peripheral neuropathy refers to many conditions that involve damage to the peripheral nervous system. In this article, we would like to discuss various aetiological factors and their manifestations, pathophysiology, diagnosis and treatment strategies of peripheral neuropathy. Generally, peripheral neuropathy is caused by many underlying disease conditions such as Diabetes mellitus, Shingles (postherpetic neuralgia), Vitamin B-12 deficiency, Alcoholism, Autoimmune disorders (Rheumatoid arthritis, Systemic lupus erythromatosus), Lyme disease, Syphilis, HIV, Exposure to toxins (lead), chemotherapies and Hereditary disorders such as Charcot-marie-tooth. The clinical presentations of peripheral neuropathy generally involve pain, burning or tingling sensations in the distribution of the affected nerves mostly in the hands and feet. The diagnosis of PN includes a physical examination, blood tests, a keen study of medical history, family history and lifestyle of the subject. Patients with peripheral neuropathy typically do not respond to traditional analgesics (paracetmol, NSAIDs) or weak opioids because these do not focus on treating various types of symptoms of PN. However, some Antidepressants, Serotonin or epinephrine reuptake inhibitors (SNRIs), Topical therapies and combinational therapies and non-pharmacological treatment were found to alleviate peripheral neuropathy symptoms.
Keywords: Peripheral neuropathy (PN), Postherpetic neuralgia (PHN), Autoimmune disorder-induced PN Toxic neuropathy, Chemotherapy induced peripheral neuropathy (CIPN), Charcot - Marie-Tooth disease-related PN
INTRODUCTION: Peripheral nerves make up an intricate network that connects the vast communication centers like the brain and spinal cord to muscles, skin, and internal organs. Hence any damage to these nerves result in peripheral neuropathy (PN). Peripheral nerves send many types of sensory information to the central nervous system, such as a message that the feet are cold, etc. They also carry signals from the CNS to the rest of the body 1, 7, 8.
Epidemiology: In epidemiological studies from various regions of India, The overall prevalence of the PN varied from 5 to 2400 per 10,000 people in various community studies 6. Diabetic neuropathy, which is otherwise called Distal symmetrical polyneuropathy (DSPN) is a common disorder caused due to diabetes mellitus.
It was found that worldwide, 382 million people are currently affected by Diabetic Neuropathy 19 of which the incidence in south Indian people was recorded as 19.1%. Peripheral neuropathy, if it occurs in shingles condition, then it is referred to as postherpetic neuralgia. The risk of postherpetic neuralgia also goes up with age. More than 80% of cases of postherpetic neuralgia occur in people over 50 years old. In contrast, the incidence among people under 60 years of age was less than one in 50 and in people aged 60-69 years, about 7% of shingles progress to PN 67. It has been estimated that 7-10% population are currently affected by alcoholic neuropathy in US60. Vitamin B-12 deficiency-related PN incidence is 10%, of which 25% are people over 80 years of age. The statistical survey reported that out of total 30 Rheumatoid arthritis patients, 10 (33%) had peripheral neuropathy 32, 34. Prevalence of HIV-related PN ranges from 50% - 60% 41, 43 and cancer-related PN is in the range of 27.5% for all grades and 4.7% for high grade 3. Hereditary charcot - marie tooth disorder associated PN was found to be affecting 150,000 people in US, and worldwide about 1 in 3000 individuals were affected 88. The prevalence of Chemotherapy-induced peripheral neuropathy is age dependant with reported rates varying from 19% to > 85% and is highest in the case of platinum-based drugs (70-100%), taxanes (11-87%), thalidomide (20-60%). Recent studies put the prevalence of CIPN at approximately 68.1% when measured in the first month of chemotherapy 3, 9, 13.
Cancer /Chemotherapy Induced Pn: Cancer is a disease caused by an abnormal, uncontrolled division of cells in the body 2. Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as a part of the standardized treatment regimen. Chemotherapy may be given with a curative intent or aim to prolong the life or alleviate symptoms. The drugs used in chemotherapy can cause peripheral neuropathy 10, a set of symptoms caused by damage to nerves that control the sensations and movements of our arms, legs, hands, and feet.
Thus chemotherapy-induced peripheral neuropathy is a common side effect of selected chemotherapeutic agents 2 like the platinum drugs, taxanes, vinca alkaloids, thalidomide and bortezomib. Among taxanes, Paclitaxel was highly neurotoxic and had major chances to cause neuropathy followed by Docetaxel. The risk of developing severe taxane-induced CIPN is related to treatment interval between first and further chemotherapy 9, 13. The morbidity associated with CPIN can lead to pronounced alterations in quality of life and independent performance of activities in daily living 13.
Some patients experience paradoxical worsening or intensification of symptoms after the cessation of the treatment known as the phenomenon of ‘coasting’, where either mild neuropathy worsens or new CIPN develops. A number of predisposing factors of CIPN have been identified, including patient age, previous medical history, lifestyle or direct cancer association 1, 18. Chemotherapy-induced PN symptoms include numbness, discomfort, sensitivity to touch and burning sensation 13. If internal organs are affected, symptoms include dizziness, constipation, and bladder difficulties. If muscles are affected, then muscle cramping, muscle weakness, muscle spasms are the symptoms 9, 13. To diagnose PN that occurs during chemotherapy, some doctors recommend neurophysiologic tests such as electromyography to detect neuromuscular abnormalities, nerve conduction studies, quantitative sensory tests to further examine peripheral nerve function 2, 7, 8. The electromyography measures electrical activity in response to nerve stimulation of the muscle 9, 10, 12.
