Do you feel numbness and tingling in your hands and feet? Let's talk about this! (Peripheral Neuropathy)

Sometimes when we stand up after sitting in the same position for a while, our hands and feet feel tingling, right? It goes away after a while. But do you often feel a tingling sensation in your hands and feet, or a pain like pins and needles, or sometimes a burning sensation? Then this could be something more than just a normal tingling sensation. Today we are talking about a condition called 'Peripheral Neuropathy' that causes these symptoms. Although this is a bit of a scary name, if you are aware of it, managing it is not as difficult as you think.

Simply put, what is Peripheral Neuropathy?

This name is a bit complicated, so let's first understand it. The nervous system of our body is divided into two main parts. One is the Central Nervous System . It includes our brain and spinal cord (the main nerve that runs through the spine). This is like the 'Head Office' of our body.

The other part is the Peripheral Nervous System . This includes all the nerves that extend from the main office, that is, the brain and spinal cord, and spread throughout the body. It is like a system of telephone wires that extends from the main office to the entire country. These nerves carry and deliver sensations and messages to our hands, feet, face, and fingertips.

So, Peripheral Neuropathy is a condition or damage to the nerves outside the 'head office', that is, the nerves of the peripheral nervous system. Since there can be many causes for this, the symptoms can vary greatly from person to person.

Who is more likely to develop this condition?

Peripheral Neuropathy can affect anyone, regardless of age, gender, or race. However, some people are at higher risk. In particular,

• For those with Diabetes Mellitus .
• The risk of developing this condition increases with age. It is estimated that between 5% and 7% of people over the age of 45 worldwide have some form of peripheral neuropathy.
• For those with certain hereditary diseases.

How do these nerves get damaged?

To understand this, we need to know a little about how our neurons are made. Think of a neuron as being like an electrical wire.

• Axon: This is the copper wire-like part of an electrical cable. This is where messages travel.
• Myelin Sheath: This is the plastic insulation that surrounds the copper wire. It helps the message travel faster, without leaks, and protects the axon.

Peripheral Neuropathy can occur in two main ways:

1. Demyelinating Neuropathy: This is like the plastic insulation on an electric wire melting. This slows down the speed at which messages travel, and the messages get tangled.

2. Axonal Degeneration: This is similar to the damage to the copper wire itself. This is the most common type. The longest nerves in our body run from the spinal cord to the tips of our toes. Therefore, when this type of damage occurs, the legs and feet are the first to be affected.

What are the symptoms of this?

There can be many symptoms. It depends on the type of nerve that is damaged. Sometimes it can affect just one nerve, or it can affect many nerves at once. There are mainly 3 types of symptoms.

What could be causing this?

There can be many causes of Peripheral Neuropathy. Sometimes, no cause can be found. We call this 'Idiopathic Neuropathy'. The most common causes are:

• Diabetes (Type 2 Diabetes): The main and most common cause of peripheral neuropathy in Sri Lanka and around the world is uncontrolled diabetes. High blood sugar levels over a long period of time damage the delicate nerves.
• Vitamin deficiencies: Deficiencies in certain vitamins, especially vitamins B12, B1, B6, B9 (folic acid), and vitamin E, can damage nerves. Excessive intake of vitamin B6 is also harmful to nerves.
• Excessive alcohol consumption: Excessive alcohol consumption over a long period of time directly damages the nerves.
• Infections: Some viruses (e.g. HIV, herpes zoster) and bacterial infections can damage nerves.
• Autoimmune Diseases: In diseases like Guillain-Barré syndrome, lupus, and rheumatoid arthritis, our own body's immune system attacks the nerves.
• Certain medications and toxins: Some chemotherapy drugs for cancer, some antibiotics, and exposure to toxins such as agrochemicals and heavy metals (lead, mercury).
• Trauma: Direct damage to a nerve from an accident or surgery.
• Genetic Conditions: Inherited diseases such as Charcot-Marie-Tooth disease.
• Other medical conditions: kidney disease, liver disease, cancer (tumor pressing on a nerve), and blood vessel problems.

How do you find this, Doctor?

When you see a doctor, he will first ask you a lot of questions about your symptoms, medical history, and whether anyone in your family has had similar illnesses. Then he will do a physical exam and test your neurological function (sensation, muscle strength, reflexes).

In addition, tests such as these can be used to pinpoint the cause:

• Blood tests: To detect things like diabetes, vitamin deficiencies, kidney function, and immune system problems.
• Nerve Conduction Study (NCS) and Electromyogram (EMG): These measure the speed at which messages travel along nerves and the electrical activity of muscles. This is very important in determining if there is nerve damage and where it is located.
• Nerve Biopsy: Sometimes, a small piece of skin, along with a small piece of nerve tissue, is taken and examined under a microscope.
• An MRI scan.

What are the treatments for this?

Treatment depends on the cause of your peripheral neuropathy.

1. Treating the underlying cause:

• If you have diabetes: The most important thing is to control your blood sugar levels well.
• If due to a vitamin deficiency: Provide the relevant vitamins.
• If due to an immune system disease: Administer prescribed medication.
• If it's due to a medication: Your doctor will decide whether to change or stop the medication, if possible.

2. Controlling symptoms:

• Pain medications: Nerve pain is not relieved by ordinary painkillers. There are specific medications for it. Some medications used for epilepsy and depression can be given in low doses to control nerve pain to a great extent.
• Ointments and Patches: There are some creams and patches that can be applied to the area of ​​pain.
• Physical Therapy: Exercises and other treatments help strengthen muscles, improve balance, and reduce pain.
• Special shoes and equipment: Your doctor may recommend special shoes to help prevent injuries for people with reduced sensation in their feet. People who have difficulty walking may need to use a device such as a cane.

When should we seek immediate medical advice? (When to go to the ETU)

Although peripheral neuropathy is not usually immediately life-threatening, some symptoms can be a sign of a serious condition. If you or someone you know has the following symptoms, go to the nearest hospital emergency department (ETU) immediately.