Kabelbrand – wenn Nerven Feuer fangen! – Die Polyneuropathie, eine weit verbreitete Erkrankung

Polyneuropathien sind schwerwiegende ernstzunehmende Erkrankungen, welche in den letzten Jahrzehnten ständig und rasant zugenommen haben.

Die betroffenen Patienten erfahren im Verlauf ein zunehmendes Leid durch diese Erkrankung. Neben oft schmerzhaften und unangenehmen Missempfindungen, vornehmlich in den Füssen, werden auch Einschränkungen der Beweglichkeit und Kraft in diesem Bereich, sowie eine Gangunsicherheit, besonders auf unebenen Untergrund bemerkt.

Die bemerkten Missempfindungen der Füße sind im allgemeinen während des Laufens und in Bewegung deutlich geringer ausgeprägt.

Die Polyneuropathien unterteilen sich in Bezug auf ihre Ursachen in drei große Gruppen:

Stoffwechselbedingte oder durch äußere Einflussfaktoren hervorgerufene Polyneuropathien und Polyneuropathien wo eine konkrete Ursache bisher nicht nachzuweisen ist.

Eine seltene zusätzliche Gruppe erfolgt durch Vererbung dieser Erkrankung.

Die Diagnose der Polyneuropathie erfolgt in erster Linie durch die Befragung des Kranken und die klinische Untersuchung.

Zur Diagnosesicherung dienen elektrophysiologische Messungen, die Nervensonographie und oft umfangreiche Laboruntersuchungen sowie in besonderen Fällen auch die Nervenbiopsie.

 

Im Folgenden einige Anmerkungen zum Krankheitsbild:

Polyneuropathien sind generalisierte Erkrankungen des peripheren Nervensystems. Dazu gehören alle außerhalb des zentralen Nervensystems (Gehirn, Rückenmark) liegenden Anteile der motorischen, sensiblen und autonomen Nerven, einschließlich der Hirnnerven.

Polyneuropathien können sich akut (wenige Wochen), subakut (über Monate) oder auch sehr langsam schleichend (über Jahre) entwickeln und haben verschiedene Verteilungsmuster.

Es gibt längenabhänge Polyneuropathien bei denen die Beschwerden an den Füssen oder Händen beginnen, Schwerpunktneuropathien und Multiplex-Neuropathien.
Ferner unterscheidet man zwischen sensiblen, vegetativen und motorischen Neuropathien, die isoliert oder gemischt auftreten können.

Für die Einteilung ist auch der Ort der Schädigung von Bedeutung.

→ neuronal, im Kerngebiet der Nerven
→ axonal, am Nervenkabel
→ demyelinsierend, an den Hüllstrukturen der Nerven wie die Schwann’schen Zellen
….und Markscheide)

Insbesondere bei voranschreitenden Polyneuropathien muss sehr sorgfältig nach den Ursachen gesucht werden.
Dabei bedarf es teilweise einer umfangreichen oder invasiven Diagnostik wobei insbesondere die Labordiagnostik von großer Bedeutung ist.

Beim Grundlabor werden untersucht:

→ Blutzucker, HbA1c
→ Leberwerte, insbesondere Gamma GT
→ Borreliose-Serologie
→ Immunelektrophorese, Immunfixation
→ Rotes Blutbild, (Hb, MCV, MCH)
→ BSG, CRP
→ ACE
→ Cholestrin,Triglyzeride
→ Vitamin B12 (Homocystein i.S., Methylmalonsäurei.U.)
→ Folsäure
→ Liquordiagnostik

Spezielle Untersuchungen bei Neuropathien unbekannter Ursache sind:

→ Schilddrüsenwerte
→ Vaskulitis-Kollagenose-Parameter (ANA, ENA, ANCA)
→ Hepatitis-C-AK
→ Kryoglobuline
→ Nervenantikörper (anti-GM1, anti-GQ 1b, anti-MAG)
→ Paraneoplasie-assoziierte Nervenantikörper (anti-Hu, anti-Yo)
→ Vitamin B1, B6, E Spiegel
→ Nervenbiobsie
→ Epidermale Hautbiopsie

Im folgenden Artikel von Julia Sasse werden weitere ausführliche Informationen zitiert:

 

„Zitat“

Polyneuropathie

Von Julia Sasse 

Bei einer Polyneuropathie handelt es sich um eine Schädigung von peripheren Nerven. Es können verschiedene Nerven betroffen sein und etwa die Muskelversorgung oder die Sensibilität der Haut in Mitleidenschaft ziehen. Zu den häufigsten Ursachen der Nervenschädigung gehören Diabetes mellitus und anhaltender Alkoholmissbrauch. Lesen Sie hier alles Wichtige über die Polyneuropathie.

