Peripheral Neuropathy
What is Peripheral Neuropathy?
Peripheral neuropathy refers to a disorder affecting the peripheral nervous system, which includes nerves outside the brain and spinal cord. It is characterized by damage or dysfunction of these peripheral nerves, leading to a variety of symptoms depending on the specific nerves involved. Peripheral neuropathy is a broad term encompassing a wide range of conditions that occur when nerves in the arms and legs are damaged, irritated, and/or not working properly.
The peripheral nervous system consists of sensory, motor, and autonomic nerves. Sensory nerves transmit information such as touch, pain, and temperature from the body to the brain, allowing for sensory perception. Motor nerves, on the other hand, enable muscle movement by conveying signals from the brain and spinal cord to the muscles. Autonomic nerves regulate involuntary functions such as heart rate, blood pressure, digestion, and bladder control.
Peripheral neuropathy can arise from various factors, including genetic disorders, metabolic abnormalities, infections, autoimmune conditions, exposure to toxins, trauma, and certain medications. Diabetes mellitus is a common cause of peripheral neuropathy, known as diabetic neuropathy, and it affects a significant number of individuals with diabetes.
Peripheral Neuropathy Symptoms
The symptoms of peripheral neuropathy are diverse and may include numbness, tingling, burning sensations, muscle weakness, muscle wasting, and changes in sensation or perception of touch, pain, or temperature. Depending on the specific nerves affected, these symptoms can manifest in a symmetrical or asymmetric pattern, involving the hands, feet, or other parts of the body. Neuropathic pain, described as a shooting or electric shock-like sensation, can also be a prominent feature of peripheral neuropathy.
Many patients experience other symptoms, which can include:
- Weakness of the arms and legs
- Difficulty holding onto things
- Difficulty maintaining balance
- Dizziness upon standing (Orthostatic hypotension)
Peripheral Neuropathy Causes
There are numerous causes of peripheral neuropathies.
In developed countries, diabetes and impaired glucose tolerance (or prediabetes) represent the most common cause.
Often neuropathy is the first sign of prediabetes, and early control of blood sugar is the best way to improve neuropathy.
The reduction of sugars later after development of neuropathy is less likely to improve neuropathy.
Other causes:
- Alcohol; even as little one drink a day increase the risk of neuropathy, and cessation of alcohol has been shown to improve nerve function
- Including medications (especially chemotherapy)
- Vitamin deficiencies (most commonly vitamin B12)
- Medical conditions (including over- or under-activity of the thyroid gland and autoimmune conditions such as Lupus)
Two other broad categories include autoimmune neuropathies, in which the immune system makes proteins (antibodies) that irritate nerves, and genetic neuropathies, in which there is usually a family history.
Peripheral Neuropathy Diagnosis
There are two stages in the process of diagnosing neuropathies.
The first is to determine if symptoms are indeed from a neuropathy. This includes a careful discussion of symptoms, one’s personal medical history and that of family members, and a review of current and prior medications.
We conduct a detailed physical exam, testing coordination, reflexes, strength, balance, and especially one’s ability to feel temperature, light touch, and other forms of sensation.
Secondly, based on the information gathered, physicians will probably order a number of tests, including blood work and, sometimes, nerve and muscle function tests called electromyograms and nerve conduction studies (EMG/NCS).
As radiculopathies and spinal stenosis (pinched nerves in the neck and back) can often present with similar symptoms.
In these cases our specialists will likely also order imaging tests of the spine, usually magnetic resonance imaging (MRI).
Peripheral Neuropathy Treatment
In many instances, an easily correctable cause can be found and remedied with a simple solution, such as supplementation for low vitamin levels.
If diabetes is found, avoidance of sugars and simple carbohydrates (such as white breads and rices), increased exercise, and working with one’s primary doctor would be the treatment.
Our neurologists can work with a number of specialists, including rheumatologists and endocrinologists to correct other medical conditions that predispose to neuropathy.
There are some forms of neuropathy that can be treated with intravenous treatments, usually corticosteroids or intravenous immunoglobulin gamma (IVIG).
Regardless of the cause, physicians are also able to manage and treat the symptoms created by neuropathy.
- For treatment of neuropathy pain, there are a number of oral and topical medications that are effective and well established for relief. These have various combinations of additional benefits and/or side effects, so your physician can work with you on tailoring a plan that is best suited for your individual situation.
- For difficulty with hand control from neuropathy, occupational therapy can be helpful, and for balance trouble and leg weakness, physical therapy is recommended. In both instances, participation in the home exercises the therapist recommends is essential. Providence Saint John’s Performance Therapy.
Peripheral Neuropathy Care Team
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