If you read the NeuropathyDR® blog frequently, you know that we tend to focus on bringing you the latest research and methods as they apply to treating neuropathy pain. As you are aware, though, with peripheral neuropathy, pain is only one component. This week, we’re going to talk about how neuropathy can affect a patient’s muscles, also called motor neuropathy.
There are essentially three kinds of motor neuropathy. The first is the overall weakening effect of the muscles, especially in a patient’s extremities, which often accompanies peripheral neuropathy. This can occur because the nerves which control motor function in the muscles have become damaged, or—in the case of a compression neuropathy—constricted. The second kind is called multifocal motor neuropathy, and takes place when a patient’s immune system itself begins to attack their own nerves, as can happen after a series of infections or after an illness. The third kind is Hereditary Motor Sensory Neuropathy, which, as the name suggests, is genetic in nature. Hereditary Motor Sensory Neuropathy, or HMSN, occurs when there is a naturally-occurring deterioration in the nerves that control a patient’s muscles, causing those muscles to not be used, become weak, or even atrophy.
Motor neuropathy usually starts in the hands and feet, and can affect the full extension of a patient’s fingers and toes. In addition to the dexterity problems this obviously causes, it often also has a visual appearance of “clawlike” fingers. The condition is degenerative, getting worse over a period of months and years. Twitching and spasms can also happen in affected limbs. While motor issues associated with peripheral neuropathy usually accompany pain, tingling, and numbness, multifocal motor neuropathy involves no pain (only the motor nerves are affected). Generally, none of the varieties of motor neuropathy are life-threatening. Nevertheless, they can all severely impact your patients’ comfort and quality of life, especially if they are left untreated.
When we met our patient Robert, he complained of a steady and declining loss of strength in his feet, which he had experienced over the past 4 years. Robert had had cancer during that time, culminating in having his prostate removed. His motor neuropathy caused Robert to have trouble walking or standing for long periods, and he even had trouble feeling his feet on some occasions. He also complained of shooting pain, tingling, and soreness in his feet, all typical calling cards of peripheral neuropathy. Since in cases of multifocal motor neuropathy, the sensory nerves are usually unaffected, Robert’s pain and numbness ruled that out. Sure enough, when we performed a battery of tests, we found that Robert’s sensation to vibration was all but absent in several places on his feet.
Robert did not respond with the typical level of relief we usually see after treating a patient with electro-stimulation. Over the course of three treatment sessions, Robert’s level of strength and comfort in his feet did not change in any meaningful way. While this is unusual, it highlights an important theme: neuropathy is a complex problem with many symptoms and manifestations, and no single therapy technique or tool—even those with a very high rate of success—can stand on their own as a complete treatment. For us to help our patients effectively, we have to encourage broader, overall adjustments to their lifestyle.
We designed just such a treatment for Robert, intended to produce more long-term benefit, as his short-term progress was not substantial. Motor neuropathies require an extensive level of treatment, sometimes pharmaceutical and sometimes homeopathic, and usually involving some level of regular exercise and controlled diet. Robert is currently improving steadily, and is seeing his NeuropathyDR® clinician as prescribed to monitor his condition and progress.
If your patients are complaining of weakness or pain in their limbs, they might have peripheral neuropathy. If so, we can help you provide the best care possible. Contact NeuropathyDR® right away and we will help you answer their questions and train you to provide therapy and treatment for specific neuropathy symptoms. We can even put patients in touch with you who will benefit from your help managing their neuropathy.