The treatment strategies for CIPN involve both pharmacological and non-pharmacological pathways. The non-pharmacological treatment is to avoid injury by paying attention to home safety by using handrails on stairs to prevent falls and using potholders in the kitchen to avoid burns. The pharmacological treatment strategies suggested by oncologists may be to discontinue or reduce the dose of chemotherapy drugs that agitates PN. The recommended drugs are over-the-counter medicines, lidocaine patches, menthol creams, or a medication called Duloxetin 10. However, some researchers suggest treatments such as vitamin E, calcium, magnesium, Anti-seizure drug, Antidepressants, and Glutathione -a vitamin that is rich in antioxidants 10, 15.
Diabetes Mellitus: Diabetes is a group of metabolic disorders in which there is a condition of increased blood glucose levels. The peripheral neuropathy that occurs due to DM is called diabetic neuropathy or distal symmetrical polyneuropathy (DSPN). DSPN affects both DM-I and DM-II 19. DSPN is characterized by Numbness or tingling of the feet and lower legs, followed by pain or burning sensation (loss of sensation). Sometimes these symptoms can occur in the hands or arms also 26, 27, 28.
Pain affects the quality of life of patients, impacting the ability to perform daily activities, and may also cause mood swings 24. The pathophysiology of diabetic neuropathy is that the increased blood glucose levels cause changes in blood vessels that supply blood to the peripheral nerves and finally damages the nerves 22. Drinking alcohol, cigarette smoking, oxidative stress, nitrosative stress, microvascular changes, and central sensitization increases the risk of DSPN 19, 28. Various diagnostic procedures are available for DN, one being physical examination based on symptoms like pain, numbness, and tickling 21, 28 other is vibration test which is done using a tuning fork of 128 Hz. A sensory examination can be performed on hands and feet bilaterally, and it is considered abnormal if the ankle and vibration reflexes are absent rather than reduced. Nerve biopsy can be done to exclude other causes of neuropathy.
Skin biopsy opts when all other above measures are negative in the diagnosis of small fiber neuropathy. Some peers suggest confocal corneal microscopy as an alternative for nerve biopsy, considering its non-invasive nature. Motor nerve conduction, F response, and sensory nerve conduction studies are also equally important methods of documentation used in follow-up therapy or as diagnostic strategies for diabetic neuropathy 22, 23, 26, 28. The therapy of diabetic neuropathy includes anticonvulsants like Pregabalin, Gabapentin which act by binding to pre-synaptic voltage-gated calcium channels to decrease pain 22, 28. Antidepressants like Duloxetine (serotonin inhibitor), Venlafaxine are suggested drugs that alleviate symptoms, and opioids like Tramadol, morphine are used to reduce the pain. Other agents like capsaicin topical cream, lidocaine patch, Alpha lipoic acid, Isosorbidedinitrate spray are also used to relieve the pain 26, 28.
Autoimmune Disorder (Rheumatoid Arthritis) Induced Pn: Autoimmune disorders are the conditions in which the body’s immune system fails. An autoimmune disorder like Rheumatoid arthritis, a systemic inflammatory disease that mainly affects the joints, presents the PN as the clinical symptom. The causes of PN in rheumatoid arthritis include nerve entrapment, drug toxicity, and rarely amyloidosis. The neuropathic pain in rheumatoid arthritis shows the symptoms of numbness, vasculitis (inflammation of blood vessels), tingling, and burning sensation in the extremities 29, 31, 33. The pathophysiology of PN in rheumatoid arthritis involves genetic factors, environmental factors (toxins, chemicals, bacteria), etc. These factors attack the immune system causing damage to the tissue around joints of elbows, shoulders, neck, knees, and ankles, causing nerve damage ultimately leading to PN 32, 37. Patients with rheumatoid arthritis should regularly undergo electrophysiology testing to rule out the existence of peripheral neuropathy. Electro-physiological studies are the gold standard diagnostic tools performed by using the EMG instrument (oxford instrument co; UK) to diagnose neuropathy in patients with rheumatoid arthritis 29, 33. Median, ulnar, peroneal and posterior tibial nerve conduction studies are performed unilaterally on the symptomatic side to diagnose the disease 29, 36, 39.
Rheumatoid arthritis induced. Peripheral neuropathy treatment involves NSAID’s(Aspirin, Ibuprofen, and Aleve) to reduce joint inflammation and pain, DMARD’s like Hydroxychloroquine, Methotrexate, Leflunomide are used to suppress the immune system and slow the onset of disease (RA), so that further progress of PN can be prevented. In some cases, surgery may also be recommended, or patients are advised to take safety measures to compensate for the loss of sensation 32, 35.
