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Old 11-25-2019, 01:35 PM #1
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Default axonal vs myelin nerve damage - can it improve?

I have read many times that once the axon is lost, the nerve cannot heal anymore and there is no hope for improvement / healing of neuropathy.

Now I have read in other sources that axons can heal if the nerve cell is still intact but only if the myelin sheath is not damaged.

I also wonder if axonal loss is the same as axonal damage or whether there is a difference between both. Maybe damaged axons can heal to some extent, but once they are lost they are lost? Then the question is whether and how one can measure if the axon is lost or damaged? And how about a damage to the myelin sheet only? does this has a better prognosis?

You see I am a bit confused. I know that I should ask my neurologist but next appointment is in a few weeks and I wonder if somebody here can help with that in the meantime. thanks a lot.
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Old 11-26-2019, 06:51 AM #2
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Default A nerve cell doesn't completely die--

--unless its cell body, the soma, is completely compromised.

So axons and myelin sheathing--if you are talking about a nerve cell that actually has myelin, as most of the small fibers that subsume the sensations of pain and temperature do not--can regenerate if the offending harmful agents are removed, whatever those may be.

Myelin, though, can be replaced much faster than axonal material. There are likely no tissues in the body that regenerate more slowly than axons; an oft-cited figure is perhaps a millimeter per day of axonal growth, even under optimal conditions.
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Old 11-26-2019, 09:08 AM #3
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Originally Posted by glenntaj View Post
--unless its cell body, the soma, is completely compromised.

So axons and myelin sheathing--if you are talking about a nerve cell that actually has myelin, as most of the small fibers that subsume the sensations of pain and temperature do not--can regenerate if the offending harmful agents are removed, whatever those may be.

Myelin, though, can be replaced much faster than axonal material. There are likely no tissues in the body that regenerate more slowly than axons; an oft-cited figure is perhaps a millimeter per day of axonal growth, even under optimal conditions.
Thank you very much. this is very, very intersting. Is there any possibility to measure whether the soma or "only" the axon is damaged? I know that neurologists can differentiate axonal damage and myelin damage but can they differentiate soma and axon damage?
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Old 11-27-2019, 07:49 AM #4
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Default If, on nerve conduction studies, and EMG testing--

--there is no response at all in certain areas, that would point to the destruction of the cell body and the entire nerve. But that is vanishingly rare.

Often, certain cells in an area have died, but since nerve are made up of so many cells and fibers others will pick up enough of the slack that there will still be some response.

Other than that, one can have biopsy material examined microscopically and observe dead cells, but I've never heard of a situation in which all of the cells from a sample were dead.

There are certain conditions in which it is thought the soma is preferentially damaged--these are often referred to as "neuronopathies" though symptomatically it may be hard to distinguish them from neuropathies. A number of these seem to be characterized by cell body destruction in the dorsal root ganglia:

Sensory Neuronopathies
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Old 11-27-2019, 11:36 AM #5
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Thanks a lot. I am impressed by your deep knowledge. I understand that only biopsy can examine nerve cell death but of course only for the biopsy material and not for the rest of the body.

Are there certain symptoms that are more likely to appear when cell is dead vs not, for example numbness, no fealing of cold and hot, paralysis, etc. ?

And if axons and myelin sheets can heal, why do so many neuropathies do not recover? is it that only very seldom the nerve cell stays intact when axons and myelin sheets are damaged? Or because it is often not possible to eliminate the cause (diabetes, ideopathic,...) ?

I am asking since my neuropathy is toxic, from chemotherapy. Unfortunatelly I have to continue chemo for 2 cycles and I wonder how to find out whether there is a chance of improvement after therapy or whether it well get even worse in the next cycles. And I thought the best is to understand which damage has actually already occured.
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Old 11-28-2019, 08:35 AM #6
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Default Yes--

--full nerve cell death in often associated with pretty severe symptoms: complete numbness, lack of propriception or positional sense, even lack of motor response or movement control.

Often, though, cell death is patchy and incomplete and neighboring cells can take over much of the function.

And because of this, myelin and axonal damage are considerably more common than the death of the cell body--neuropathies are much more common than neuronopathies. When recovery does not occur it is usually because the pathologizing cause of the situation hasn't been arrested and is still ongoing.

Fortunately, if your neuropathy is chemotherapy induced, you actually have a pretty good chance of at least partial recovery once the chemo is completely stopped. Many of the most common chemotherapy drugs are notoriously neurotoxic (although not a lot of oncologists mention this up front), but as neuropathies go, chemo-induced neuropathies have a better track record than most, especially if you can do supportive supplementation--Vitamin B12 and essential fatty acids (EFA's) especially, and some people report good results with things like coenzyme Q10 (Cq10).
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Old 11-28-2019, 10:09 AM #7
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this is very helpful information. thank you very much again. i am already taking b12 but i will try to add EFAs and Q10 to it.

as you seem to have much better knowledge than my neurologist, may I ask you another question: would you recommend to take lyrica in the meantime or what do you think about it?

I have just started to take it 5 days ago (without any impact up to now anyhow) but since it influences the nervous system I am wondering whether it has negative (or even positive) impact on a) the potential healing of the nerves and b) nerve protection during chemo. my neurologist said it has no impact but I would be interested in your opinion.

i hope i do not bother you too much with all my questions but this is very valuable for me
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Old 11-28-2019, 12:45 PM #8
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lyrica is used for pain, it wont help your nerves to heal or protect them from chemotherapy. another supplement taken by people undergoing chemotherapy and which seems to have success for helping to prevent and ameliorate damage to peripheral nerves is aceyl l carnitine.
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Old 11-28-2019, 04:03 PM #9
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Thanks for the info. I found the following article about acetyl-l-cartine for chemotherapy. the results are rather mixed. what do you think?

Acetyl-l-Carnitine Yields Mixed Results for Chemo-Induced Neuropathy – Oruen
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Old 11-28-2019, 10:01 PM #10
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Thanks for the info. I found the following article about acetyl-l-cartine for chemotherapy. the results are rather mixed. what do you think?

Acetyl-l-Carnitine Yields Mixed Results for Chemo-Induced Neuropathy – Oruen
it seems to have helped for people i talked to who tried it during and/or after chemo therapy but thats only anecdotal evidence. I know a lot of people who have gotten cancer in the last few years
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