Current Status of Therapeutic Approaches against Peripheral Nerve Injuries: A Detailed Story from Injury to Recovery

Abstract

Peripheral nerve injury is a complex condition with a variety of signs and symptoms such as numbness, tingling, jabbing, throbbing, burning or sharp pain. Peripheral nerves are fragile in nature and can easily get damaged due to acute compression or trauma which may lead to the sensory and motor functions deficits and even lifelong disability. After lesion, the neuronal cell body becomes disconnected from the axon's distal portion to the injury site leading to the axonal degeneration and dismantlement of neuromuscular junctions of targeted muscles. In spite of extensive research on this aspect, complete functional recovery still remains a challenge to be resolved. This review highlights detailed pathophysiological events after an injury to a peripheral nerve and the associated factors that can either hinder or promote the regenerative machinery. In addition, it throws light on the available therapeutic strategies including supporting therapies, surgical and non-surgical interventions to ameliorate the axonal regeneration, neuronal survival, and reinnervation of peripheral targets. Despite the availability of various treatment options, we are still lacking the optimal treatments for a perfect and complete functional regain. The need for the present age is to discover or design such potent compounds that would be able to execute the complete functional retrieval. In this regard, plant-derived compounds are getting more attention and several recent reports validate their remedial effects. A plethora of plants and plant-derived phytochemicals have been suggested with curative effects against a number of diseases in general and neuronal injury in particular. They can be a ray of hope for the suffering individuals.

Botulinum Toxin and Neuronal Regeneration after Traumatic Injury of Central and Peripheral Nervous System

“…The spontaneous nerve repair may not be sufficient to achieve proper functional recovery [17], and regeneration of PNI is aided by many different types of treatment [18,19]. The primary medical therapy for complete lesions is an end-to-end repair by suturing of nerve stumps via epineurial and/or group fascicular suturing.…”

“…In the case of a significant nerve gap formation where end-to-end repair is not possible, peripheral nerve grafts (autografts, allografts or xenografts) and nerve conduits (synthetic, biological or hybrid) and tubulization are required to serve as a bridge between the nerve stumps across the gap and to support axonal regrowth [20][21][22][23][24][25]. Other approaches, ranging from cell-based therapy [26], electrical stimulation [27] or pharmacological medications [19], are also used. In particular, pharmacological medications, which essentially include analgesics, corticosteroids, and opioids, are helpful to relieve pain but, unfortunately, they are not useful to treat PNIs because they cannot accelerate the nerve regeneration/functional recovery.…”

Strychnos nux-vomica L. seed preparation promotes functional recovery and attenuates oxidative stress in a mouse model of sciatic nerve crush injury

“…Despite a remarkable work on this aspect, a complete and accurate functional recovery yet remains a challenge. Among other multifarious factors, the occurrence of muscular atrophy and lethargic regeneration rate appear major obstacles in attaining a complete functional recovery [3]. Therefore, there is a growing need for identifying and develop novel therapeutic strategies to stimulate this regeneration process.…”

Neuroprotective Effect of Nypa fruticans Wurmb by Suppressing TRPV1 Following Sciatic Nerve Crush Injury in a Rat

“…Among other therapeutic strategies, pharmacotherapy has been shown to be a promising approach to neurorehabilitation, with the exploration of potential natural products that can improve the efficacy of nerve regeneration attracting considerable research interest [13]. Several plants and plant-derived compounds have been identified to accelerate the recovery process after peripheral nerve injury [14]. Recently, N.fruticans Wurmb (NF), which was used as a folk remedy, is a plant that is getting more attention because of its various effects.…”