Neuritis means inflammation of a nerve or nerves; it may cause pain, weakness, and dysfunction of sensation. It can cause damage to different kinds of nerves – peripheral, cranial, or even optic nerve.

Peripheral Neuritis: One of the conditions that relates to the swelling of nerves that are other than the brain and the spinal cord.

Causes: Diabetic neuropathy, vit B12 deficiency or other deficiency disorders, some infections, certain toxins.

Optic Neuritis: Optic neuritis refers to inflammation of the optic nerve that plays an important role in the transmission of information about visual images from the eye to the brain. This condition is usually associated with autoimmune and demyelinating diseases.

Causes: Multiple sclerosis (MS), autoimmune diseases, infections, and sometimes the cause remains unidentified.

Brachial Neuritis (Parsonage-Turner Syndrome): Brachial neuritis is characterized by the inflammation of brachial plexus which is a part of the nervous system arising from cervical spinal nerves and controls functions of the shoulder, arm and hand. This condition can result in a considerable amount of discomfort as well as limitations in functioning.

Causes: More frequently of an unknown cause but have been linked to infections, trauma, or vaccinations.

Optic Neuritis is a type of inflammation that affects the optic nerve that controls vision and is estimated to occur between 1 and 5 times per 100000 people in a year. It is most prevalent among adults between the ages of 20 and 40, though is more frequent in women than in men 2:1. It is primarily observed in countries with temperate climates, with MS being the most important associated cause. It may also affect patients with other autoimmune disorders such as neuromyelitis optica and systemic lupus erythematosus.

Parsonage-Turner Syndrome or Brachial Neuritis, which is an inflammation of the brachial plexus nerves that results in shoulder and arm pains and weakness, with approximately 1 to 2 cases per 100000 individuals yearly. It is concerned with people of working-age, most commonly between 20 and 60 years of age, though it is most frequent in the third and fourth decades of life. This condition is common almost in all countries worldwide; however, a slight difference is noted sometimes due to infections or other factors affecting the environment.

Optic neuropathic diseases are characterized by disorders in the optic nerve which is responsible for transmitting impulses from the eye to the brain. The mechanisms that can underlie these diseases can include demyelination, autoimmune processes, viral infections, and autoimmune factors. Demyelination interferes with the usual transmission of electrical signals, affecting visual signal and therefore vision. Inflammatory processes take place due to autoimmune reactions and result in damage and inflammation of the optic nerve.

Brachial neuropathic diseases are characterized by inflammation of the brachial plexus- the system of nerves that serve the shoulder, arm, and hand areas. The cause of nerve inflammation is usually not well understood but is believed to be an autoimmune disease where the body’s immune system turns against the nerves. The sequelae inflammation is a frequent situation that develops after viral infections; autoimmune processes can trigger immune dysfunction and inflammation.

The cause of acute optic neuritis (ON) is not clearly understood, but it is familiar that an autoimmune attack interferes with the myelin of the neurons of the optic nerve. Patients having autoimmune diseases are more likely to develop ON and some of the gene tests like HLA DRB1 and HLA-B27 are associated with ON. Certain research suggests that viral infections can activate autoimmune responses, which may lead to ON attacks. ON is often one of the first symptoms of demyelinating diseases in multiple regions of the CNS.

The exact cause of brachial neuritis still cannot be determined; however, its occurrence is believed to be closely linked to immune issues. While specific sensitizations have not been delineated, other causal factors include infections especially hepatitis E virus, coxsackie viruses, COVID-19, Escherichia coli, Staphylococcus aureus and Aspergillus, immune stimulation, pregnancy and radiation therapy. However, Hepatitis E virus is distinguishably connected to brachial neuritis, reported in 10% of the affected individuals.

Optic neuritis is a condition that comes with variable prognosis depending on the cause that led to ON.

Short-term: Ocular pain or discomfort generally lasts for a few days to weeks particularly in relation to eye movement. Visual acuity and color visions gradually recover within 2 weeks to 3 months post-injury, where the eye enjoys almost normal function in 90% of the cases within a span of 6 months. It is important to note that at five years postintervention, only approximately 3 percent of the patients meet the definition of poor vision as defined by having a best-corrected visual acuity of 20/200 or worse.

