Polyneuropathie

Polyneuropathy is a syndrome in which many peripheral nerves are damaged simultaneously. It most often presents as a symmetric, distal sensorimotor neuropathy that begins in the feet and hands, but it can involve autonomic fibers and vary in tempo from acute to chronic. The term polyneuropathie is used in several languages and refers to the same condition.

Etiology and classification: Causes are diverse. Major categories include diabetes and other metabolic disorders, nutritional deficiencies (notably vitamin B12), alcohol and other toxins, autoimmune/inflammatory diseases (CIDP, systemic vasculitis), infections (HIV, hepatitis), renal or liver disease, and hereditary neuropathies (Charcot–Marie–Tooth). Pathologically, polyneuropathy can be primarily axonal or demyelinating and may be acute, subacute, or chronic.

Clinical assessment and diagnosis: History and examination focus on sensory loss, paresthesias, weakness, and autonomic symptoms. Nerve conduction studies and electromyography distinguish axonal from demyelinating processes. Laboratory workup targets common causes (glucose control, vitamin levels, thyroid function, liver and renal tests, infectious serologies). Genetic testing is considered for hereditary forms. In some cases, nerve biopsy or MRI is indicated.

Management and prognosis: Treatment aims at identifying and addressing the underlying cause when possible, avoiding neurotoxins, and relieving symptoms. Neuropathic pain is commonly treated with gabapentinoids, SNRIs, or tricyclic antidepressants; physical therapy and occupational therapy help maintain function; safety measures reduce fall risk. The prognosis varies with etiology and severity; some patients stabilize or improve, while others have chronic or progressive disease.