Modern views on the differential diagnosis and treatment of polyneuropathy

O.O. Kopchak


The article presents the clinical characteristics of polyneuropathies in various diseases and pathological conditions; the list of examinations for the diagnostic search for the causes of polyneuropathy, algorithm for differential diagnosis of polyneuropathies. The place of B vitamins in comprehensive therapy of polyneuropathies is considered.


polyneuropathy; clinical picture; diagnosis; treatment; B vitamins


Hakim M., Kurniani N., Pinzon R., Tugasworo D., Basuki M., Haddani H., Pambudi P., Fithrie A., Wuysang A. Management of peripheral neuropathy symptoms with a fixed dose combination of high-dose vitamin B1, B6 and B12: A 12-week prospective non-interventional study in Indonesia. Asian Journal of Medical Sciences. 2018. 9(1). 32-40. URL:

Head K.A. Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern. Med. Rev. 2006. 11(4). P. 294-329.

Watson J.C., Dyck P.J.B. Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. Mayo Clin. Proc. 2015. 90(7). P. 940-951 URL:

Mattle H., Mumenthaler M. Fundamentals of Neurology: An Illustrated Guide. 2nd ed. Berlin: Thieme, 2017. 456 pp. 567 ill.

Barohn R.J., Amato A.A. Pattern-recognition approach to neuropathy and neuronopathy. Neurol. Clin. 2013. 31. P. 343-61.

Yu H.-J., Koh S.-H. Overview of symptoms, pathogenesis, diagnosis, treatment, and prognosis of various acquired polyneuropathies. Hanyang. Med. Rev. 2017. 37. P. 34-39. URL: pISSN 1738-429X eISSN 2234-4446.

American Diabetes Association. Standards of medical care in diabetes 2014. Diabetes Care. 2014. 37 (suppl. 1). S14-S80.

Perkins B.A., Olaleye D., Zinman B., Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001. 24(2). P. 250-256.

Azpiroz F., Malagelada C. Diabetic neuropathy in the gut: pathogenesis and diagnosis. Diabetologia. 2016. 59(3). P. 404-408.

Azhary H., Farooq M.U., Bhanushali M., Majid A., Kas-sab M.Y. Peripheral neuropathy: differential diagnosis and management. Am. Fam. Physician. 2010. 81(7). P. 887-92.

Miranda-Massari J.R., Gonzalez M.J., Jimenez F.J. et al. Metabolic correction in the management of diabetic peripheral neuropathy: improving clinical results beyond symptom control. Curr. Clin. Pharmacol. 2011. 6(4). P. 260-273.

England J.D., Gronseth G.S., Franklin G. et al. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of laboratory and genetic testing (an evidence-based review); report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology. 2009. 72(2). P. 185-192

Tesfaye S., Boulton A.J., Dyck P.J. et al. Diabetic neuropathies:update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010. 33(10). P. 2285-2293.

Boulton A.J., Vinik A.I., Arezzo J.C. et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005. 28(4). P. 956-962. doi:10.2337/diacare.28.4.956

Van Acker K., Bouhassira D., De Bacquer D. et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009. 35(3). P.206-213.

Román-Pintos L.M., Villegas-Rivera G., Rodríguez-Carrizalez A.D., Miranda-Díaz A.G., Cardona-Muñoz E.G. Diabetic Polyneuropathy in Type 2 Diabetes Mellitus: Inflammation, Oxidative Stress, and Mitochondrial Function. J. Diabetes Res. 2016. 2016. 3425617. Published online 2016 Dec 12. doi: 10.1155/2016/3425617.

de Jager J., Kooy A., Lehert P. et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. British Medical Journal. 2010. 340. c2181.

Nervo M., Lubini A., Raimundo F.V. et al. Vitamin B12 in metformin-treated diabetic patients: a cross-sectional studyin Brazil. Revista da Associação Médica Brasileira. 2011. 57(1). P. 46-49.

Ahmed M.A., Muntingh G.L., Rheeder P. Perspectives on Peripheral Neuropathy as a Consequence of Metformin-Induced Vitamin B12 Deficiency in T2DM. Int. J. Endocrinol. 2017. 2017. 2452853. doi: 10.1155/2017/2452853.

American Diabetes Association. Pharmacologic approaches to glycemic treatment. Diabetes Care. 2017. 40(1). S64-S74.

Chin R.L., Sander H.W., Brannagan T.H. et al. Celiac neuropathy. Neurology. 2003. 60(10). P. 1581-1585.

McKeon A., Lennon V.A., Pittock S.J., Kryzer T.J., Murray J. The neurologic significance of celiac disease biomarkers. Neurology. 2014. 83(20). P. 1789-1796.

Kumar N., Gross J.B. Jr, Ahlskog J.E. Copper deficiency ­myelopathy produces a clinical picture like subacute combined dege­neration. Neurology. 2004. 63(1). P. 33-39.

Thaisetthawatkul P., Collazo-Clavell M.L., Sarr M.G., Norell J.E., Dyck P.J. A controlled study of peripheral neuropathy after bariatric surgery. Neurology. 2004. 63(8). Р. 1462-1470.

Saperstein D.S., Katz J.S., Amato A.A., Barohn R.J. Clinical spectrum of chronic acquired demyelinating polyneuropathies. Muscle Nerve. 2001. 24(3). P. 311-324.

Mygland A., Monstad P. Chronic acquired demyelinating symmetric polyneuropathy classified by pattern of weakness. Arch. Neurol. 2003. 60(2). P. 260-264.