Long-term: It is reported that up to 15-20% of patients specifically develop multiple sclerosis after optic neuritis and having recurrent optic neuritis increases the risk of developing multiple sclerosis or neuromyelitis optica spectrum disorder. About 30-50% of the patients with multiple sclerosis will have experienced at least one attack of optic neuritis in the past one and a half decade.

As to the prognosis of brachial neuritis, they are largely determined by the degree of the nerve injury followed by reinnervation. According to one of the small surveys, most of the patients regain the nerve function within 2 to 3 years, however, more than seventy percent of the patients carry some amount of weakness or the symptoms persist. Many patients remain symptomatic and might not be able to go back to work within the first six months from the onset of the symptoms; though by the third year, only 7%.

Visual impairment within the age group of 20 to 40 years is relatively frequent and may present with features like acute loss of vision, eye pain and variability in visual acuity. The condition is typically of sudden onset, evidenced clinically over days and can be profound, however, using the current treatment paradigm, vast majority of patients are known to have significant recovery within a few weeks to few months. It mainly affects people in the age group of 20 to 60 years; the highest prevalence is recorded in the third and fourth decades. Conditions commonly associated with SIB include autoimmune disorders like multiple sclerosis and infections that cause autoimmune like events. There, geographic and demographic factors come into consideration; it is much higher in temperate climate regions, further, MS is prevalent here.

Brachial neuritis also referred to as Parsonage- Turner Syndrome is an ailment that manifest through excruciating shoulder pain and weakness of the arm and hand muscles resulting to atrophy. The condition it often linked to viral infections, physical stress or trauma, and autoimmune disease/injuries. HNA as one of the genetic disorders the causes have been attributed to genetic mutation and family history.

Optic Neuritis

Visual Acuity Testing: Check visual acuity in each eye with help of an eye chart. This condition is characterized by a reduction in the patient’s visual clarity and may be severe or mild in nature.

Visual Fields Testing: Since the optic nerve is involved in the pathology, undertake visual field test to look for abnormalities. It may lead to loss of visual acuity or field as in central or peripheral visual field defects, common manifestation being a central scotoma.

Color Vision Testing: It is recommended to use Ishihara plates or equivalents for the assessment of the color vision. Lack of depth perception and that patient may have trouble distinguishing between colors particularly between red and green.

Brachial Neuritis

Shoulder and Arm Examination: Take a special look at the shoulder, the upper arm, and the hand for signs of atrophy or muscle wastage.

Palpation: Look for signs of inflammation, pain, redness, or warmth in the shoulder and upper arm region.

Strength Testing: Include manual muscle strength testing of the shoulder arm and hand to determine muscle strength. Aimination may be evident in parts of the body supplied by the involved nerves and muscles.

Sensory Examination: Assess sensory loss in the arm and hand by using light touch, temperature, vibration, and proprioception. One may be unable to feel things, have pins and needles or some other change in the way one’s body feels in the areas where the brachial plexus nerves affected are located.

Diagnosis and Assessment: Patient history and general clinical examination to assess presence and potential etiology of symptoms. May include blood tests, imaging studies (MRI, CT scan), nerve conduction studies, and electromyography (EMG).

Pharmacological Treatment: Anti-inflammatory medications like ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation and pain. Anti-inflammatory steroids to prevent or decrease severe inflammation are administered orally or intramuscular. For pain, acetaminophen analgesics are used, and other medication related to it. Selective serotonin reuptake inhibitors (SSRIs) may be used for pain control along with anticonvulsants such as gabapentin and tricyclic antidepressants like Amitriptyline. If neuritis results from an infection, the appropriate antibiotics or antiviral medication are offered.

Non-Pharmacological Treatment

Physical Therapy

Occupational Therapy

Nutritional Support

Acupuncture

Mind-Body Techniques

Physical Medicine and Rehabilitation

Physical Therapy: Simple exercises like stretching and exercising muscles can go a long way in helping to keep the muscles well-toned and thereby reducing the pressure on the nerves. Non-pharmacological methods include therapeutic massage and manually induced change in muscle tone can relax muscles and increase blood flow respectively.

