Peripheral neuropathy is common, estimated to occur in 5-10% of the adult population. It results from damage to the peripheral nerves that span the body and connect the brain and spinal cord to the muscles, skin, joints and internal organs. The motor nerves control muscle movement, the sensory nerves convey sensation and pain, and the autonomic nerves control the involuntary functions of the blood vessels, heart, gastrointestinal system, bladder, and glands. Neuropathy can affect any one or a combination of these types of nerves. Making the correct diagnosis can be difficult due to the varied clinical presentation and the many possible causes. At WCM, our neurologists have extensive experience in the diagnosis and treatment of neuropathies and can create a treatment plan for your specific condition.
Symptoms of Peripheral Neuropathy
Depending on the type, distribution, and severity of the damage, peripheral neuropathy can result in any one or a combination of the following symptoms:
Motor Symptoms
- Weakness in the arms or legs
- Incoordination
- Difficulty walking, especially up or down stairs
- Easy fatigability
- Muscle cramps or twitching
Sensory Symptoms
- Loss of sensation resulting in reduced sensitivity to painful stimuli, or awareness of the position of the hands or feet.
- Pain in the in the legs, arms, torso or face
- Poor balance and unsteady gait
- Paresthesias – spontaneous sensations such as numbness, tingling, burning, pins and needles, stinging, stabbing, itching, or buzzing
- Dysesthesias – disagreeable sensations or hypersensitivity caused by ordinary stimuli such as clothing rubbing against the skin
Autonomic Symptoms
- Orthostatic intolerance – feeling dizzy or faint when standing up due to fall in blood pressure or tachycardia (POTS)
- Exercise intolerance
- Chronic fatigue or "brain fog"
- Dry eyes or mouth
- Sexual dysfunction
- Intolerance to heat or cold; abnormal sweating
- Incomplete bladder emptying; urinary urgency, hesitancy or incontinence
- Gastrointestinal bloating, nausea, diarrhea, or constipation
- Difficulty adjusting vision from light to dark
Causes of Peripheral Neuropathy
Peripheral neuropathy can have many causes. Some are restricted to the peripheral nerves, whereas others result from systemic disorders that affect other organs. If no known cause can be found, the neuropathy is considered idiopathic, pending further research. The following is a list of the known causes of neuropathy:
Infections
- Lyme disease
- Hepatitis C
- Herpes Zoster (Shingles)
- HIV-1
- West Nile virus
- Zika virus
- Leprosy
Nutritional Anomalies
- Vitamins B12, B1, or B6 deficiency
- Vitamin B6 toxicity
- Copper deficiency
- Alcohol toxicity
Metabolic & Endocrine
- Diabetes
- Glucose intolerance
- Thyroid disease
- Renal failure
Cancer-Associated
- Paraneoplastic neuropathy
- Neuropathy Associated with osteosclerotic myeloma (POEMS syndrome)
- B-cell lymphoproliferative diseases
- Primary amyloidosis
Autoimmune or Inflammatory
- Chronic inflammatory demyelinating polyneuropathy
- Multifocal motor neuropathy
- Guillain Barre syndrome
- Vasculitic neuropathy
- Sjogren's syndrome
- Neuropathy associates with anti-MAG or ganglioside autoantibodies
- Autoimmune autonomic neuropathy
- Celiac disease
- Sarcoid
- Lumbosacral plexopathy
- Brachial Plexitis
Toxins & Drug-Induced
- Heavy metals – mercury, arsenic, lead
- Ciguatera poisoning
- Thallium
- Lipid lowering and cardiovascular agents – Statins, Amiodarone
- Anti-inflammatory agents – Colchicine, Tacrolimus
- Chemotherapy agents – Vincristine, Cisplatin and related agents, Paclitaxel, Thalidomide, Bortezomib, Misonidazole
- Anti-infectious agents – Fluoroquinolones, INH, Linezolid, Metronidazole, INH, Nucleoside analogs, Nitrofurantoin, INH, Chloroquine, Chloramphenicol, Dapsone
- Other – Disulfiram
Entrapment/Compressive Neuropathies
- Carpal Tunnel Syndrome
- Tarsal Tunnel Syndrome
- Lumbar Radiculopathy
- Cervical Radiculopathy
- Ulnar Neuropathy
- Radial Neuropathy
- Peroneal Neuropathy
- Trigeminal Neuralgia
- Occipital Neuralgia
Hereditary Causes & Charcot-Marie-Tooth (CMT) Disease
- Hereditary demyelinating neuropathies
- Hereditary axonal neuropathies
- Hereditary small fiber neuropathies
- Hereditary amyloidosis
- Mitochondrial neuropathies
- Porphyria
- Ehlers Danlos syndrome
Treatment of Peripheral Neuropathy
Therapy is directed at both the underlying cause of the neuropathy and the symptoms. Patients are treated by the center physicians in close collaboration with colleagues at the Pain Center to relieve pain, the Rehabilitation Medicine and Physical Therapy to improve strength, ambulation, and coordination, and in Cardiology, Gastrointestinal Medicine, and Urology to improve autonomic functions.