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Sensorimotor polyneuropathy

Definition

Sensorimotor polyneuropathy causes a decreased ability to move or feel (sensation) due to nerve damage.

Alternative Names

Polyneuropathy - sensorimotor

Causes, incidence, and risk factors

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 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:

• 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.

Signs 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.

Expectations (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.

Complications

• Deformity
• Injury to feet (caused by bad shoes or hot water when stepping into the bathtub)
• Numbness
• Pain
• Trouble walking
• Weakness

Calling your health care provider

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.

References

Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 446.