Occupational Therapy: New techniques that may be applied in performing certain tasks in order not to exert pressure on the nerves. By changing the work environment so that the postures can be altered minimizing the pressure on nerves.

Nutritional Support: Consuming foods containing or supplemented with vitamins, particularly B1, B6 and B12 since they have a role to play in maintaining the health of nerves. Taking foods with anti-inflammatory content such as antioxidants and omega-3 fatty acids.

Acupuncture: There may be a possibility that you may get rid of the pain and can enhance the function of the nerves through touch points on the surface of the skin.

Mind-Body Techniques: Such approaches as meditation and mindfulness may help in treating pain and stress, hence, relieving the symptoms.

Biofeedback: Increasing patient’s ability to regulate autonomic responses which include muscle contraction is beneficial in pain management and decreasing symptoms.

Lifestyle Modifications: Exercises that are less hard on the nervous system such as swimming, walking and yoga can greatly assist in improving health and decreasing stinging feeling in the nerves. Hence adequate sleep and rest which is vital for the healing process and minimized on the nervous system.

Heat and Cold Therapy

Heat Therapy: Adding heat assists in a muscle’s relaxant effect as well as increase the flow of blood in the area that is being treated.

Cold Therapy: Cold packs can also help bring down inflammation and numb the affected area which will mean less in terms of pain.

Physical Medicine and Rehabilitation

Ibuprofen: Well-known NSAID that works for the purpose of eradicating inflammation and or pain. There is a regular formula that can be purchased at any supermarket or pharmacy and the prescription formula that is stronger.

Naproxen: An additional highly used NSAID that has a longer duration of action rather than the typical treatment given by ibuprofen.

Aspirin: Being anti-inflammatory and analgesic it is frequently used.

Prednisone: A hydrocortisone that can be taken orally and it is commonly prescribed for cases of neuritis which are more severe; it helps in reducing inflammation and pain that is very severe.

Methylprednisolone: Orally absorbable and can also be administrated by injections for faster decrease in inflammation.

Dexamethasone: Another potent corticosteroid which may be used in cases of severe inflammation.

Physical Medicine and Rehabilitation

sensitivity to aspirin or any other NSAID, a history of upper gastrointestinal disease or those on oral anticoagulants.

Acetaminophen and Codeine: They are used in managing light to moderate type of pain.

Hydrocodone Bitartrate and Acetaminophen:  The combinations of these drugs are prescribed for moderate to severe pain relief.

Oxycodone and Acetaminophen: This combination is taken to ease out moderate severe pain and it’s advised for patients with aspirin adverse effects.

Physical Medicine and Rehabilitation

Nortriptyline: Used in the management of neuropathic pain; is a low dose selective serotonin reuptake inhibitor (SSRI). The drug is therefore useful in chronic pain management because it enhances the concentration of serotonin and norepinephrine in the CNS by preventing their re-uptake through the presynaptic neuronal membrane. Other effects are thought to have antagonistic effects against alpha-1 adrenoceptors, increased strength of contraction of the myocardium, adenyl cyclase desensitization, and beta adrenergic as well as serotonin receptors down regulation.

Doxepin: An antagonist drug that is prescribed for neuropathic pain and the dose is much lower than what is normally used in depression treatment. Doxepin is known to act through raising levels of serotonin and norepinephrine in the CNS by blocking these neurotransmitters’ reuptake by the presynaptic neuronal membrane of the cell. It also helps to reduce the level of histamine and acetylcholine, which makes gabapentin useful in treating different forms of depression associated with pain.

Physical Medicine and Rehabilitation

Gabapentin (Neurontin, Gralise, Neuraptine, Fanatrex FusePaq): It is related to other anticonvulsant drugs and has antineuralgic action. The exact way through which gabapentin works has not been fully established; however, it closely resembles gamma-aminobutyric acid (GABA) but does not combine with GABA receptors. It acts on the alpha2-delta subunit and is effective for it. They are also used off-label for this condition for patients who cannot tolerate first line medications such as selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.