 

Polyneuropathie: Beschreibung

Der Oberbegriff Polyneuropathie steht für Erkrankungen mehrerer (poly = viele) peripherer Nerven. Das Rückenmark und das Gehirn als zentrales Nervensystem sind bei einer Polyneuropathie also nicht betroffen. Zu den peripheren Nerven zählen zum Beispiel solche, die den Muskeln ihre Befehle geben, sich zu kontrahieren. Weitere periphere Nerven findet man in der Haut, wo sie für das sensible Empfinden von Berührungen, Temperatur und Vibration verantwortlich sind. Auch autonome Nerven zählen zum peripheren Nervensystem. Sie kontrollieren beispielsweise lebenswichtige Funktionen wie Atmung und Verdauung

Die Polyneuropathie lässt sich nach unterschiedlichen Kriterien einteilen:

Polyneuropathie – Einteilung nach dem Verteilungsmuster der Symptome:

Die Nervenschädigung betrifft in der Regel die vom Rumpf entfernt gelegenen Körperteile (distale Polyneuropathie). Füße und Hände zählen dazu (meist sind die Füße als erstes betroffen). Sehr viel seltener erstreckt sich die Erkrankung auf rumpfnahe Körperteile (proximale Polyneuropathie).

Eine periphere Polyneuropathie an Armen und Beinen wird zudem in eine symmetrische und eine asymmetrische Form unterteilt. Bei der symmetrischen Form treten die Symptome auf beiden Körperseiten (etwa an beiden Füßen) auf, bei der asymmetrischen nur auf einer Seite.

Polyneuropathie – Einteilung nach der betroffenen Nervenfaserqualität:

Zusätzlich wird differenziert, welche Nervenfaserqualität von der Schädigung betroffen ist, also ob motorische, sensible oder autonome Nerven geschädigt sind.

Polyneuropathie – Einteilung nach dem Befall von Markscheide oder Axon:

Ein peripherer Nerv besteht aus mehreren Nervenzellen. Eine Nervenzelle setzt sich zusammen aus einem Zellkörper und einem Nervenfortsatz (Axon). Das Axon kann bis zu einem Meter lang sein. Man kann sich die Nervenfortsätze wie ein Kabel vorstellen. Der Körper schützt seine „Kabel“ mit einer Isolierschicht (Myelinschicht oder Markscheide). Neben seiner Schutzfunktion hat das Myelin noch eine weitere Aufgabe: Es ermöglicht eine schnellere elektrische Erregungsleitung der Signale zwischen den Nervenzellen.

Die sogenannte demyelinisierende Polyneuropathie ist durch den Zerfall der schützenden Myelinschicht gekennzeichnet. Ist dagegen nicht die schützende Markscheide, sondern das Axon selbst betroffen, handelt es sich um eine axonale Polyneuropathie. Besonders bei einer Schädigung des versorgenden Blutgefäßes kommt es zu einer Polyneuropathie, bei der die Myelinscheide und das Axon gleichermaßen betroffen sind.

Polyneuropathie – Einteilung nach der Grunderkrankung:

Eine Nervenschädigung kann genetisch bedingt sein. Des Weiteren unterscheidet man Polyneuropathien nach der zugrundeliegenden Erkrankung:

Diabetische Polyneuropathie: Die diabetische Polyneuropathie ist die häufigste Form von Polyneuropathie. Etwa die Hälfte aller Diabetiker leiden irgendwann unter dieser Nervenschädigung, wobei sowohl Typ-1- als auch Typ-2-Diabetiker betroffen sein können. Ursache der Nervenschädigung ist ein schlecht eingestellter Diabetes beziehungsweise ein dauerhaft zu hoher Blutzuckerwert. Es gibt verschiedene Erklärungsansätze, wie die Nerven im Detail geschädigt werden.