Hiv Induced Pn: HIV /AIDS is one of the leading causes of peripheral neuropathy 47. The neurological complications of HIV mostly showed synergism in the presence of diabetes mellitus, possibly affecting 50% of all the individuals infected with HIV 43. The pathophysiology of HIV-related DSPN is the neurotoxicity resulting from virus, along with the adverse effects of drugs used for treatment of HIV causing damage to the nerves and resulting in decreased nerve reflexes. The neuroinflammation associated with symptoms like burning, stiffness, prickling, tingling sensation is a common feature of HIV-associated peripheral neuropathy 45, 46, 48. Diagnosis of HIV-induced PN is done by physical examination based on symptoms or by Electromyography [EMG], a test in which a needle is connected to a computer to study whether the patient's muscle is healthy or affected by a disease of the muscle or nerve. Nerve conduction studies, including motor nerve conduction, F response and sensory nerve conduction studies, are also considered important documentation methods and follow-up of nerve functions in HIV/AIDS induced neuropathy. Skin punch biopsy reveals the damaged nerves, especially the damaged axon, a part of the nerve cell that transmits impulses 43, 45, 46. Generally, antiretroviral therapy is used to treat HIV/AIDS, But for the treatment of HIV-induced neuropathy, other medications such as anticonvulsants like gabapentin, pregabalin and antidepressants like amitriptyline, duloxetine, which are selective serotonin reuptake inhibitors (SSRIs) have been prescribed to reduce the pain. Some topical agents, non-specific analgesics are also suggested. It is better to withdraw drugs like Stavudine, Dapsone (used for pneumocystis pneumonia), metronidazole (used to treat amoebic dysentery) and increase the risk of developing peripheral neuropathy 45, 50, 51.
Shingles (Post Herpetic Neuralgia): Herpes zoster, commonly called Shingles is an infection caused by same virus that causes Chicken poxm 67, 70. Peripheral neuropathy occurs as a symptom of Shingles The first sign is long-lasting pain that might feel like burning or tingling on the side of the face, chest, and back. This can be improved to itching sensation, extreme sensitivity to touch followed by electric shock-like symptoms 67, 73, 75.
The pathophysiology involves entry of Herpes zoster and/or reactivation of chickenpox virus; this virus then travels down the nerve fibers and ultimately results in PN that is associated with painful skin rash. The risk of PHN generally increases with age, primarily affecting people older than 50 years. The diagnosis of shingles induced peripheral neuropathy can be done by the medical practitioner thorough examination of the skin, including physical examination possibly touching it in places to determine the borders of the affected areas 70, 74, 76.
The treatment of shingles includes antiviral agents like guanosine analogues (Acyclovir, Valacyclovir (Valtrex) three times per day. These medications target the virus by relying on viral kinases for phosphorylation that (kinases) are used to promote incorporation into viral DNA, thus disrupting replication. Therefore the disease can be reduced to a certain extent and further occurrence of shingles induced PN can also be prevented 70, 74, 76.
Peripheral Neuropathy In Lyme Disease Patients: Lyme disease is an inflammatory disease caused by the bacteria Borrelia burgdorferi transmitted to humans by biting an infected black-legged or deer tick. Lyme disease was once a more common disease in the northeast section of US is now spreading to southern and western parts of the country. The number of cases is constantly decreasing, but the risk of untreated lyme disease progressing to neurological disorders involving symptoms of pain in limbs, skin rashes, painful inflammation of joints, flu-like symptoms, irregular heartbeat, the stiff neck has been raised through years 52, 56. The diagnosis can be done by neurological exam, electromyography, blood tests to identify the infective agent that causes Lyme disease or by nerve conduction velocity tests to indicate the percentage of damage to the nervesm 52, 56. The therapy associated with Lyme disease is antibiotics to reduce or inhibit the organism and to alleviate the pain, along with steroids to reduce inflammation of the nerve. Sometimes Intravenous therapy and surgery may also be recommended based on the severity of the disease 52. Avoiding exposure to the I. Scapularis or I. pacificus ticks by the use of protective clothing, tick repellants, checking the entire body for ticks daily, and prompt removal of attached ticks before transmission of these microorganisms can prevent the Lyme disease so that further occurrence of PN can be prevented 52.
Hereditary Disorder Related Pn [Charcot-Marie-Tooth]: Hereditary neuropathies are passed on genetically from parent to child, so they are sometimes called inherited neuropathies 91. Generally, hereditary neuropathy depends on the group of nerves affected, for instance, Charcot -Marie tooth (CMT) disease was one of the most common types of hereditary neuropathies affecting motor and sensory nerves 91, 92. More than 30 genes have been linked to CMT neuropathies out of which at least 4 genes are involved in the transmission of CMT from parent to child 90, 95. Approximately 1 out of 3300 people is affected by CMT and the cases are constantly rising in years 87, 88. There are subtypes for CMT; they are type IA (CMTIA), CMT-4A, CMT-4BI, CMT-4B II, CMT-4C and CMT-4D. The symptoms of CMT include difficulty in lifting foot, unsteady balance, and poor hand coordination 90, 91. The hereditary disorder is mostly diagnosed by genetic testing accompanied by some other procedures like nerve biopsy, neurological evaluations, nerve conduction tests 73, 74, 76. The drug therapy for hereditary neuropathy are Acetaminophen, NSAIDs, Carbamazepine, Gabapentine (decreases neuropathic pain), Prednisone and immunoglobulins (reduces inflammation). The medications like vincristine, isoniazid and nitrofurantoin should be avoided to prevent any further nerve damage 89, 91, 92.