Pregabalin (Lyrica, Lyrica CR): It is a structural derivative from GABA. Its exact way of working is not clear although it has been identified to interact with the alpha 2-delta subunit of calcium channels with a high measure of affinity. In vitro, pregabalin decreases the release of various neurotransmitters which depend on calcium ions, most likely via interaction with calcium channels. In other cases, FDA-approved drugs might be utilized for this condition despite lacking authorization for this specific purpose (off-label use).

Physical Medicine and Rehabilitation

Eculizumab (Soliris): It is a monoclonal antibody that selectively targets synthetic complement C5 protein and inhibits it from being cleaved in C5a and C5b, the formation of terminal complement complex C5b-9 is also prevented. The specific method through which rituximab has a positive therapeutic impact in NMOSD is still not fully understood, but it is thought to interrupt the terminal complement C5b-9 deposition when aquaporin-4-antibody is present. Eculizumab has been recommended to patients with NMOSD fully diagnosed who are anti-aquaporin-4 (AQP4) antibody positive.

Inebilizumab (Uplizna): It is a monoclonal antibody that selectively and with high avidity interacts with the target protein, CD19, expressed on numerous B cells, including the antibody producer cells, plasmablasts, and plasma cells. Once the cells adhere to the CD19 receptor, the amount in circulation is quickly reduced significantly. To decide about the compulsory treatment of NMOSD, it’s necessary to know that about 80% of NMOSD patients have auto antibodies to aquaporin-4 (AQP4).

Satralizumab (Enspryng): It is an anti-inflammatory monoclonal antibody that selectively binds to the interleukin-6 (IL-6) receptor. IL-6 is thought to be the upstream cytokine in NMOSD because it is known to elicits the inflammatory sequence in the pathogenesis of this disease. Satralizumab can be prescribed for NMOSD in adults with the AQP4-IgG antibody seropositive status.

Physical Medicine and Rehabilitation

Nerve Block: Injection of local anesthetic or corticosteroid around the site of the nerve may help to reduce the pain and inflammation. This could be particularly useful in cases where neuritis is accompanied by intense pain.

Plasma Exchange (Plasmapheresis): This procedure is applied in some of the forms of neuritis, for instance, the Guillain-Barré Syndrome which is a syndrome of peripheral neuritis. It refers to the procedure that requires the extraction of a patient’s blood, the separation of the plasma, and the reintroduction of the blood cells in combination with a replaceable solution. This can assist in the elimination of any undesirable antibodies from the circulating blood.

Intravenous Immunoglobulin (IVIG): In autoimmune related neuritis, sometimes it is useful to administer IVIG because it adjusts the activity of the immune system and decreases inflammation.

Surgical Intervention: In certain circumstances, surgery may be required where neuritis is due to an underlying cause such as a compressive lesion or other structural pathological changes that are surgically treatable.

Electrical Stimulation Therapy: For instance, the facilitation of transcutaneous electrical nerve stimulation (TENS) may be quite useful in managing pain and serving functional goals in certain situations.

Physical Medicine and Rehabilitation

Neuritis is treated based on various approaches and stages so as to manage the condition and promote healing of the affected nerves. During the acute stage, treatment is aimed at decreasing pain and inflammation by using drugs like nonsteroidal anti-inflammatory drugs or corticosterone, avoiding strain on affected part, immobilizing affected limb. Physical therapy may also be initiated gradually to avoid reappearance of severe conditions. In the intermediate or recovery stage, the treatment focus reverts to healing with physiotherapy and occupational therapy to facilitate the restoration of function, strength, and adaptation to daily activity. Aftercare is ongoing, pain management if still an issue, non-pharmacological options might include acupuncture and TENS. In the long-term care, aiming at avoiding the reappearance of the problems, there are focalized interventions concerning diet, physical activity, follow-up care, and patient awareness of any manifestations of the problems. This last phase comes with emphasis on follow-up care through the continued physical therapy and practice of other relevant changes in lifestyles to ensure that the gains and health are continually maintained.