Es wird vermutet, dass bei einem zu hohen Blutzucker die Zuckermoleküle mit verschiedenen Proteinen reaktive Verbindungen eingehen. Diese Zucker-Eiweiß-Komplexe greifen die Nervenzellen an und schädigen diese mit der Zeit unwiderruflich.

Zudem weisen schlecht eingestellte Diabetiker vermehrt Entzündungsbotenstoffe im Blut auf. Diese beeinträchtigen den Zellstoffwechsel und somit die Funktion der Nervenzellen.

Ein hoher Blutzucker schädigt auf Dauer besonders ganz kleine Blutgefäße. Wenn die Blutgefäße, die den Nerv versorgen, zerstört werden, entsteht ebenfalls eine diabetische Polyneuropathie. Meist verläuft diese Nervenschädigung schleichend, und die ersten Symptome zeigen sich nicht sofort.

Formen der Diabetischen Nervenschädigung sind die autonome und die sensomotorische Polyneuropathie.

Toxische Polyneuropathie: Eine toxische Nervenschädigung ist die zweithäufigste Form von Polyneuropathie. Alkohol-Konsum im Übermaß und über einen längeren Zeitraum ist hier oftmals die Ursache (alkoholische Polyneuropathie). Daneben gibt es noch weitere Auslöser für eine Toxische Polyneuropathie wie Schwermetalle (Blei, Arsen), Medikamente (Vitamin B12 hochdosiert, Vinca-Alkaloide) und Drogenkonsum. Die toxische Nervenschädigung betrifft in der Regel zuerst die Finger und Zehen.

 

Polyneuropathie: Symptome

Alles Wichtige über die Anzeichen einer Nervenschädigung lesen Sie im Beitrag Polyneuropathie-Symptome.

Polyneuropathie: Ursachen und Risikofaktoren

Da die Polyneuropathie in der Regel die Folge einer anderen Grunderkrankung ist, sollte stets an folgende Auslöser gedacht werden:

  • Stoffwechselerkrankungen (Diabetes mellitus)
  • Gifte (Alkohol, Medikamente, Schwermetalle)
  • Autoimmunreaktionen (hierbei greift das eigene Immunsystem die Nervenzellen an)
  • Tumorerkrankungen (können durch verdrängendes Wachstum die Versorgung des Nervs abdrücken)
  • Erhöhter Blutdruck
  • Vitaminmangel (Vitamin B12, Vitamin B1 und Vitamin B6)

 

Polyneuropathie: Untersuchungen und Diagnose

Bei Verdacht auf eine Polyneuropathie erhebt der Arzt zunächst die Krankengeschichte (Anamnese). Anschließend kann er verschiedene Tests durchführen:

Bei einer Elektroneurografie (ENG) wird die Nervenleitgeschwindigkeit gemessen. Der Untersucher setzt dafür einen kleinen elektronischen Impuls an mindestens zwei verschiedenen Stellen eines Nervs und misst die Zeit bis zur Reaktion (Kontraktion) des dazugehörigen Muskels. Bei der Polyneuropathie ist diese Nervenleitgeschwindigkeit meist herabgesetzt.

Die Elektromyografie (EMG) ist eine Untersuchung zur Bestimmung der elektrischen Muskelaktivität. Dazu kann eine spezielle feine Nadel-Elektrode durch den Muskel gestochen werden. Sie kann die Aktivität des Muskels in Ruhe sowie in Aktivität messen. Bei einer veränderten langsamen Reizantwort erhärtet sich der Verdacht auf eine Polyneuropathie mit motorischer Nervenbeteiligung.

Ein weiteres diagnostisches Mittel stellt die quantitative sensorische Untersuchung dar. Hiermit lässt sich das Druck- und Temperaturempfinden messen: Mithilfe einer Thermo-Elektrode wird die Warm-Kalt-Schwelle des Patienten ermittelt. Einen Empfindlichkeitsverlust durch die Polyneuropathie lässt sich mit dieser Untersuchung somit gut nachweisen. Allerdings ist diese Untersuchungsmethode sehr zeitaufwändig und erfordert eine hohe Konzentration der Beteiligten. Daher handelt es sich hierbei noch nicht um eine Routineuntersuchung.

