Although people who carry the HNPP gene may have no symptoms initially ,as time goes by and as people are evaluated more carefully, it has become clear that mildly affected individuals often have symptoms attributed to other common disorders such as Carpal Tunnel Syndrome or lumbar disc disease. Some researchers believe that eventually (and this may take a lifetime) all individuals will show signs of a generalized neuropathy. And it may be when the general neuropathy has developed that the person first sees a physician.
For some the HNPP symptoms progress to a generalized neuropathy very slowly. For others the progression is quite rapid. Some are younger, others are older when this happens. This is another area where medical science does not have answers yet.
There also appears to be a cumulative component to HNPP symptoms and activity. We tend to think of each nerve as one nerve. In fact, there are many nerve fibers making up the one nerve. Some people report being able to do an activity one day without any problems. But have increasing symptoms if they continue to do the same activity many days in a row. When people experience increasing problem such as this, they are thought to be damaging more and more of the nerve fibers. Although nerve fibers are probably damaged on the first day of the activity, there are enough fibers still functioning to compensate for the damaged ones. As the activity continues, more and more fibers are damaged and the symptoms become more apparent as the nerves are unable to continue to compensate for the injury .
Recovery from palsy episodes is usually complete at first with numbness and weakness going away entirely. So, at first, the nerves are damaged and eventually heal completely. Over time, with repeated injury, the nerves are damaged and only partially heal. And with further injury, the damaged nerves again only partially heal. This continued partial healing leads to the generalized neuropathy symptoms of permanent numbness and weakness. The numbness is often a "stocking and glove" distribution and the weakness can cause foot drop, hand weakness and general fatigue from activity.
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