`
`Symptoms and causes - Mayo Clinic
`
`MAYO
`CLINIC
`
`Cry
`
`Peripheral neuropathy
`
`Overview
`
`Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord
`(peripheral nerves), often causes weakness, numbness and pain, usually in your hands and feet. It
`can also affect other areas of your body.
`
`Your peripheral nervous system sends information from your brain and spinal cord (central nervous
`system) to the rest of your body. The peripheral nerves also send sensory information to the
`central nervous system.
`
`Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited
`causes and exposure to toxins. One of the most common causes is diabetes.
`
`People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In
`many cases, symptoms improve, especially if caused by a treatable condition. Medications can
`reduce the pain of peripheral neuropathy.
`
`Symptoms
`
`Every nerve in your peripheral system has a specific function, so symptoms depend on the type of
`nerves affected. Nerves are classified into:
`
`• Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the
`skin
`
`• Motor nerves that control muscle movement
`
`• Autonomic nerves that control functions such as blood pressure, heart rate, digestion and
`bladder
`
`Signs and symptoms of peripheral neuropathy might include:
`
`• Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread
`upward into your legs and arms
`
`• Sharp, jabbing, throbbing or burning pain
`
`• Extreme sensitivity to touch
`
`• Pain during activities that shouldn't cause pain, such as pain in your feet when putting weight
`on them or when they're under a blanket
`
`https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061?p=1
`
`1/4
`
`Sanofi Exhibit 2183.001
`Mylan v. Sanofi
`IPR2018-01676
`
`
`
`6/20/2019
`• Lack of coordination and falling
`
`• Muscle weakness
`
`Symptoms and causes - Mayo Clinic
`
`• Feeling as if you're wearing gloves or socks when you're not
`
`• Paralysis if motor nerves are affected
`
`If autonomic nerves are affected, signs and symptoms might include:
`
`• Heat intolerance
`
`• Excessive sweating or not being able to sweat
`
`• Bowel, bladder or digestive problems
`
`• Changes in blood pressure, causing dizziness or lightheadedness
`
`Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different
`areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome is an
`example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.
`
`When to see a doctor
`
`Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or
`feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and
`preventing further damage to your peripheral nerves.
`
`Causes
`
`Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions.
`Health conditions that can cause peripheral neuropathy include:
`
`• Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis,
`Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
`
`• Diabetes. More than half the people with diabetes develop some type of neuropathy.
`
`• Infections. These include certain viral or bacterial infections, including Lyme disease, shingles,
`Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and J::UY..
`• Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of
`neuropathy.
`
`• Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the
`nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to
`the body's immune response. These are a form of a degenerative disorder called
`paraneoplastic syndrome.
`
`• Bone marrow disorders. These include an abnormal protein in the blood (monoclonal
`gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease
`amyloidosis.
`
`• Other diseases. These include kidney disease, liver disease, connective tissue disorders and
`an underactive thyroid (hypothyroidism).
`
`https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061?p=1
`
`2/4
`
`Sanofi Exhibit 2183.002
`Mylan v. Sanofi
`IPR2018-01676
`
`
`
`6/20/2019
`Other causes of neuropathies include:
`
`Symptoms and causes - Mayo Clinic
`
`• Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin
`deficiencies.
`
`• Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such
`as lead and mercury.
`
`• Medications. Certain medications, especially those used to treat cancer (chemotherapy), can
`cause peripheral neuropathy.
`
`• Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or
`sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having
`a cast or using crutches or repeating a motion such as typing many times.
`
`• Vitamin deficiencies. B vitamins -
`crucial to nerve health.
`
`including B-1, B-6 and B-12 -
`
`vitamin E and niacin are
`
`In a number of cases, no cause can be identified (idiopathic).
`
`Risk factors
`
`Peripheral neuropathy risk factors include:
`
`• Diabetes, especially if your sugar levels are poorly controlled
`
`• Alcohol abuse
`
`• Vitamin deficiencies, particularly B vitamins
`• Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and J::l.lV
`• Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system
`attacks your own tissues
`
`• Kidney, liver or thyroid disorders
`
`• Exposure to toxins
`
`• Repetitive motion, such as those performed for certain jobs
`
`• Family history of neuropathy
`
`Complications
`
`Complications of peripheral neuropathy can include:
`
`• Burns and skin trauma. You might not feel temperature changes or pain on parts of your body
`that are numb.
`
`• Infection. Your feet and other areas lacking sensation can become injured without your
`knowing. Check these areas regularly and treat minor injuries before they become infected,
`especially if you have diabetes.
`
`• Falls. Weakness and loss of sensation may be associated with lack of balance and falling.
`
`https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061?p=1
`
`3/4
`
`Sanofi Exhibit 2183.003
`Mylan v. Sanofi
`IPR2018-01676
`
`
`
`6/20/2019
`
`Symptoms and causes - Mayo Clinic
`
`Prevention
`
`Manage underlying conditions
`
`The best way to prevent peripheral neuropathy is to manage medical conditions that put you at
`risk, such as diabetes, alcoholism or rheumatoid arthritis.
`
`Make healthy lifestyle choices
`
`These habits support your nerve health:
`
`• Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy.
`Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and
`fortified cereals. If you're vegetarian or vegan, fortified cereals are a good source of vitamin B-
`12, but talk to your doctor about B-12 supplements.
`
`• Exercise regularly. With your doctor's OK, try to get at least 30 minutes to one hour of
`exercise at least three times a week.
`
`• Avoid factors that may cause nerve damage, including repetitive motions, cramped positions
`that put pressure on nerves, exposure to toxic chemicals, smoking and overindulging in alcohol.
`
`By Mayo Clinic Staff
`
`Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below.
`
`Terms and Conditions
`Privacy Policy
`Notice of Privacy Practices
`Notice of Nondiscrimination
`
`Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Mayo Clinic does
`
`not endorse any of the third party products and services advertised.
`
`Advertising and SP-OnsorshiP-.P-OlicY.
`
`Advertising and SP-OnsorshiP- OP-P-Ortunities
`
`A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic,"
`
`"MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation
`
`for Medical Education and Research.
`
`© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.
`
`https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061?p=1
`
`4/4
`
`Sanofi Exhibit 2183.004
`Mylan v. Sanofi
`IPR2018-01676
`
`