Re: Periphral Neuropathy and lack of balance
Re: Periphral Neuropathy and lack of balance
Posted by CCF M.D. on May 16, 1997 at 08:12:19:
In Reply to: Periphral Neuropathy and lack of balance posted by Theodore McMullen on May 12, 1997 at 12:52:12:
: I have been diagnosed with periphral neuropaty, a
condition that I have had for several years. The effects
appear to be increasing, ie: difficulty in walking, loss
of muscle mass, inability to negotiate stairs and
general weaknees of the lower limbs.
Lately I have been experiencing a lack of balance, quite
severe at times. I am 69 years of age, but do not believe
this to be age related.
Could this symptom be attributed to the PN?
Thank you; Ted Ted, Thank you for your interesting question that nicely highlights some
of the complexities of the peripheral nervous system. As a peripheral
neuropathy progresses, it typically affects more and more sensory fibers in
the affected nerves. Some of these fobers are larger and control one's
ability to sense where one's joints and muscles are in space. Loss of these
fibers gradually causes difficulty with things like sensing the contour of
the ground one is walking on, so that for example, you might not be able
to feel a crack in the sidewalk and accidentally trip. This type of loss of
sensation can become so severe that you have to literally stare at your feet
to visually compensate for the lack of ability to FEEL where your feet/legs
are. This type of sensory loss is most pronounced at night or in the dark
where the ability to compensate with vision is most limited. A second type
of fiber that helps send the corrdination centers of the brain information
are the cerebellar sensory fibers. These, however, are
deliverers of UNconscious sensory information and the loss of them
causes one to feel wobbly or even drunk (alcohol temporarily affects the
part of the brain they send messages to when consumed.) They are also
involved in catching yourself if you are pushed or trip, and impairment of
them would make you more likely to fall for this reason. A third type of
sensory fiber is the very SMALL nerve fibers that send messages about
PAIN and TEMPERATURE to your brain. Involvement of these fibers by
the neuropathy produces burning pain and prickling, and sensations of
cold, followed eventually by anesthesia to pain and cold as the last of the
nerve fibers are destroyed. This is the most common thing that people with
neuropathy complain about in general, and is often especially bothersome
at night. A final problem that may also develop as a result of damage to
these smaller nerve fibers are so-called autonomic changes. Autonomic
fibers control things like blood pressure, heart rate, breathing, intestinal
movement, and
sexual function. Damage to them may cause so-called orthostatic
hypotension, a condition where your blood pressure drops an abnormal
amount when you go from lying down to sitting, or even worse, standing.
30 seconds to 2 minutes later, you feel like you want to faint, and
sometimes do if you don't lie down fast enough. A combination of
impairment of any 2 of these sets of nerve fibers can cause a person to
perceive significant problems with balance like those you describe. If your
neuropathy involves MOTOR fibers as well, then weakness can also occur
as muscle fibers die from lack of nerve supply as the fibers that go to them
are slowly destroyed by the neuropathy. This combination of weakness
with sensory input problems is particularly dangerous in terms of risk of
falls and injury. Some types of neuropathies are connected to underlying
diseases like diabetes, whereas in other cases the cause is never known. If
you have not had a very comprehensive investigation to explore the cause
of your neuropathy, I
would strongly suggest that you do so, since it sounds like your
neuropathy is getting out of hand and threatening to cause significant
impairment in your daily living and functioning. Tests used in such an
investigation may include an EMG, a muscle and nerve biopsy, and certain
blood tests. The Cleveland Clinic has one of the world's most respected
neuromuscular centers with several specialists that deal with this sort of
thimg for a living. If you would be interested in a second opinion about
your neuropathy here in Cleveland, our appointment number is
1-800-223-2273 extension 45559, or 216-444-5559. I would recommend
Dr. Kerry Levin or Dr. Robert Shields or Dr. Erik Pioro for this sort of
problem. I hope this information is useful to you. You are correct--- your
symptoms are very likely secondary to the neuropathy, not "old age".
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