Mononeuritis multiplex

Alternative names:

mononeuropathy multiplex; multifocal neuropathy

Treatment:

The goals of treatment include treatment of the cause if possible, supportive care to maximize independence, and control of symptoms. This may include control of blood sugar levels for diabetics, nutritional supplementation, or medical treatments of conditions as appropriate.

To maximize self-care and independence; physical therapy, vocational therapy, occupational therapy, and orthopedic interventions may be recommended to promote independence. For example, exercises and retraining may increase muscle strength and control. Appliances such as wheelchairs, braces, and splints may enhance mobility.

Safety is an important consideration for people with sensation or movement difficulties. Lack of muscle control may increase the risk of falls or other injury. Decreased sensation may increase the risk of falls. It may also increase the risk of injury because the person is unable to perceive a potential source of injury.

Safety measures for people with movement difficulty may include railings, removal of obstacles (such as loose rugs that may slip on the floor), and other measures as appropriate.

Safety measures for persons with limited sensations include an awareness of the lack of sensation and compensation through other measures. Specific measures may include the use of adequate lighting (including lights left on at night), testing of water temperature before bathing or immersing parts of the body in water, the use of protective shoes (no open toes or high heels), and similar measures. Shoes should be checked often for grit or rough spots that may injure the feet.

People with decreased sensation should check their feet (or other affected area) frequently for bruises, open skin areas, or other injuries, which may go unnoticed and become severely infected.

People with mononeuropathy multiplex are prone to new nerve injury at pressure points (knees, elbows, etc.). They should avoid prolonged pressure on these areas from leaning on the elbows, crossing the knees, or similar positions.

Over-the-counter analgesics or prescription pain medications may be needed to control pain. Various other medications may be used to reduce the stabbing pains that some people experience, including anticonvulsants (phenytoin, carbamazepine) or tricyclic antidepressants. Whenever possible, their use should be avoided or minimized to reduce the risk of medication side effects.

Positioning, the use of frames to keep bedclothes off of a tender body part, or other measures may be helpful to control pain.
Autonomic symptoms may occur and can be treated symptomatically. They may be difficult to treat or respond poorly to treatment.

Use of elastic stockings and sleeping with the head elevated may reduce postural hypotension. Fludrocortisone or similar medications may be beneficial in reducing postural hypotension for some persons.

Medications that increase gastric motility (such as Reglan), eating small frequent meals, sleeping with the head elevated, or other measures may increase reduced gastric motility (digestion).

Medications such as bethanechol, manual expression of urine, or intermittent catheterization may be necessary to treat bladder dysfunction.

Impotence, diarrhea, constipation, or other symptoms are treated as appropriate.

Expectations (prognosis):

If the cause can be identified and successfully treated, and if damage is limited, there is a possibility of full recovery from mononeuritis multiplex. The extent of disability varies, from no disability to partial or complete loss of movement, function, or sensation. Nerve pain may be quite uncomfortable and persist for a prolonged period of time.

Complications:

• recurrent or unnoticed injury to any part of the body
• deformity, loss of tissue mass
• disturbances of organ functions
• decreased self esteem
• relationship problems associated with impotence

Calling your health care provider:

Call your health care provider if you notice signs of mononeuritis multiplex.