POLYNEUROPATHIES

Abstract

Polyneuropathies are generalized, predominantly symmetric diseases of the peripheral nerves, where pathological changes and clinical manifestations begin in the distal parts of the extremities and gradually spread to the proximal parts. They are classified based on the type of nerve fibers (motor, sensory, autonomic, and mixed), duration (acute, subacute, chronic), type of damage (axonal, demyelinating), and origin (inherited or acquired). The most well-known inherited sensorimotor polyneuropathy is Charcot-Marie-Tooth disease. Acquired polyneuropathies have a wide range of causes, including metabolic, toxic, iatrogenic, inflammatory, autoimmune, paraproteinemia-related polyneuropathies, polyneuropathies associated with systemic diseases, those resulting from vitamin deficiencies (B1, B6, B12, E), malignancies and infectious diseases. Among acquired polyneuropathies, diabetic polyneuropathy is the most common, presenting in various forms with distal symmetric polyneuropathy of large fibers. Its clinical presentation is characterized by symptoms typical of lower motor neuron lesions, divided into negative and positive symptoms depending on the affected fiber types. These symptoms often include muscle weakness and sensory sensations. A distinctive feature is the symmetric distribution of symptoms, resembling a "socks or gloves" pattern in the distal extremities. Diagnosis relies on clinical presentation, disease progression, physical examination, laboratory findings and electrophysiological testing with electromyography. Polyneuropathy treatment involves addressing the underlying disease and alleviating associated symptoms. While medications are commonly employed, they may offer modest effects with notable side effects. Consequently, non-pharmacological treatments, including diverse physical therapy modalities, with kinesiotherapy playing a pivotal role, are crucial. The future of inherited polyneuropathy treatment lies in gene therapy, guided by an enhanced understanding of genetics and biochemical processes.