Stabler S.P. Vitamin B12 deficiency. N. Engl. J. Med. 2013. 368(2). P. 149-160.

Saperstein D.S., Wolfe G.I., Gronseth G.S. et al. Challenges in the identification of cobalamin-deficiency polyneuropathy. Arch. Neurol. 2003. 60(9). P. 1296-1301.

Smith A.G., Singleton J.R. The diagnostic yield of a standar-dized approach to idiopathic sensory-predominant neuropathy. Arch. Intern. Med. 2004. 164(9). P. 1021-1025.

Morrison B., Chaudhry V. Medication, toxic, and vitamin related neuropathies. Continuum (Minneap. Minn.). 2012. 18(1). P. 139-160.

Windebank A.J., Grisold W. Chemotherapy-induced neuropathy. J. Peripher. Nerv. Syst. 2008. 13(1). P. 27-46.

Braathen G.J., Sand J.C., Lobato A., Høyer H., Russell M.B. Geneticepidemiology of Charcot-Marie-Tooth in the general population. Eur. J. Neurol. 2011. 18(1). P. 39-48.

Saporta M.A. Charcot-Marie-Tooth disease and other inhe-rited neuropathies. Continuum (Minneap. Minn.). 2014. 20 (5, Peri­pheral Nervous System Disorders). P. 1208-1225.

Haanpää M., Attal N., Backonja M. et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011. 152(1). P. 14-27.

Geller M., Oliveira L., Nigri R. et al. B Vitamins for Neuropathy and Neuropathic Pain. Vitam. Miner. 2017. 6. 2. DOI: 10.4172/2376-1318.1000161.

van Hecke O., Austin S.K., Khan R.A. et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014. 155. P. 654-662. doi: 10.1016/j.pain.2013.11.013.

Baron R., Binder A., Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. The Lancet Neuro-logy. 2010. 9. P. 807-819.

Данилов А.Б. Боль смешанного типа. Патофизиологические механизмы — значение для клинической практики. Подходы к диагностике и лечению смешанных типов болевых синдромов. РМЖ. 2014. С. 10-15.

Cohen S.P., Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014. 348. f7656. doi: 10.1136/bmj.f7656.

Basbaum A.I., Bautista D.M., Scherrer G., Julius D. Cellular and molecular mechanisms of pain. Cell. 2009. 139. P. 267-284.

Attal N., Cruccu G., Baron R. et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur. J. Neurol. 2010. 17(9). P. 1113-e88.

Mervaala E., Auranen M., Partanen J.V. Настанова 00781. Полінейропатії. Настанови на засадах доказової медицини. Створені DUODECIM Medical Publications, Ltd. Адаптовані для України групою експертів МОЗ України. 2014.

Chaparro L.E., Wiffen P.J., Moore R.A., Gilron I. Combination pharmacotherapy for the treatment of neuropathic pain in adults. Cochrane Database Syst. Rev. 2012. 7. CD008943. doi: 10.1002/14651858.CD008943.pub2.

Gazoni M.F., Malezan W.R., Santos F.C. B complex vitamins for analgesic therapy. Rev. Dor. Sao Paulo. 2016. 17(1). P. 52-6 DOI 10.5935/1806-0013.20160013.

Maladkar M., Tekchandani C., Dave U. Post-marketing surveillance of fixed dose combination of methylcobalamin, alpha lipoic acid, folic acid, biotin, benfotiamine & vitamin В6-nutripathy for the management of peripheral neuropathy. J. Diabetes Mellitus. 2014. 4. P. 124-32.

Al-Saaeed S.M., Al-Khalisy M.H. The Regenerative Role of Vitamins B1, B6, B12 in Treatment of Peripheral Neuropathy Dr. International Journal of Science and Research. 2017. 6(3). Р. 2411-2415. DOI: 10.21275/ART20171627.

Altun I., Kurutas E.B. Vitamin B complex and vitamin B12 levels after peripheral nerve injury. Neural. Regen. Res. 2016. 11. P. 842-845.

Song X.S., Huang Z.J., Song X.J. Thiamine suppresses thermalhyperalgesia, inhibits hyperexcitability, and lessens alterations of sodium currents in injured, dorsal root ganglion neurons in rats. Anesthesiology. 2009. 110. P. 387-400.

Gadau S., Emanueli C., Van Linthout S. et al. Benfotiamine accelerates the healing of ischaemic diabetic limbs in mice through protein kinase B/Akt-mediated potentiation of angiogenesis and inhibition of apoptosis. Diabetologia. 2006. 49. P. 405-420.

Wu S., Ren J. Benfotiamine alleviates diabetes-induced cerebral oxidative damage independent of advanced glycation end-product, tissue factor and TNF-alpha. Neurosci Lett. 2006. 394. P. 158-162.

Mauro G.L., Martorana U., Cataldo P., Brancato G., Leti-zia G. Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study. Eur. Rev. Med. Pharmacol. Sci. 2000. 4. P. 53-58.

Takeshige C., Ando Y., Ando M. Effects of vitamin B12 and aldosterone on the conduction of sensory and motor nerve impulse. Vitamins. 1971. 44. 272- 282.

Зайченко, А.В., Лыткин Д.В., Коваленко Е.Н. Фармацевтическое обоснование комбинации действующих и вспомогательных веществ в составе препарата Мильгамма® ампулы. Международный неврологический журнал. 2015. № 1(71). С. 138-141.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта