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Polyneuropathy Handbook

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Chronic symmetrical peripheral neuropathy

Peripheral neuropathies are chronic &  develop over several months. Diagnosis of the underlying cause may require three stages of investigation. Patients should always be asked about alcohol consumption, toxin exposure (insecticides, solvents), and drugs. They need a full examination, of breasts and genitalia, to exclude underlying cancer.

The commonest causes of neuropathy can be identified from the history, & stage 1 investigations (box 2)Predominantly sensory & subacute  neropathy with ataxia that is worse in the dark because of loss of large fibre function and postural sensation, is produced by  drugs (such as cisplatin), an underlying cancer, Sjögren's syndrome, or C.I.D.P. If family have similar symptoms, pes cavus, or claw toes, the patient may have hereditary motor and sensory neuropathy or Charcot-Marie-Tooth disease, which is usually autosomal dominant. Difficulty with walking in childhood also suggests a hereditary neuropathy. If patients have a clear cause for their neuropathy and a typical clinical picture, treatment—for instance, of diabetes mellitus or alcohol misuse—can be started without further investigation.

If the cause of the neuropathy is not clear from the stage 1 investigations or is atypical, the patient should be referred to a neurologist. The most important stage 2 investigation is neurophysiological testing (figure). About 80% of symmetrical peripheral neuropathies are axonal and are due to gradual dying back of the axons. In the remaining 20% (demyelinating neuropathies) most of the damage is to the myelin, although axonal degeneration often occurs as the disease advances. The other second stage investigations (box2) are simple outpatient tests for the commonest causes of peripheral neuropathy.

Muscle action potentials after distal and proximal stimulation of a nerve to a muscle such as abductor pollicis brevis. The upper trace of each pair is the record after distal stimulation. In the normal nerve the distal motor latency is short and nerve conduction velocity rapid (>50m/sec). In demyelinating neuropathy the distal motor latency is prolonged and nerve conduction velocity slowed to less than 80% of normal. In axonal neuropathy the action potential is reduced, but the distal motor latency and nerve conduction velocity are unaffected.Multifocal abnormalities with normal conduction velocity suggest multiple mononeuropathy

Third stage investigations

The choice of third stage investigation will depend on whether neurophysiological testing has shown the neuropathy to be demyelinating or axonal.

The causes of demyelinating neuropathy are limited (box3). If the slowing of nerve conduction affects all nerves roughly equally the diagnosis is likely to be the demyelinating form of Charcot-Marie-Tooth disease (type 1). Seventy per cent of such patients have a duplication of the gene for a 22 kDa peripheral nerve myelin protein on chromosome 17. The duplication causes overexpression of the protein. The clinical picture ranges from classic pes cavus with inverted champagne bottle legs to scarcely detectable clawing of the toes. Different mutations of the same protein and of other myelin proteins cause a similar clinical picture. Genetic counselling and prenatal diagnosis can be offered.

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Charcot Marie Tooth disease, CMT the legs look like inverted wine bottles or stork legs)

Hippocrates said, the human body should be treated as a whole and not in parts, as is being routinely done. The CIDP autoimmune clinic works on the Hippocratic principal. We offer treatment to help the whole body.

Avicenna (Ibn Cenna),in his encyclopedia of medicine wrote, "it is best for the patient that the cause of their disease be treated". Narcotics cause immune suppression. Any sick patient will be depressed, one needs to treat the disease not the symptoms. Once the disease is treated, then depression and pain will go away. In postpartum PTSD & depression treat the inflammation rather then give a serotonin reuptake inhibitor.

President Franklin D Roosevelt President J.F. Kennedy (medical (click to see medical history)

President Regan,had chest cancer and did not get any treatment in USA, alternative treatments fully recovered him from the cancer.

diet section. Help yourself and read We are all suffering due to pollution and a poor diet. We need to detoxify. All the above info is taken from research literature available at the National Library of Medicine in Washington DC. If you have a autoimmune disorder then avoid Vaccination! If you have IgG sub-class deficiency frequent allergies, infections & fatigue) then stay away from tetanus and flu shots. Do not vaccinate or give vaccination drops to sick children.

A progressive pain reversed instantly, read the story in our story page. (story 25)Avoid Flu Vaccines they trigger autoimmune diseases.

Higher incidence of autoimmune disease seen in colder climates. Northern half of USA has a higher incidence and much lower in Florida. Studies show that vitamin-D levels have some relationship. Please take supplements of Vitamin-D daily to prevent all diseases andcancer.

CIDPUSA Foundation

DrI Khan served in the United States Public Health Service, appointed by the President of the United States. Promoted by theSurgeon General of USA to a Lt. Commander in the USPS. Served in the United States Civil Service as a Research Fellow at the National Institutes of Health, Bethesda. Residency Neurology at University of Arizona,Royal Postgraduate Medical School London & Institute of Neurology Queens Square London.

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