Perspectives for Better Neurological Care

Dr. Adams
Dr. C. Robert Adams
Board Certified Neurologist
109 N. 15th St., Ste 14, Norfolk Ne. 68701 Phone: 402-371-0226
3900 Dakota Ave, South Sioux City, Ne. 68776 Toll Free: 888-516-2398
Brodstone Memorial Hospital, 520 E. 10th, Superior, Ne. 68978

The peripheral nerves are the “wiring” for our body, coordinating signals between the central nervous system, brain, and spinal cord with the skin, muscles, and organs. The nerves consist of a central core called of the axon and an outer “insulation” called the myelin sheath. Diseases of either one of these parts can cause problems with nerve conductions and the messages coming out from the brain to the body. Diseased nerves are like “rusty wiring” that impairs the impulse or message to the skin, muscles, and organs that they ordinarily regulate. Nerve injuries can be focal, often called a nerve entrapment, or transection or can be diffuse involving multiple nerves in the body, so-called peripheral polyneuropathy.

Focal or localized neuropathies (entrapment):

  1. Carpal tunnel syndrome causing hand numbness and tingling, particularly of the thumb and second, third, and fourth fingers as well as hand weakness and arm and shoulder discomfort.
  2. Ulnar nerve (“funny bone nerve”) or tardive ulnar palsy coursing through the elbow causing numbness and tingling of the fourth and fifth fingers and muscle dysfunction of the hand or “claw hand.”
  3. Cervical radiculopathy (pinched nerves in the neck) causing arm pain, numbness, tingling, and weakness.
  4. Lumbar radiculopathy (pinched nerves in the back) causing leg pain, numbness, tingling, and weakness.
  5. Sciatic nerve trauma or physical injury to the sciatic nerve as it courses through the hip or buttock as from motor vehicle accidents, surgical injury (stretch), injection, etc.
  6. Brachial plexus stretch or compression of the nerves going through the armpit to the arm resulting in severe and possibly permanent arm paralysis, numbness, and pain.
  7. Optic neuropathy or disturbed function of the nerve providing vision to the eye such as in multiple sclerosis for instance.
  8. Bell’s palsy causing facial paralysis usually on one side.

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Diffuse peripheral polyneuropathy:

  1. Affects all the body’s nerves.
  2. Symptoms include foot and leg numbness, tingling, pain, cramping, and weakness. The toes or feet are often very symptomatic due to the length of the nerves from the spine to the feet. The hands can be also affected, sometimes manifested by the onset of carpal tunnel entrapment or ulnar neuropathy at the elbow.

Etiologies of nerve injury include:

  1. Physical trauma.
  2. Diabetes.
  3. Vitamin deficiency (especially B12, thiamin, and folic acid).
  4. Alcoholism.
  5. Drug toxicity (such as with chemotherapy and prescribed medications with toxic side effects).
  6. Infectious processes (such as shingles or Guillain-Barré syndrome).
  7. Inflammatory conditions (such as from autoimmune disease such as lupus or rheumatoid arthritis).
  8. Hereditary or mutated conditions (such as Friedreich ataxia and neurofibromatosis).
  9. Radiation treatment side effects.
  10. Developmental abnormalities (cerebral palsy).

Diagnostic evaluation:

  1. Examination by a neurologist who can identify the disease processes and injuries.
  2. Electrophysiologic testing such as by nerve conduction velocities (mild shock to stimulate nerves) and electromyography (“acupuncture” like examination to look at muscle electrical activity).
  3. MRI imaging to delineate structural cause of injury such as for a pinched nerve.
  4. Blood testing to screen for diabetes, thyroid disease, vitamin deficiency, and infectious-inflammatory states.
  5. Biopsy of nerve or muscle for pathology evaluation.
  6. Genetic testing.

Treatment:

  1. Peripheral polyneuropathy -- “correction” of systemic condition by a neurologist, internal medicine specialist, or family practice physician.
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  • Diabetic treatment might require dietary change, weight loss, and medications.
  • B12 or other types of vitamin shots.
  • Elimination of alcohol.
  • Recognition of “poisonous” side effects by pharmacologic drugs (chemotherapy and other commonly used prescriptions).
    1. Focal nerve entrapment or injuries sometimes require surgery.
    1. Carpal tunnel release at the wrist.
    2. Ulnar nerve release at the elbow.
    3. Neck or back operation to relieve pinched-nerve pressure.
    4. Reattachment or connection of nerves in cases of severe trauma.

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    1. Palliation of pain.
    1. Antineuralgic medication.
      1. Antidepressant medication such as amitriptyline; selective serotonin norepinephrine reuptake inhibitors such as Effexor, Pristiq, Cymbalta, and Savella; and, anticonvulsant agents such as gabapentin (Neurontin) and pregabalin (Lyrica).
    2. Local or systemic injection of anesthetics and/or cortisone steroids.
    3. Elimination of smoking, which “chokes off” the circulation to the arms and legs.
    4. Diet additives to improve the vitality of the nerves as with supplements (alpha lipoic acid, coenzyme Q10, etc.)
    5. Medications to improve peripheral blood supply and to help facilitate healing of the nerves as with cilostazol (Pletal), pentoxifylline (Trental), gingko, etc.