Peripheral neuropathy is the nervous disorder characterized by loss of myelination or the axonal degeneration of the nerves supplying the distal parts of the body like upper limbs, lower limbs, etc. The damage of afferent fibers causes the loss of sensory input from the skin of affected part like touch, pain, temperature, vibrations, etc. The damage of efferent fibers causes the loss of motor output from the spinal cord to the muscles of the limbs which leads to weakness, tiredness, difficulty in movement, loss of muscular function, tremors, etc. The involvement of autonomic fibers is uncommon because of its central location in the body and more ability to sustain the damage in comparison of sensory or motor nerve fibers.
What Is The Prognosis For Peripheral Neuropathy?
The prognosis for peripheral neuropathy is variable because of a lot of causes responsible for it. Each cause has its own damaging extent and progression rate which makes the predictability of prognosis very difficult for peripheral neuropathy. As of now, the most common cause recognized for peripheral neuropathy is diabetes mellitus also known as a modern epidemic disease . Other common causes include vitamin deficiencies, leprosy, Guillian Barre syndrome, drug-induced neuropathies, etc.
In the case of diabetic peripheral neuropathy, the untreated or neglected cases have a very poor prognosis as compared to cases with strict glycemic control. The lack of trophic factors that are supplied by nerves to the various tissues causes nonhealing trophic ulcers on the bony prominences like shin of the tibia, medial malleolus, lateral malleolus, calcaneum, radial process, etc. Serious disabilities and debilitating problems can be caused if the cause persists for a long period of time and can result in contractures, bony deformities, etc. Amputations and major surgeries may be needed to perform. Major surgery like amputation itself carries a poor prognosis because of various intraoperative and post-operative complications making the overall prognosis bad. (1)
Adequate care and hygiene are to be maintained to prevent the spread and superadded infection of already present ulcers. Prognosis improves as the cause responsible for it is removed or well-controlled like in case of diabetic neuropathy where adequate blood glucose levels must be maintained. Slower peripheral neuropathies like Charcot Marie tooth disease can even pass through a lifetime without causing much damage and shows a good prognosis.
Other diseases causing peripheral neuropathies like Guillain barre syndrome, systemic lupus erythematosus, leprosy, vasculitis, heavy metal toxicity, amyloidosis, etc. carry very poor prognosis because of the progressive nature of the causes and severe involvement of peripheral nerves in a short period of time.
A few of the causes can also be reversible including various vitamin deficiencies like vitamin b12 deficiency, vitamin b6 deficiency, and drug-induced peripheral neuropathies. Replenishment of body stores of the deficient vitamins with exogenous supply and stoppage of the causative drugs can lead to the reversibility of nerve damage to a great extent and approximately all of the functions can become normal. These show a very good prognosis among other causes and are to be treated with simple supplements. (1)
Absolute conclusion about the prognosis and future of the condition cannot be made because the causes and their damage differ to a great extent. Some causes can lead to peripheral neuropathy in days to a few months and carry very poor prognosis like for example Guillian Barre syndrome, drug-induced peripheral neuropathy, etc. Others may take 15 to 20 years to even lifetime to cause peripheral neuropathy like diabetes mellitus, Charcot Marie tooth disease, etc. which carries a good prognosis because these can be controlled easily.
It is a dangerous condition and affects the quality of life of the patient very strongly. Even though the patient may not be so much affected by the condition but it can be very debilitating on the mental health of the patient. Many cases are seen suffering from depression due to the poor quality of life. Prognosis largely depends upon the early diagnosis and adequate treatment of the causes.
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