Metabolic neuropathies are nerve disorders that occur with diseases that disrupt the chemical processes in the body.
In some cases, nerve damage is caused by the inability to properly use energy in the body -- often due to a nutritional deficiency. In other cases, dangerous substances (toxins) build up in the body and damage nerves.
Diabetes is one of the most common causes of metabolic neuropathies. People who are at the highest risk of nerve damage from diabetes include:
Other common metabolic causes of neuropathies include:
Some metabolic disorders are passed down through families (inherited), while others develop due to various diseases.
These symptoms occur because nerves cannot send proper signals to and from your brain:
Usually, these symptoms start in the toes and feet and move up the legs, eventually affecting the hands and arms.
An exam may show:
Abnormal findings on any of these tests can indicate that you have a neuropathy.
Tests used to detect most metabolic neuropathies:
For most metabolic neuropathies, the best treatment is to correct the metabolic problem.
Vitamin deficiencies are treated with diet or injections. Abnormal blood sugar or thyroid function may need medication to correct the problem. Alcoholic neuropathy is treated with alcohol abstinence.
In some cases, pain is treated with medications that reduce abnormal pain signals from the nerves (duloxetine, gabapentin, pregabalin). Lotions, creams, or medicated patches can provide relief in some cases.
Clinical trials of new medications include antioxidants, neuroprotectants, insulin-like drugs, and aldose reductase inhibitors.
Weakness is often treated with physical therapy. You may need to learn how to use a cane or walker if your balance is affected. You may need special braces on the ankles to walk better.
For additional information and support, see www.neuropathy.org and http://diabetes.niddk.nih.gov/DM/pubs/neuropathies.
The outlook mainly depends on the cause of the disorder. In some cases, the problem can easily be treated. In other cases, the metabolic problem cannot be controlled and nerves may continue to become damaged.
Maintaining a healthy lifestyle can reduce the risk of neuropathy.
If you already have a metabolic problem, regular doctor visits can help control the problem and reduce the chance of further nerve damage.
Patients who already have metabolic neuropathy can reduce the risk of some complications. A foot doctor (podiatrist) can teach you how to inspect your feet for signs of injury and infection. Proper fitting shoes can lessen the chance of skin breakdown in sensitive areas of the feet.
Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 446.