If you have transthyretin cardiac amyloidosis (ATTR-CM) , the same misshapen proteins that affect your heart can also build up around the nerves, leading to nerve damage, or neuropathy. Symptoms are wide-ranging, from tingling toes to dizziness and incontinence. This transthyretin amyloidosis with polyneuropathy, sometimes called ATTR-PN, is a relatively rare but serious condition. It occurs in hereditary cases of ATTR-CM, in which you inherit a specific gene, and in wild-type cases, which have no known cause.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f5e8d52e-7ea8-4778-8458-0d51fb55ae3be60dc2a1-f33c-4a05-9b50-8e3e8e597629c902e552-8350-47f9-b4ce-48025231afa7 Because neuropathy associated with ATTR-CM can happen gradually, it’s important to understand how these neurologic changes may show up and progress over time.
Symptoms of Neuropathy in ATTR-CM Symptoms The neurological symptoms of ATTR-CM may show up before heart-related symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291911b334-28a7-465c-b2ac-8be7c553138a This is because amyloid deposits form on our peripheral nerves, which help control everything from our heart and other muscles to our digestive system. This network of nerves manages communication between our central nervous system (the brain and spinal cord) and the rest of our body. ATTR-CM may affect:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c9fb393b-f94e-45a2-bbaf-0f4d56ed48a0 Sensory nerves, which help us determine temperature, pain, and touch Motor nerves, which control movement Autonomic nerves, which control subconscious tasks like breathing and digestion Neuropathic symptoms may include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c9fb393b-f94e-45a2-bbaf-0f4d56ed48a0 Diarrhea and constipation Sexual dysfunction Problems with urination Eye problems, from dry eye and cloudiness to glaucoma e60dc2a1-f33c-4a05-9b50-8e3e8e5976295ff654bc-fb6b-4a6b-979d-9ddf1b17fb04 Orthostatic hypotension , a drop in blood pressure when you stand up that can cause dizziness and faintinge60dc2a1-f33c-4a05-9b50-8e3e8e5976295ff654bc-fb6b-4a6b-979d-9ddf1b17fb04 Numbness or weakness Pain and tingling Burning sensation Fatigue Excessive sweating or lack of sweating Most of these symptoms are not exclusive to ATTR-CM, however. This makes it possible for ATTR-CM and neuropathy to be missed or misdiagnosed as something else, such as a gastrointestinal issue alone.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291911b334-28a7-465c-b2ac-8be7c553138a That’s why it’s important for doctors to consider all symptoms and identify the disease early. In extreme cases that are not caught and treated, peripheral neuropathy can make it harder to walk, button a shirt, or use motor skills to perform other essential tasks. “As someone accumulates amyloid deposits, their disease progresses,” says Elizabeth A. Mauricio, MD , neurologist at Mayo Clinic in Jacksonville, Florida. “Earlier treatment will lead to a better quality of life.”
Treating the Root Cause Treatment ATTR-CM medications include “gene silencers” that stop protein production and transthyretin stabilizers. Gene silencers also can treat neurologic symptoms, Dr. Mauricio says. “Gene-silencing therapies work by reducing the production of problematic transthyretin proteins,” says Rabia Malik, MD , a neurologist with Rush Medical Group in Oak Brook, Illinois, adding that they can help mobility, pain, and digestive-system issues associated with ATTR-CM. The U.S. Food and Drug Administration originally approved gene-silencing treatment, such as vutrisiran (Amvuttra), to treat neuropathy related to hereditary transthyretin amyloidosis. Vutrisiran is now approved to treat ATTR-CM.e60dc2a1-f33c-4a05-9b50-8e3e8e597629747b548b-5ea8-4f6a-9f49-c426d6f1ec73 Other gene-silencing medications include: patisiran (Onpattro), which can stall progression of nerve-related symptoms and potentially help with mobility issuese60dc2a1-f33c-4a05-9b50-8e3e8e5976299571b780-8413-45aa-8074-56aeba65ea74e60dc2a1-f33c-4a05-9b50-8e3e8e5976299e2386d9-f094-423c-8a0f-f143da46d11d eplontersen (Wainua), which is prescribed to treat neuropathy in hereditary ATTR-CMe60dc2a1-f33c-4a05-9b50-8e3e8e59762992464188-be41-4578-9d9a-b926d3143922 Although these medications may stop symptoms from progressing, they are not a cure. “Nerves can repair themselves, but it’s a low, slow, and often incomplete process,” Mauricio says.