Toxic Neuropathy: On exposure to some of the metals such as lead, mercury, arsenic, thallium etc., peripheral nerves are susceptible to damage 77. Lead is a ubiquitous, versatile, toxic heavy metal that has been used by mankind for many years. Research conducted in recent years has increased public health concerns about the toxicity of lead, even at low doses. Neuropathy is one most common complications of lead poisoning or leads intoxication in humans leading to axonal degeneration, but in some other cases, it primarily causes demyelinating neuropathy. The battery industry is one main setting related to lead intoxication 78, 84 others include pesticide arsenic, copper, acid arsenate, Paris green of leather industry and wood preservative. Neuropathy can also occur by inhalation of smoke from burning wood that has been preserved with arsenic from occupational dust or soil 78. Long term exposure to thallium as intentional poison, insecticide or as rodenticide was sometimes mentioned as reason for progress of peripheral neuropathy 85. Peripheral neuropathy from mercury exposure is also common, involving distal latency sensory slowing for short-term exposures, followed by motor slowing for more long-term exposures.
Inorganic and elemental mercury exposures are more likely to cause peripheral nervous system damage 77. Central nervous system effects are more common with organic mercury exposure than inorganic mercury. On prolonged exposure to inorganic mercury, there will be a slow progression of generalized paralysis of limbs 77, 78. Symptoms associated with toxic neuropathy are tingling and numbness in the feet which progresses to weakness and difficulty in walking. The diagnostic tests to evaluate toxins involve physical examination, neurological exam, electromyography, urine analysis, and blood tests. Management of toxic neuropathy can be done by using over-the-counter pain medication to reduce mild pain and for severe pain, use of tricyclic antidepressants, anticonvulsants (pregabalin, gabapentin), opiates, or topical capsaicin cream is recommended. Peripheral neuropathy can be prevented by avoiding exposure to toxins and avoiding drugs like acrylamide, alcohol, arsenic, brevetoxin, carbon disulphide, ethylene glycol, hexacarbions, lead, nitrous oxide, organophosphates, and saxitoxin 78, 81, 82.
Vitamin B-12 Deficiency Associated Pn: PN may occurs as a result of malnutrition [vit-B12 deficiency] for which there are many causes including poor nutrition caused by an unbalanced diet or alcoholism 100. Additionally, a clear link has been established between a lack of vitamin B12 and PN. Decreased vitamin B 12 causes an increase in the risk of PN. The symptoms of vitamin B 12 deficiency cause anaemia [serious], nerve damage and nerve degeneration (PN) associated with pain, numbness, tinglingin hands or feet 99. The pathophysiology is that lack of vitamin B 12 damages the myelin sheath (that surrounds and protects the nerves) so, results in nerve damage and leading to PN 103. Lack of vitamin B 12 is associated with haematological, neurological, psychiatric manifestations. Generally, the symptoms include anaemia that may arise as a serious complication, pain, numbness, tingling sensation in the hands or feet 100, 104.
Alcoholic Neuropathy: Alcoholic neuropathy may experience either one or many symptoms ranging from mild to severe like limb cramps, loss of movement, muscle atrophy, muscle spasms or contractions, muscle weakness, numbness (loss of sensation), pins and needles, tingling or prickling, bowel and urinary system constipation, incontinence, urinary retention and diarrhoea. In some people other areas of the body are also involved leading to infertility and sexual dysfunction in men or difficulty in swallowing 58, 63. Diagnosis for alcoholic neuropathy involves Nerve biopsy. A local anaesthetic was used to numb the area. The surgeon makes a small incision and removes a portion of the nerve, usually from the ankle or the calf. The sample is then examined for abnormalities under a microscope. Nerve conduction velocities are normal or mildly slowed in patients with alcoholic neuropathy 58, 62, 63. The best treatment a person with alcoholic neuropathy can do is to stop or significantly reduce alcohol intake. An inpatient detox may be suggested when a person’s alcohol use disorder is very severe. Taking safety measures to compensate for loss of sensation, Quitting recreational drug habits, eliminating exposure to alcohol and other related liquids can stop progression of disease 61. Alcoholic neuropathy can make daily life difficult, so it is essential to begin by managing the symptoms 58, 59, 63. Community-based support is also available from voluntary organizations such as “Alcoholics anonymous “self-management” and “recovery training” to drive out the person from alcohol abuse. The pharmacological treatment involves vitamin supplements like vit-E, B6, B12, over-the-counter pain relief (for minor discomfort associated with alcoholic neuropathy), pain relief therapy such as capsaicin cream, tramadol and anticonvulsants (gabapentin) are recommended. Even physical therapy (gentle exercises and activities) can help with muscle and balance problems 58.
CONCLUSION: Thorough review of articles concludes that Peripheral neuropathy is one of the leading causes of general weakness that disturbs one's quality of life. Therefore, new research strategies must be carried out to provide standardized therapeutic outcomes that would ultimately give security to the nerves and prevent all kinds of damage that may occur to the “sensorium” of the body (nervous system).
Diabetes, being the first and most leading cause for PN, may also lead to insomnia and increases the chance of developing further neurological complications. So, utmost attention needs to be taken by thoroughly examining the feet for blisters, cuts or calluses. The next superior cause was analyzed to be Cancer, more likely breast cancer, a leading killer disease that uses chemotherapy as frontline treatment which aids in developing PN. The disease can be subsided by reducing the dosage of chemotherapeutic agents (cyclophosphamide etc). Apart from the above cases even the lifestyle of the present scenario; food habits, lack of sufficient physical activity and the comforts to which the people got accustomed altogether play a pivotal role in reverting into various pathological conditions of Peripheral neuropathy. Natural therapeutic strategies like massaging the pain area with warm oils or vaporous, acquiring traditional acupuncture techniques, and having hot bath could possibly relieve PN symptoms. Besides the therapy, establishing dietary habits that aid in overcoming vitamin deficiencies, especially choosing vit B12 rich foods ( meat, eggs, low fortified dairy foods, and fortified cereals), a diet rich in fresh fruits and vegetables, legumes, whole grains, omega-3 rich foods (salmon, walnuts, chia seeds, flax seeds, cod liver oil), etc. and by avoiding sedentary lifestyle through a regular practice of meditation, exercises, getting rid of alcohol intake and smoking could help to maintain nerve health and reduces the risk of PN as well as other neurological disorders.
