Neurology

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About Peripheral Neuropathy

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.

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

Auonomic 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:

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

Infections

  • Lyme disease
  • Hepatitis C
  • Herpes Zoster (Shingles)
  • HIV-1
  • West Nile virus
  • Zika virus
  • Leprosy

Metaboilic and Endocrine

  • Diabetes
  • Glucose intolerance
  • Thyroid disease    
  • Renal failure

Nutritional Anomalies    

  • Vitamins B12, B1, or B6  deficiency
  • Vitamin B6 toxicity
  • Copper deficiency
  • Alcohol toxicity

Toxins and Drug Induced

  • Heavy metals – mercury, arsenic, lead
  • Ciguatera poisoning
  • Thalium
  • Lipid lowering and cardiovascular agents – Statins, Amiodarone
  • Anti-inflammatory agents – Colchicine, Tacrolimus
  • Chemothrapy agents – Vincristine, Cisplatin and related agents, Paclitaxel, Thalidomide, Bortezomib, Misonidazole
  • Anti-infectious agents – Fluoroquinolones, INH, Linezolid, Metronidazole, INH,  Nucleoside analogs, Nitrofurantoin, INH, Chloroquin, Chloramphenicol, Dapsone
  • Other - Disulfuram

Hereditary Causes and Charcot-Marie-Tooth (CMT) Disease

  • Hereditary demyelinating neuropathies
  • Hereditary axonal neuropathies
  • Hereditary small fiber neuropathies
  • Hereditary amyloidosis
  • Mitochondrial neuropathies
  • Porphyria
  • Ehlers Danlos syndrome

Cancer Associated

  • Paraneoplastic neuropathy
  • Neuropathy Associated with osteosclerotic myeloma (POEMS syndrome)
  • B-cell lymphoproliferative diseases
  • Primary amyloidosis

Entrapment/Compressive Neuropathies

  • Carpal Tunnel Syndrome
  • Tarsal Tunnel Syndrome
  • Lumbar Radiculopathy
  • Cervical Radiculopathy
  • Ulnar Neuropathy
  • Radial Neuropathy
  • Peroneal Neuropathy
  • Trigeminal Neuralgia
  • Occipital Neuralgia

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.

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