Finding relief for peripheral neuropathy

development of this neuropathy and are probably closely related to diabetic control. There are complex relationships between high blood sugar levels, the enzyme aldosereductase, the formation of You wake up in the middle of the night with sorbitol in the cells, and myoinositol in the tissues, burning and tingling in your feet. The weight of the which have been implicated in the development of sheets makes things worse, so you can forget about neuropathy. Poor blood sugar control may also lead falling asleep again. When you visit your doctor and to glycosylation (attachment of glucose molecules describe your symptoms, he tells you the t problem to proteins) of the myelin coating nerve fibers, and is your nerves. Does he mean that you're under too this may contribute to the development of much stress or that the problem is all in your mind? Absolutely not. You are suffering from a very real Not all cases of peripheral neuropathy in condition known as neuropathy, which is damage to people with diabetes are caused by the diabetes the nerves caused by diabetes. Symptoms of itself. Other disorders may cause it and your diabetic neuropathy are more likely to occur if physician should look for them. These include diabetes has been present for many years, and nutritional disorders (especially vitamin B prevalence increases with increasing duration of deficiencies), alcoholism, collagen vascular diseases diabetes. Symptoms are often related to both short- (such as lupus), some infectious diseases (such as term and long-term blood sugar control. Sixty leprosy), kidney failure, and disorders of the percent of people with poor diabetic control have pituitary and thyroid glands. There are also many symptoms of neuropathy after 20 years, whereas drugs that can cause peripheral neuropathy, only 15% of people with good control for 20 years including allopurinol (used for gout), vinblastine and vincristine (anti-cancer drugs), hydralazine (used for high blood pressure) , isoniazid (for Mononeuritis simplex involves a single nerve with tuberculosis), nitrofurantoin (often used for bladder severe pain, and mononeuritis multiplex involves and kidney infections), some sulfanilamides (a class several nerves. Cranial nerve neuropathies may of antibiotics), and others. If you have symptoms of cause facial or eye abnormalities. Autonomic neuropathy and are taking any of these medications, neuropathies disrupt the working of internal organs, your physician may be able to prescribe alternative causing diarrhea, impotence, stomach bloating, constipation, bladder dysfunction and similar Research published last year using healthy, nondiabetic individuals showed that they could not Peripheral neuropathy, discussed here, may tolerate as much pain when they were given an affect only one nerve but more often affects many. injection of glucose before a pain-perception and It usually starts at the toes, feet, and then legs and pain-tolerance test. In another study, 13 men with spreads to the fingers, hands, and arms in a "glove Type II (non-insulin-dependent) diabetes were and stocking" distribution. Peripheral neuropathy tested for their perception of pain. It was found that may affect only the sensory nerves (which give us compared with nondiabetic individuals, they could the sense of touch) but may also affect motor not sense nonpainful electrical stimulation until it nerves, which control movement and strength. Pain was at a much higher level--yet they perceived pain may be severe or absent, and such sensations as at a much lower level than nondiabetics. These taste may also be affected. This decreased sense of findings again suggest that good blood sugar control taste may cause a person to add salt and sugar to his may de- crease the symptoms of peripheral diet in an attempt to regain flavor which, of course, can be harmful to blood pressure and blood sugar SYMPTOMS
Peripheral neuropathy may occur suddenly but more often occurs gradually. Symptoms vary from individual to individual. The more common symptoms are sensations described as dull, aching, weeks. Carbamazepine (Tegretol) is often tingling, numbness, itching, crawling, formication successful in two weeks. Phenazopyridine (like worms crawling in the legs), supersensitivity, (Pyridium) and aspirin together have also worked burning, stabbing, "dead," "woody," "asleep," or for some patients. If you take one of these "walking on air or cotton. " These symptoms are medications and it fails to work, let your physician typically worse at night in people with diabetes, and know--an alternative drug may turn out to be more often cause them to become depressed because of constant discomfort and sleepless nights. Loss of sensation may make a person incapable of telling have read about is sorbinil, which might prove to where his feet are if he can't see them, which may help the discomfort and may be available for cause him to fall when walking in the dark or on general use within the next few years. One of the stairs. Generally, a numb foot may result in more problems with sorbinil is a high incidence of serious consequences than a painful one, since the intolerable side effects. Sorbinil may prove to be numbness may prevent him from feeling foot more useful in preventing neuropathy than treating injuries and taking prompt action to prevent infection or gangrene. (See "Side-stepping Foot Problems" in the Spring 1985 issue of Diabetes neuropathic pain is to interrupt the "gate" that allows pain impulses to pass from the spinal cord into the brain. This treatment, transcutaneous neuropathy is getting better because the pain gives electronic nerve stimulation (TENS) uses a small way to numbness. This is not an improvement--it is device with electrodes that send impulses from the a worsening of the condition. The loss of pain is a skin into the spinal cord to block these pain signals. good sign only if normal sensation returns. Other attempts at blocking pain messages include hypnosis, acupuncture, relaxation techniques, TREATMENT
rhythmic breathing, biofeedback, self-distraction, Four out of five people with neuropathy will have some improvement in their symptoms in 6-18 professionals, these techniques are successful in months. Nonetheless, that seems a long time to wait some patients. Other methods some patients have if you are feeling discomfort. The best course would tried successfully for temporary relief include be to try to avoid it in the first place by getting your dipping the affected part of the body in warm (not blood sugar into control and keeping it there. hot) or cool water, wearing a body stocking or panty Therapy for peripheral neuropathy should hose to decrease sensation from other objects, using include good nutrition to avoid vitamin deficiencies, a foot cradle over the bed to keep sheets from avoiding alcohol and, perhaps, selecting foods that touching the feet at night, and rubbing the affected are rich in myoinositol--one of the chemicals that area with analgesic balm such as Ben Gay. It is very may be important for preventing the development of neuropathy. These foods include nuts, whole grains, appropriate padding, closed toes, and well-fitting cherries, and melons. Do not take myoinositol socks, and observe good nail hygiene. Exercises tablets, since this may cause an overdose, making may help to strengthen some of the muscles that have been weakened by neuropathy. Avoid heating There are several drugs your physician may pads on areas that are numb, because you may get prescribe for diabetic peripheral neuropathy. One is burned without realizing it. Likewise, you should Benadryl, a drug which can be taken at bedtime to not test the water in your bathtub or shower with help alleviate the discomfort and ensure a good your foot or hand if their sensation of temperature is night's sleep. The antidepressant class of drugs, impaired. Rather, you should dip in the upper arm such as amitriptyline (Elavil), trazadone (Desyrel), to test the temperature before climbing in. Although and fluphenazine (Prolixin), may be useful in peripheral neuropathy is currently the most common treating neuropathy as well as depression. complication of diabetes, most people can find Anticonvulsants such as phenytoin (Dilantin) are relief from the symptoms-through good blood sugar often helpful, especially for stabbing pain and, if control and the many modes of therapy available. effective, usually gives good results within two



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Pii: s0014-5793(98)01258-7

The role and source of 5P-deoxyadenosyl radical in a carbon skeletonrearrangement catalyzed by a plant enzymeSandrine Ollagnier, Eric Kervio, Jaènos Reètey*Lehrstuhl fuër Biochemie, Institut fuër Organische Chemie, Universitaët Karlsruhe, Kaiserstr. 12, D-76128 Karlsruhe, GermanyReceived 15 August 1998; received in revised form 24 September 1998Abstract The last step in the biosynthesi

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