CONFLICTS OF INTEREST: The authors declare that they have no conflicts of interest.
Ethics Approval: This article does not contain any studies with human participants or animals performed by any authors.
ACKNOWLEDGEMENT: The authors are thankful to Sir CR Reddy College of pharmaceutical sciences for providing research facilities to carry our research work.
- https://WWW.foundationforpn.org. The Foundation For Peripheral Neuropath Y accessed 20: 2019.
- JANE BIEHL.PH.D; Cancer and peripheral neuropathy; https://www.curetoday.com 20: 2019.
- Ling Peng, Yun Hong, Xianghua Ye and Peng Shi: Incidence and relative risk of peripheral neuropathy in cancer patients with eribulin: a meta-analysis. Oncotarget 2017; 8(67): 19.
- Osuntokun BO, Epidemiology of peripheral neuropathies; Neurology, pp Sringer-Verlag Berlin Heidelberg1986; 257-73.
- CN Martin and RA Hughes: Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry 1997; 62(4): 310-18.
- Sweetytrivedhi, Alak Pndit, Goutam Ganguly and Shyamal Kumar Das: Epidemiology of peripheral neuropathy: An indian perspective. Published Indian Academy of Neurology 2010; 17: 173-84.
- Richard AC: Hughes Peripheral neuropathy. BMJ 2002; 12: 2020.
- LA Colvin and Dogherty PM: Peripheral neuropathic pain: signs and symptoms, mechanisms, and causes: are they linked. BJA British J of Anaesthesia V 2014; 114: 24.
- Timothy J, Brown MD, Ramy Sedhom MD and Arjun Gupta MD: Chemotherapy induced neuropathy. JAMA Oncol 2019; 5(5): 750.
- Renata Zajaczkowska, Magdalena Kocot Kepska and Anna Wrzosek: Mechanisms of chemotherapy induced peripheral neuropathy. Int J Mol Sci 2019; 20(6): 145.
- Rostock M, Jaroslawski K, Guethlin C, Ludtke R, Schroder S: Chemotherapy induced peripheral neuropathy in cancer patients: A four arm randomized trial on. The Effectiveness of the Electro-Acupuncture 2013; 349653: 9.
- Krista G Brooks and Tiffany L Kessler: Treatments for neuropathic pain. CP December 2017; 9: 2017.
- Mary Egan, Eimear Burke and Pauline Meskell: Quality of life and resilience related to CIPN in patients post. Treatment with Platinum and Taxanes 68(3); 143-48.
- J Gingerich, D Wadhwa, Lemanski, Krahn M and Daeninck PJ: The use of cannabinoids (CBs) for the treatment of CIPN a retrospective review. Journal of Clinical Oncology (15-suppl) 2009; 27: 20743-43.
- Hou S, Huh B and Kim HK: Abdis, treatment of CIPN: Systematic review and recommendations. Pub Med Pain Physician 2018; 21(6): 571-92.
- Nthan P Staff, Anna Grisold, Wolfgary Grisold and Anthony J. Windebank: CIPN: A current review; Ann Neural 2017; 81(6): 772-81.
- James Addington and Miriam Freimer: CIPN An update in current understanding; version I. FIOO Res 2016; 5: 22.
- Shelia Perry, Theresa L Kowalski and Chih-Hung Chang: Quality of life assessement in women with breast cancer: benefits, acceptability and utilization; published online 2007; 2: 24.
- Mark Davies, Sinead Brophy, Rhys Williams and Ann Taylor: The prevalence, severity and impact of painful Diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care 2006; 29(7): 1518-22.
- Rodica Pop-Busui MD, Jiang Lu, MS and Maria Mori Brooks PHD: Impact of glycemic control strategies on the progression of diabetic peripheral neuropathy in the bypass angioplasty revascularization investigation 2 Diabetes (BARI 2D) Cohort. Diabetes Care 2013; 36(10): 3208-15.
- S Dixit and A Maiya: Diabetic peripheral neuropathy and its evaluation in a clinical scenario: A review. Published On 2014; 60: 33-40.
- Anne K Schreiber, Carina FM Nones and Joice M Cunha: Diabetic neuropathic pain: physiopathology and treatment. World J Diabetes 2015; 6(3): 432-44.
- Saad Javed, Ioannis N Petropoulos and Rayaz A. Malik: Treatment of painful diabetic neuropathy. The Adv Chronic Dis 2015; 6(1): 15-28.
- Zeng L, Along Kronrusmeed and Vna Rijn RM: An integrated perspective on diabetic, alcoholic, drug induced neuropathy, etiolgy and treatment in the US. Published Online 2017; 20: 219-28.
- Serdar Olt and Orhan Oznas: Investigation of vitamin B12 deficiency with peripheral neuropathy in patients with type 2 Diabetes mellitus treated using metformin; Northclin istanb 2017; 4(3): 233-36.