Eine Elektrokardiografie (EKG) kann Auskunft darüber geben, ob die autonomen Nervenfasern des Herzens von der Nervenschädigung betroffen sind.

Bei einer Nervenbiopsie wird über einen kleinen Hautschnitt eine Nervengewebeprobe entnommen. Die Gewebeprobe wird anschließend unter dem Mikroskop diagnostisch begutachtet. Dieses Verfahren wird aber nur sehr selten zur Abklärung einer Polyneuropathie angewendet.

 

Polyneuropathie: Behandlung

An erster Stelle im Versuch der Polyneuropathie-Heilung steht immer die Therapie der Grunderkrankung.

Die Schmerztherapie ist ebenfalls ein essentieller Bestandteil der Polyneuropathie-Therapie. Denn viele Betroffene leiden sehr unter den brennenden Schmerzen, die mit der Nervenschädigung einhergehen.

Medikamentöse Polyneuropathie-Therapie

Das Medikament der ersten Wahl ist ein einfaches Schmerzmittel wie Acetylsalicylsäure. Es gibt noch andere Schmerzmittel, die bei der Polyneuropathie helfen können. Die Wirksamkeit muss jedoch unter ärztlicher Aufsicht erprobt werden. Opioide sind sehr starke Schmerzmedikamente, die aber schnell abhängig machen können. Die Einnahme muss daher vom Arzt genau überwacht werden.

Einige Patienten berichten von einer Besserung der Symptome durch bestimmte Antidepressiva wie beispielsweise Amytryptilin.

Antiepileptische Medikamente (Gabapentin oder Carbamazepin) dämpfen die Erregbarkeit von Muskelzellen. Deshalb werden sie auch vorrangig zur Vorbeugung von Krampfanfällen eingesetzt. Bei einer Polyneuropathie können diese Medikamente zusätzlich die Schmerzen lindern.

Transkutane elektrische Nervenstimulation (TENS)

Eine Stimulation der Nerven in der betroffenen Hautregion kann die Schmerzen einer Polyneuropathie bessern. Dazu wird eine kleine Elektrode auf der schmerzhaften Hautregion positioniert, über die kleine elektrische Impulse abgegeben werden. Die Hautnerven werden also elektrisch gereizt.

Diese Wirksamkeit der TENS ist wissenschaftlich noch nicht eindeutig belegt. Es gibt jedoch zahlreiche Patienten, die durch diese Behandlung eine Besserung ihrer Polyneuropathie-Symptome erfahren. Ein möglicher Erklärungsansatz dafür ist, dass die abgegebenen elektrischen Impulse schneller sind als die Schmerzreize, also vor diesen das Rückenmark erreichen, wo sie die Schmerzweiterleitung blockieren.

Einer anderen Theorie zufolge setzen die elektrischen Impulse körpereigene Botenstoffe (Endorphine) frei. Endorphine gelten nicht nur als „Glückshormone“, sondern ihnen wird auch eine schützende (protektive) Funktion zugeschrieben.

Physikalische Therapie

Die Physikalische Therapie nutzt Verfahren wie Wärme, Gleichstrom oder Infrarot-Licht, um sensible und motorische Störungen aufgrund einer Polyneuropathie zu beheben. So fördern Krankengymnastik, Wechselbäder oder Elektrobehandlungen die Durchblutung und stärken geschwächte Muskeln.

Polyneuropathie: Krankheitsverlauf und Prognose

So gut verschiedene Therapien auch die Beschwerden lindern können, möchten viele Patienten dennoch wissen: Ist Polyneuropathie heilbar? Grundsätzlich gilt: Je früher die Nervenschädigung erkannt wird, desto besser ist die Prognose. Der Polyneuropathie-Verlauf kann aber nur dann positiv beeinflusst werden, wenn die Grunderkrankung diagnostiziert ist und behandelt wird. Entscheidend ist außerdem, wie weit die Polyneuropathie zum Zeitpunkt der Diagnose bereits fortgeschritten ist und ob schon irreversible Schäden entstanden sind. Da die Polyneuropathie oftmals lange Zeit symptomlos verläuft, sollten erste Anzeichen stets ernst genommen werden.

Leider ist in vielen Fällen ist eine komplette Heilung nicht mehr möglich. Dann geht es darum, den Patienten bestmöglich dabei zu unterstützen, mit der Polyneuropathie zu leben. Dabei helfen die richtige Schmerztherapie und unterstützende Verfahren wie Krankengymnastik oder Wechselbäder.

Polyneuropathie – Symptome

 

Polyneuropathie-Symptomevariieren je nachdem, welche Nervenfaserqualität geschädigt ist. So kann etwa eine Muskelerschlaffung der Beine auftreten, wenn motorische Nervenfasern geschädigt sind. Auch Sensibilitätsstörungen der Haut treten häufig auf. Das Schmerzempfinden und das Temperaturempfinden können herabgesetzt sein. Sind autonome Nervenfasern betroffen, kann es zu einer Beeinträchtigung lebenswichtiger Organfunktionen kommen, etwa von Lunge oder Herz. Erfahren Sie alles Wichtige über Polyneuropathie-Symptome.

Polyneuropathie-Symptome: Allgemein

Die Polyneuropathie-Symptome sind davon abhängig, welche Nerven geschädigt sind. Die Erkrankung kann sich demnach in sensiblen, autonomen oder motorischen Störungen äußern. Je stärker fortgeschritten die Nervenschädigung ist, desto langsamer können die Nervensignale weitergeleitet werden. Bei einer schweren Polyneuropathie kann der Nerv eventuell gar keine Befehle mehr weiterleiten, und das zu versorgende Gewebe degeneriert daraufhin. Denn nur eine regelmäßige Aktivierung hält die Zellen aufrecht. Gewebe, das vom Körper nicht gebraucht oder genutzt wird, stellt sonst eine unnötige Energieverschwendung für den Körper dar. Muskeln degenerieren dabei besonders schnell (Muskelatrophie).

Die Polyneuropathie Symptome werden unter anderem nach ihrer Lokalisation klassifiziert. Wenn beide Füße oder beide Arme betroffen sind, spricht man von einer symmetrischen Polyneuropathie. Bei einseitigem Befall handelt es sich um eine asymmetrische Polyneuropathie.

Polyneuropathie-Symptome bei Schädigung sensibler Nerven

Nerven, die von der Haut zum Gehirn führen, sind von sensibler Qualität. Das Gehirn erhält über sie Informationen über Berührungen, Temperatur oder Vibrationen. Wenn die Sensibilität durch eine Polyneuropathie gestört wird, leidet oftmals die Wahrnehmung in Armen und Beinen. Die Zehen sind häufig als erstes betroffen. Es kommt zu Missempfindungen, Kribbeln oder auch stechenden, brennenden Schmerzen. Die Polyneuropathie kann außerdem zu einem Schwellungsgefühl führen.

Durch ein herabgesetztes Temperaturempfinden, kann es leichter zu Verletzungen kommen. Das Schmerzempfinden kann bei einer ausgeprägten Polyneuropathie ebenfalls eingeschränkt sein und das Verletzungsrisiko erhöhen.

Polyneuropathie-Symptome bei Schädigung motorischer Nerven

Motorische Nerven leiten Befehle vom Gehirn zu den Skelettmuskeln. Die Befehle veranlassen einen Muskel, sich zu kontrahieren. Bei einer motorischen Polyneuropathie kann es dementsprechend zum Ausfall bestimmter Muskelgruppen kommen. Die Muskeln können je nach Schweregrad der Polyneuropathie an Kraft verlieren, oder es kommt zu Muskelkrämpfen. Weitere Polyneuropathie-Symptome bei Schädigung motorischer Nerven sind Lähmungen und als Folge der Minderversorgung und der mangelnden Bewegung Muskelschwund.

Polyneuropathie-Symptome bei Schädigung autonomer Nerven

Die autonomen (vegetativen) Nerven versorgen die inneren Organe (wie Herz, Lunge, Magen-Darm-Trakt, Blase) mit Funktionsbefehlen. Siesind nicht dem Willen unterworfen. Man kann also nicht zum Beispiel gezielt entscheiden, ob der Herzmuskel sich jetzt kontrahieren soll oder nicht.