Supportive Medications Medications Some medications can provide short-term relief from symptoms of neuropathy, such as relieving pain, itching, and burning. These include: Medications typically prescribed to prevent seizures , such as gabapentin (Neurontin) and pregabalin (Lyrica)e60dc2a1-f33c-4a05-9b50-8e3e8e5976298d4bfff4-6708-40a9-9f98-ea71ec823c40 Antidepressants , including duloxetine hydrochloride and nortriptylinee60dc2a1-f33c-4a05-9b50-8e3e8e59762933668eaf-0e62-4af3-b56a-a8d313f57509 Topical treatments, such as lidocaine patches or the topical cream capsaicine60dc2a1-f33c-4a05-9b50-8e3e8e59762933668eaf-0e62-4af3-b56a-a8d313f57509 Medicinal cannabis, which may be helpful for some patients, despite little supporting evidence (consult your doctor before trying) Doctors should avoid recommending opioids to treat peripheral neuropathy because of their dangers and side effects, Mauricio says.
Nonmedicinal Techniques Nonmedicinal Techniques Some people with ATTR-CM and nerve damage may find relief in nonmedicinal options. Many are backed with anecdotal evidence only, however, and may not work for everyone. Treatments may include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976298490932b-5ee7-4ea8-be2c-d95443029a79e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f7a42ae-468f-4e22-9a15-46d3e805ea2c Ergonomic supports to reduce strain, such as splints or shoe inserts Relaxation exercises like breath work, meditation, massage, and yoga Acupuncture Dietary changes to reduce inflammation from food and beverages Transcutaneous electronic nerve stimulation (TENS) devices, over-the-counter machines that attempt to block pain with electrical stimulation applied to nerves Exercise, with a focus on low-intensity exercise like walking Cognitive behavioral therapy Hypnosis Avoiding alcohol and tobacco Getting at least seven hours of sleep each nighte60dc2a1-f33c-4a05-9b50-8e3e8e597629dceea7a2-12e4-454b-939e-ba55455a57c2 Green tea, which could help reduce amyloid depositse60dc2a1-f33c-4a05-9b50-8e3e8e597629174ba34e-6c08-4a30-8eb1-84e12d810f53 Alpha-lipoic acid supplements, antioxidants that can help with neuropathy associated with diabetes, Dr. Malik says, though there’s no data supporting its use with ATTR-PNe60dc2a1-f33c-4a05-9b50-8e3e8e5976298a90c142-8bfc-413d-8730-fe73fa853ed3
Preserving Independence Staying Independent In addition to pain, neuropathy can cause numbness, tingling, weakness, and other sensations that make it harder to function every day. Talk to your care team about safe ways for you to stay mobile inside and outside your home. To avoid complications from a fall, your doctor might suggest using a walking stick, cane, or walker, Malik says. Other ways to keep your environment safe include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291b0e3963-a1af-4e13-a864-5e32b45e7c5f Ensuring rooms in your home are properly lit Installing grab rails and bars in stairwells and bathing areas Removing rugs and other slip risks from floors Replacing furniture that has sharp edges or corners Purchasing specialized tools to help you get dressed, such as zipper pulls and dressing sticks
The Takeaway Nerve damage may accompany ATTR-CM, sometimes appearing before the heart disease is diagnosed. Symptoms of neuropathy with ATTR-CM, such as numbness and gastrointestinal issues, may resemble those of other conditions, making it important for you to share what you are experiencing to help your healthcare team. Although there is no cure for the condition, medications like gene-silencing therapies may stop the progression of neuropathy and improve your quality of life. Dietary changes, ergonomic supports, and relaxation techniques may help ease symptoms.
Resources We Trust Cleveland Clinic: Transthyretin Amyloidosis (ATTR-CM)Amyloidosis Research Consortium: Finding SupportFoundation for Peripheral Neuropathy: Peripheral Neuropathy NutritionMedlinePlus: Transthyretin AmyloidosisMemorial Sloan Kettering Cancer Center: Managing Peripheral Neuropathy
Great Job Jessica Migala & the Team @ google-discover Source link for sharing this story.