- Thomas PK: Diabetic neuropathy: mechanisms and future. Treatment Options Volume 67; 3.
- Bansal V, Kalita J and Misra UK: Department of neurology. DNPMJ 2006; 82(964): 95-100.
- Al Vinik and Anahit Mehrabyan: Diabetic neuropathies; The medical clinics of north America 2004; 88(4): 947-99.
- Abd EI-Samad I EI-Hewala, Samar G Soliman and Alaa A Labeeb: Foot neuropathy in rheumatoid arthritis patients: clinical, electrophysiological, and ultrasound studies. Published On 7(43): 85-94.
- Amre Nouh, Olimpia Carbunar and Sean Ruland: Neurology of rheumatologic disorders. Current Neurology and Neuroscience Reports 14(7): 456: 2014.
- Inimioara Mihaela COJOCARU, Manole COJOCARU and Isabela SILOSI: Peripheral nervous system manifestations In systemic autoimmune diseases. Medica 289; 9(3): 2014.
- John R Golding: Rheumatoid neuropathy. British Medical Journal 1971; 2(5754): 169.
- Ayse Oytun, Bayrak Dilek Durmus and Yunus Durmaz: electrophysiological assessment of polyneuropathic involvement in RA: relationships among demographics, clinical and laboratory findings. Neurological Research 2010; 32(7): 711-14.
- Monodeep Biswas, Arghya Chatterjee, Sudipkumar Ghosh and Kartik Ghosh: Prevalence, types, clinical associations and determinants of peripheral neuropathy in RA; Annals of Indian Academy of Neurology 14(3): 194; 2011.
- Nidhi Kaeley, Sohaib Ahmad and Monica Pathania: Prevalence and patterns of peripheral neuropathy in patients of Rheumatoid arthritis; Journal of Family and Medicine and Primary Care 8(1): 22: 2019.
- R Aneja, MB Singh, S Shankar, Dhir, R Grove, R Gupta and A Kumar: Prevalence of peripheral neuropathy in patients with newly diagnosed rheumatoid arthritis; 2007; 2(2): 47-50.
- Yehudina Y, Syniachenko O and Bevzenko TAB: Peripheral neuropathy in inflammatory joint disases. Volume 77: 2.
- Mikyung Sim, MD, Dae Yulkim, MD and Jisunyoon MD: Assessment of peripheral neuropathy in patients with Rheumatoid arthritis who complain of neurologic symptoms; Ann Rehabil Med 2014; 38(2): 249-55:
- Alberto RM, Martinez Marcelo B and Nunes Anamarli Nucci: Sensory neuropathy and auto immune diseases. Volume 2012; 6: 873587.
- Anastasi, joyceK. phD, Dr NP, capili, Bernadette phd, NP-C, Chang, Michelle MS, HIV peripheral neuropathy and foot care management A review of assessment and relevant guidelines; December 2013; 113(12): 34-40.
- Sonja G Schutz and Jessica Robinson-Papp: HIV related neuropathy: current perspectives, HIV/ AIDS (AUCKI); 2013; 15: 243-51.
- Pillay P, Wdley AL, Cherry CL and Kamerman PR: Pharmacological treatment of painful HIV-associated sensory neuropathy. SAfr Med J 2015; 105(9): 769-72.
- Rachel A Nardin MD and Roy Freeman MD: Epidemiology, clinical manifestations, diagnosis, and treatment of HIV associated peripheral neuropathy; https://WWW.uptodate.com/conter.
- Amruth G, Praveen-kumar S, Nataraju B and Ngaraja B S, HIV Associated sensory neuropathy; J ClinDiagn Res.2014 jul; 8(7): MC04-MC07. https://www.foundationforpn.org/…the Foundation for Peripheral Neuropathy.
- Claes Martin, Goran Solders, Anders Sonnerborg, Per Hansson, Anti retro viral therapy may improve sensory function in HIV-infected patients: a pilot study; Neurology 54(11), 2120-2127, 2000.
- Michele Tagliati, Juliet Grinnell, James Godbold, David M Simpson, Peripheral nerve function in HIV infection: clinical, electro physiologic, and laboratory findings; Archives of neurology 56(1), 84-89, s1999.
- R F Miller, S Bunting, S T Sadiq, H Manji, Peripheral neuropathy in patients with HIV infection: consider dual pathology; volume 78, issue 6.
- Lisa M.Mangus, Jamie L.Dorsey, and Joseph L.Mankowski, Unraveling the pathogenesis of HIV peripheral neuropathy: insights from a simian immune deficiency virus Macaque Model; ILAR J.2014; 54(3): 296-303.
- Romy parker, Dan J Stein, Jennifer Jelsma, in people living with HIV/AIDS: a systematic review; journal of the international AIDS Society 17(1), 18719, 2014.
- Henry Namme Luma, Benjamin Clet Nguenkam T chaleu, Marie Solange Doualla, etal, HIV associated sensory neuropathy in HIV-1 infected patients at the Douala General hospital in Cameroon: a cross sectional study; AIDS research and therapy 9(1).
- Michelle Kaku, David M Simpson, HIV neuropathy, current opinion in HIV and AIDS; 9(6), 521-526, 2014.view at journals.lww.com.
