PARESTHESIA

What Is Paresthesia?

The medical term “Paresthesia” refers to an unusual tingling sensation of the feet, legs, hand, or arms (Inoue et al., 2013). This condition usually corresponds with numbness, which means a loss of capacity to feel or perceive pressure or texture. A variety of conditions, such as prolonged nerve pressure, multiple sclerosis, nutrient and vitamin deficiencies, stroke, etc. may cause tingling and paresthesia. 

Mild tingling results from simple pressure on a nerve of the feet or legs. This pressure can occur while sleeping, when the nerves remain in the same position for a prolonged time. Tingling can sometimes herald a more significant nerve injury or an underlying illness. As a result, physicians find it critical to diagnose any inexplicable or odd sensation. 

What Are The Common Signs And Symptoms Of Paresthesia?

The signs and symptoms of paresthesia vary according to the underlying disease, disorder, or condition. The most common symptoms of paresthesia include tingling, muscle weakness, bluish or cold skin, seizures or convulsion, severe pain in the affected area, numbness, sudden changes in vision, incoordination, urinary incontinence, fecal incontinence, paralysis, eye pain, etc. (Tihanyi, Ferentzi, Beissner, & Köteles, 2018). Potential complications of paresthesia may cause permanent damage and increase the risk of amputation, coma or unconsciousness, paralysis, etc.

What Are The Common Causes Of Paresthesia?

One of the most common causes of peripheral neuropathy includes diabetes, which accounts for almost 30% of cases. Tingling and other symptoms in diabetic neuropathy frequently start in both feet and travel up the legs, followed by symptoms in both hands and moving up the arms. Nerve damage affects around two-thirds of diabetics, ranging from moderate to severe. Other causes of tingling may include the following (Romeo et al., 2018):

  •     Nerve entrapment syndromes such as carpal tunnel syndrome, radial or ulnar nerve palsy, etc.
  •     Vitamin deficiencies.
  •     Stroke
  •     Seizures or convulsions
  •     Infections like Lyme disease, HIV, herpes simplex, cytomegalovirus, etc.
  •     Autoimmune diseases like Guillain-Barre syndrome, rheumatoid arthritis, and lupus.
  •     Hereditary disorders like Charcot-Marie-Tooth disease
  •     Multiple sclerosis
  •     Migraine headache
  •     Hypothyroidism
  •     Nerve compression or damage due to a herniated disc or dislocated bone.
  •     Transient ischemic attack
  •     Systemic diseases like liver disease, vascular damage, blood disease, kidney disorders, hormonal imbalance, etc.

Other causes of tingling may include excessive alcohol or tobacco consumption, deficiency of minerals like calcium, sodium, or potassium, exposure to toxins like heavy metals such as arsenic, lead, mercury, etc., radiation exposure or therapy, etc.

How Do Spinal Specialists Diagnose Paresthesia?

Initial diagnosis of tingling starts with the physician asking patients various questions regarding their symptoms. Neurosurgeons will perform a complete physical examination and take an extensive medical history about the symptoms to provide proper care according to the diagnosis. Medical history may include work environment, history of alcohol use, exposure to a toxin, risk of some diseases, genetics, etc. Other test procedures may include (Mansfield, Bleacher, Tadak, & Briggs, 2017):

  1.     Blood tests: This helps to detect diabetes, organs like kidney or liver dysfunction, metabolic problems, autoimmune diseases, and vitamin deficiencies. 
  2.     Fluid test: This examines the cerebrospinal fluid of the brain and spinal cord to identify antibodies associated with peripheral neuropathy.
  3. Muscle test: Neurosurgeons will conduct an electromyogram and nerve conduction velocity to test the electrical activity of muscle and velocity of the nerves.
  4.     Other tests: This includes various imaging tests like Magnetic resonance imaging (MRI), Computed tomography (CT) scan, etc. to visualize the problems.

Sometimes neurosurgeons perform nerve biopsy and skin biopsy to observe the nerve fiber endings.

How Do Spinal Specialists Treat Paresthesia?

Successful treatment depends upon an accurate diagnosis of the tingling. For inherited peripheral neuropathy, neurosurgeons offer no treatment. But improvement can occur in the case of acquired neuropathy. Following suggested lifestyle changes can help patients with severe symptoms. For example, controlling blood sugar in diabetics can help manage diabetic neuropathy, and nutrient supplements help to correct vitamin deficiencies in peripheral neuropathic patients. The proper treatment for numb legs and feet may include the following (Lennertz, Tsunozaki, Bautista, & Stucky, 2010):

  1.     Medications: This includes a wide variety of drugs like antidepressants (such as duloxetine and milnacipran), corticosteroids (which help to reduce inflammation), and Gabapentin and pregabalin, which block nerve signals to reduce the numbness associated with neuropathy.
  2.     Ice and hot therapy: Ice therapy helps to reduce swelling upon the nerve and hot compression helps to loosen stiff muscles that put pressure on nerves and cause numbness.
  3.     Home remedies: This includes a variety of ways to relieve uncomfortable numbness in the legs and feet such as gentle exercise like yoga, Pilates, and tai chi to promote blood flow and reduce chronic inflammation. Massaging the affected area also improves blood flow and reduces the symptoms. 
  4. General lifestyle recommendations: This includes maintaining a balanced weight, avoiding exposure to toxins, eating a balanced diet, and restricting excess alcohol consumption. 

Other alternative therapies may include acupuncture, reflexology, hydrotherapy, biofeedback, meditation, etc. Please contact us with any questions you may have.

References

Inoue, S., Ikeuchi, M., Okumura, K., Nakamura, M., Kawakami, C., Ikemoto, T., … Ushida, T. (2013). Health Survey of Numbness/Pain and Its Associated Factors in Kotohira, Japan. PLoS ONE, 8(4), 1–6. https://doi.org/10.1371/journal.pone.0060079

Lennertz, R. C., Tsunozaki, M., Bautista, D. M., & Stucky, C. L. (2010). Physiological basis of tingling paresthesia evoked by hydroxy-α- sanshool. Journal of Neuroscience, 30(12), 4353–4361. https://doi.org/10.1523/JNEUROSCI.4666-09.2010

Mansfield, C. J., Bleacher, J., Tadak, P., & Briggs, M. S. (2017). Differential examination, diagnosis and management for tingling in toes: fellow’s case problem. Journal of Manual and Manipulative Therapy, 25(5), 294–299. https://doi.org/10.1080/10669817.2016.1260675

Romeo, A. R., Lisak, R. P., Meltzer, E., Fox, E. J., Melamed, E., Lucas, A., … Gelfand, J. M. (2018). A young man with numbness in arms and legs from the National Multiple Sclerosis Society Case Conference Proceedings. Neurology: Neuroimmunology and NeuroInflammation, 5(6). https://doi.org/10.1212/NXI.0000000000000509

Tihanyi, B. T., Ferentzi, E., Beissner, F., & Köteles, F. (2018). The neuropsychophysiology of tingling. Consciousness and Cognition, 58(December), 97–110. https://doi.org/10.1016/j.concog.2017.10.015