Zieht eine Polyneuropathie die autonomen Nerven in Mitleidenschaft, kann es zu lebensbedrohlichen Symptomen kommen. Wenn der Darm beispielsweise nicht mehr richtig arbeitet, kann es zu Durchfall oder Verstopfung kommen. Bei der Lunge kann die Nervenschädigung zu einem Atemstillstand führen, und auch am Herzen kann die Polyneuropathie schwerwiegende Schäden verursachen.

Die wichtigsten Polyneuropathie-Symptome im Überblick

Zusammengefasst sind die wichtigsten Polyneuropathie-Symptome:

  • Kribbeln, Taubheitsgefühl oder Schmerzen in Armen und Beinen
  • Schnelle Ermüdung der Beine
  • Koordinationsschwierigkeiten und Gehstörungen
  • Störungen der Feinmotorik
  • Muskellähmungen
  • Störungen der Blasen- oder Darmentleerung

 

Diabetische Polyneuropathie: Symptome

Bei der Diabetischen Polyneuropathie werden in der Regel die sensiblen Nervenfasern als erstes geschädigt. Dementsprechend treten oftmals ein Taubheitsgefühl oder Kribbeln in den Beinen auf. Die Patienten berichten zudem oft von einem brennenden Schmerz in den Füßen (Burning-Feet-Syndrom). Dabei klagen die Betroffenen besonders nachts in Ruhe über eine Verschlimmerung der Polyneuropathie-Symptome. Das Gewicht und die Berührung der Bettdecke sind für den Patienten manchmal kaum zum Aushalten.

Die Diabetische Polyneuropathie kann aber auch zu einer Verminderung der Schmerzempfindung führen. Kleine Verletzungen werden von den Patienten dann oft nicht bemerkt. Weil zusätzlich bei Diabetes oft die Blutzirkulation beeinträchtigt ist, können so schlecht heilende Wunden entstehen (diabetisches Fußsyndrom). Das betroffene Gewebe kann sogar absterben. Die meisten Diabetiker sind an beiden Füßen oder Beinen von der Polyneuropathie betroffen.

Als weitere Polyneuropathie-Symptome können sich im Verlauf der Krankheit auch autonome Störungen einstellen. Möglich sind zum Beispiel Schluckstörungen, Erbrechen und abwechselnd Durchfall und Verstopfung. Auch unkontrolliertes Wasserlassen sowie Potenzstörungen bei Männern können sich als Polyneuropathie-Symptome entpuppen.

Alkoholische Polyneuropathie: Symptome

Bei der häufigen alkoholischen Polyneuropathie werden Nerven durch den Alkohol geschädigt. Außerdem liegt bei vielen Alkoholikern eine Mangelernährung vor. Besonders schädlich unter anderem für die Nerven ist dabei eine unzureichende Aufnahme von Vitamin B12. Die alkoholische Nervenschädigung schreitet in der Regel langsam voran.

Polyneuropathie-Symptome bei Alkoholikern zeigen sich vor allem an den Beinen, und zwar an beiden (symmetrische Polyneuropathie). Hier kann es etwa zu Schmerzen, Missempfindungen, Sensibilitätsstörungen, Muskelschwund und schweren Muskelerschlaffungen (Paresen) kommen, wodurch die Patienten nicht mehr stehen können. In schweren Fällen zeigen sich Polyneuropathie-Symptome auch im Augenbereich wie etwa Pupillenstörungen und eventuell Augenmuskellähmungen. In einigen Fällen verläuft eine alkoholische Polyneuropathie aber auch ohne Symptome.

Rasch handeln

Polyneuropathie-Symptome sollten umgehend von einem Arzt abgeklärt werden. Bei frühzeitigem Erkennen der Symptome kann rasch eine geeignete Behandlung eingeleitet werden, die den Verlauf der Erkrankung positiv beeinflussen kann. So lassen sich etwa mit einer Veränderung der Lebensgewohnheiten oder physikalischer Therapie die oft sehr belastenden Polyneuropathie-Symptome bessern.

 

9.389 Gedanken zu „Kabelbrand – wenn Nerven Feuer fangen! – Die Polyneuropathie, eine weit verbreitete Erkrankung

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