- Gary P.Wormser, Raymondj.Da Ttwyler, Eugene D.shapiro, johnj.Halperin, Allen C.Steere et.al, The clinical assessment, treatment, and prevention of Lyme disease, human Granulocytic anaplasmosmosis, and babesiosis: clinical practice guidelines by the infectious disease society of America, clinical infectious diseases; volume 43, issue 9, 1 november 2006, pages 1089-1134.
- Peter Novak, Donna Felsenstein, Charlotte Mao, et al, Association of small fibre neuropathy and post treatment Lyme disease syndrome; published on Feb 12, 2019, PLoS ONE 14(2): e0212222.
- Michael T Melia, Paul G Auwaerter, Time for a different approach to Lyme disease and longterm symptoms; New England Journal of Medicine 374(13), 1277-1278, 2016.
- Sebastian Rauer, Stefan Kastenbauer, Volker Fingerle, etal, Lyme neuroborreliosis; Deutsches Arzteblatt international 115(45), 751, 2018.
- Thomas S.Murray, MD PhD and Eugene D.Shapiro, MD, Lyme disease; clin Lab Med.2010 Mar; 30(1): 311-328.
- Tanja Petnicki-ocwieja and Catherine A.Brissette, Lymedisease: recent advances and perspectives; published online 2015 Apr 1, Front Cell infect Microbiol.2015; 5:27.
- Jamie Crawford, understanding and treating alcoholic neuropathy; Medical News Today.Medilexicon, intl., 18 may.2018.web.20jul.2019.
- Tarakad S Ramachandran, Alcohol (Ethanol); med scape, https://emedicine.medscape.com.
- Giovanni Vittadini, Michelangelo Buonocore et al, Alcoholic polyneuropathy: A clinical and epidemiological study, Alcohol and Alcoholism; vol 36, issue 5, sep 2001, 393-400, published 1st sep 2001.
- Ammendola, M.R.Tata, C.Aurilio, G.Ciccone, Perpipheral neuropathy in chronic alcoholism: A retrospective cross-sectional study in 76 subjects, Alcohol and Alcoholism; vol 36, issue 3, may 2001, 271-275, pub 1 may 2001.
- Kanwaljit Chopra and Vinod Tiwari, Alcoholic neuropathy: possible mechanisms and future treatment possibilities; Br J Pharmacol.2012 Mar; 73(3): 348-362, published online 2011 oct 11.
- Haruki Koike, Gen Sobue, Alcoholic neuropathy; Current opinion in neurology 19(5), 481-486, 2006.
- Michelle Mellion, James M Gilchrist, Suzanne De La Monte, Alcohol related peripheral neuropathy: nutritional, toxic or both; Muscle and nerve 43(3), 309-316, 2011.view at online library, wiley.com.
- P Kucera, M Balaz, P Varsik, E Kurca, Pathogenesis of alcoholic neuropathy; Bratislavs keie karskelisty 103(1), 26-29, 2002. researchgate.net.
- Adam Sadowski, Richard C Houck, Neuropathy, Alcoholic; StatPearls[internet], 2018, view at ncbi.nlm.nih.gov.
- Mathew Hoffman, MD, At risk for shingles and post herpetic neuralgia?; WebMD, https://www.webmd.com.
- Feller, R.A.G.Khammissa and J.Lemmar, Post herpetic neuralgia and trigeminal neuralgia; published online 2017 dec 5, Pain Res Treat 2017; 2017:1681765.
- Aaron Saguil, MD, MPH; Shawn Kane, MD; and Michael Mercado, MD, F.Edward Hebert, Herpes zoster and post herpetic neuralgia: prevention and management; Am Fam Physician.2017 Nov 15; 96(10):656-663.
- DH Gliden, AN Dueland, R Cohrs, JR Martin, BK Kleinschmidt-De Masters, R Mahalingham, Preherpetic neuralgia; Neurology 41(8), 1215-1215, 1991.
- Ravi Mhalingam, Mary Wellish, John Brucklier, et al, Persistence of varicella-zoster virus DNA in elderly patients with post herpetic neuralgia; Journal of neurovirology 1(1), 130-133, 1995.
- Katherine E Galluzzi, Management strategies for herpes zoster and postherpetic neuralgia; The Journal of the American Osteopathic Assoc 107(suppl-1), S8-S13, 2007.
- Priya Sampath kumar, Lisa A Drage, David P Martin, Herpes zoster(shingles) and postherpetic neuralgia; Mayo clinic Proceedings 84(3), 274-280, 2009.
- Srinivas Nalamachu, Patricia Morley-Forster, Diagnosing and managing postherpetic neuralgia; Drugs and aging 29(11), 863-869, 2012.
- RW Jhonson, J Mc Elhaney, Postherpetic neuralgia in the elderly; International journal of clinical practice 63(9), 1386-1391, 2009.
- Theresa Mallick-Searle, Brett Snodgrass, Jeannine M Brant, Postherpetic neuralgia: epidemiology, pathophysiology and pain management pharmacology; Journal of multidisciplinary healthcare 9, 447, 2016.
- CC Chu, CC Huang, SJRyu, T-N Wu, chronic inorganic mercury induced peripheral neuropathy; Actaneurologicascandinavica 98(6), 461-465, 1998.
- Usha kant Misra, Jayantee Kalita, Toxic neuropathies; Published on 30-jan-2010, volume 57, issue 6, pages 697-705, Neurology india.
- Norman Latov, Gaurav kumar, Mary L Vo, Russell L chin et al, Elevated blood mercury levels in idiopathic axonal neuropathy; JAMA neurology; 72(4), 474-475, 2015.
- Yangho Kim, Kyoungsoo k Jeong, Young-Hun Yun, Myoung-soon Oh, occupation al neurological disorders in Korea; Journal of clinical neurology 6(2), 64-72, 2010.
- Arnold B Sterman, Toxic neuropathy; Mayo clinic proceedings 60(1), 59-61, 1985.
- Chafic Karam, P.James B.Dyck, Toxic neuropathies; volume 35(04):448-457, october 2015.Researchgate.
- Christopher H Gibbons, Treatment induced neuropathy of diabetes; current diabetes reports 17(12), 127, 2017.link.springer.com.
- Dababrata Ghosh, Classic picture of lead neuropathy; Indian pediatrics 41, 1270-1271, 2004.
- N Kubis, C Talamon, D Smadja, G Said, Peripheral neuropathy caused by thallium poisoning; Revenue neurologique 153(10), 599-601, 1997.europepmc.org.
- JB Cavanagh, Neurotoxic effects of metals and their interactions, Recent Advances in Nervous System Toxicology; 177-202, 1988.link.springer.com.
- Barreto LC, Oliveira FS, Nunes PS et al, Epidemiologic study of Charcot-tooth marie disease: A systemic review; Neuro epidemiology. 2016; 46(3):157-65.
- Mladenovic J, Milik Rasic V, Keckarevic Markovic M, Romac S, Hofman A et al, Epidemiology of charcot-marie tooth disease in the population of Belgrade, Serbia; Neuro epidemiology 2011; 36:177-182.
- Alulin Tacio Quadros Santos MonterioFonseca, Edmarzanoteli, Charcot marie tooth disease; Revista Medica Clinica Las Condes 29(5), 521-529, 2018.sciencedirect.com.
- Katja Eggermann, BurkhardGess, Martin Hausler, Joachim Weis, etal, Heriditary neuropathies: clinical presentation and genetic panel diagnosis; Deutsches Arzteblatt international 115(6), 91, 2018.
- Mario A Saporta, Michael E Shy, Inherited peripheral neuropathies; Neurologic clinics 31(2), 597-619, 2013.
- Thomas D Bird, MD, Charcot marie tooth disease; published by University of Washington, Seattle; 1993-2019, pub 1998 Sep 28.
- Seung Min Kim, Ki Wha Chung, Byung Ok Choi, Eui Soon Yoon Choi, et al, Hereditary neuropathy with liability to pressure palsies (HNPP)patients of Korean ancestry with chromosome 17p11.2-p12 deletion; Experimental and molecular medicine 36(1), 28, 2004.nature.com.
- Hampig Raphael Kourie, Nicolas Mavroudakis, Philippe Aftimos et al, Charcot-marie-tooth hereditary neuropathy revealed after administration of docetaxel in advanced breast cancer; World J ClinOncol.oct 10, 2017; 8(5):425-428, published online Oct 10, 2017.
- Christopher J Klein, The inherited neuropathies; Neurologic clinics 25(1), 173-207, 2007.
- Michael E Shy, Agnes Patzko, Axonal charcot-marie-tooth disease; current opinion in neurology 24(5), 475-483, 2011.view at journals, lww.com.
- Nutritional and vitamin deficiency neuropathy; The foundation for peripheral neuropathy, https://www.foundationforpn.org/…19njan].
- Jayne Leonard, What is the purpose of vit B 12 level test?; MEDICAL NEWS TODAY, ps://www.medicalnewstoday.com.
- Cyril Jabea Ekabe, Jules Kehbila and Gottlibe Lobe Monekosso, Vitamin B 12 Deficiency neuropathy: a rare diagnosis in young adults: a case report; BMC Res Notes.2017; 10:72, published online 2017 Jan 28.
- Mc Combe PA, Mc Leod J G, The peripheral neuropathy of vitamin B 12 deficiency; J Neurol Sci.1984 oct; 66(1):117-26.PubMed.
- Lawrence R Solomon, Vitamin B 12 and neuropathy in the elderly; The American Journal of clinical nutrition 103(5), 1378-1378, Published 1st may 2016.OXFORD ACADEMIC.
- Kenneth S Kosik, Thomas F Mullins, Walter G Bradley, Larry D Tempelis, Alfred J Cretella, Coma and axonal degeneration in vitamin Network.
- Israel Steiner, Daphne Kidron, Dov Soffer, Itzhak Wirguin, Oded Abramsky, Sensory peripheral neuropathy of vitamin B 12 deficiency:A primary demyelinating disease?; Journal of neurology 235(3), 163-164, 1998.link.Springer.com.
- Lindsay H Allen, How common is vitamin B-12 deficiency; The American journal of clinical nutrition 89(2), 693S-696S, 2008.Oxford Academic.
How to cite this article:
Vineela S and Tulasi JR: Peripheral neuropathy-the leading cause for general weakness. Int J Pharm Sci & Res 2021; 12(11): 5706-14. doi: 10.13040/IJPSR.0975-8232.12(11).5706-14.
All © 2021 are reserved by International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Sumala Vineela and J. R. Tulasi *
Sir CR Reddy College of Pharmaceutical Sciences, Andhra University, Eluru, Andhra Pradesh, India.
07 September 2020
21 May 2021
19 July 2021
01 November 2021