Neuropathy is a condition that affects the nerves outside the brain and spine, causing symptoms such as numbness, strange sensations, pain, weakness, and loss of reflexes. It can be categorized based on the type of damage to the nerves and can impact motor, sensory, and autonomic nerves.

What are signs and symptoms of Neuropathy?

Signs and symptoms of neuropathy can vary depending on the underlying cause, but they often include: - Initial symptoms in the fingers and toes, which then progress to the arms and legs. - Changes in sensation, such as tingling, burning, or a "pins and needles" sensation. - Weakness in the affected areas, which can make it difficult to perform everyday tasks. - Shrinkage in muscle size, also known as muscle atrophy. - Pain, which can range from mild to severe and may be constant or intermittent. - Numbness, where the affected areas may feel numb or have reduced sensitivity to touch. - Issues with automatic body functions, such as changes in blood pressure, heart rate, or digestion. - In advanced cases, there may be diminished or absent reflexes. - Loss of sensation in a "stocking or glove" pattern, where the affected areas follow a specific distribution. - Muscle loss and weakness, which can lead to difficulty with movement and coordination. To determine the cause of neuropathy, doctors will often take a detailed patient history, including past medical history, exposure to harmful substances, medication use, physical injuries, dietary and nutritional deficiencies, and alcohol use. This information can help guide further diagnostic testing and treatment options.

How do you get Neuropathy?

Peripheral neuropathy can be caused by several factors, including diabetes, long-term alcohol misuse, nutrient deficiencies (specifically certain B vitamins and vitamin E), inflammatory conditions, underactive thyroid, autoimmune diseases, infections, exposure to toxins, certain medications, tumors, inherited conditions, physical injury, multiple myeloma, and abnormal proteins in the blood. Sometimes, the exact cause remains unclear.

What else can Neuropathy be?

Myelopathies, radiculopathies, autoimmune diseases, and diseases of muscles.

What kinds of test are needed for Neuropathy?

Some of the tests that may be ordered to diagnose neuropathy include: - Full blood count to check for macrocytic anemia - Metabolic panels to assess electrolyte balance and identify kidney failure - Hemoglobin A1c to check blood sugar levels - Tests for deficiencies in vitamins and minerals - Tests for infectious diseases - Thyroid function test and autoimmune disease antibody tests - Nerve conduction study and electromyography - MRI or CT scans - Nerve biopsy - Genetic testing - Urine test to check for Bence-Jones protein

How is Neuropathy treated?

Neuropathy is treated by addressing the root cause of the issue, such as regulating blood sugar levels in cases of diabetes or stopping alcohol consumption in cases of alcoholism. Eating a well-balanced diet or taking dietary supplements can also help manage the condition. Physical and occupational therapy can assist in improving muscle strength and functional capabilities. Chronic inflammatory demyelinating neuropathy can be treated with corticosteroids, intravenous therapies, plasma exchange, or immunosuppressant drugs. Neuropathic pain, especially common in small-fiber neuropathies, may require specialized treatments such as medications to stabilize nerve cell membranes, anti-seizure drugs, specific antidepressants, or Transcutaneous Electrical Nerve Stimulation (TENS).

What are the side effects when treating Neuropathy?

The side effects when treating Neuropathy can include pain, altered sensation, muscle atrophy (shrinkage), weakness, foot ulcers (in the case of Diabetic peripheral neuropathy), gangrene in digits and limbs (in severe cases), and amputation (in extreme circumstances).

Are there long term effects of Neuropathy?

The prognosis for neuropathy depends on the type of damage to the nerves. If the neuropathy is caused by axonal degeneration, the chances of improvement are not as high because the nerves have difficulty repairing themselves. However, if the neuropathy is caused by segmental demyelination, the prognosis is usually more optimistic because the process of remyelination allows the nerve fibers to regain their function more rapidly.

Neuropathy

What is Neuropathy?

Peripheral neuropathies are conditions that affect the nerves outside your brain and spine. These nerves, which can be anything from cranial nerves (originating in your brain), spinal nerve roots (emerging from the spinal cord), and autonomic nervous system nerves (controlling automatic bodily functions), can be affected by many different factors.

There are several ways to categorize peripheral neuropathies. They can be single nerve (mononeuropathies), affect multiple specific nerves (multifocal neuropathies), or impact many nerves (polyneuropathies). Not only that, but they can also be classified based on the type of damage: to the nerve fibers themselves (axonal), to the protective covering of the nerves (demyelinating), or a mix of both, which is helpful in terms of what treatments are needed.

The main symptoms of peripheral neuropathy often include numbness and strange sensations (paresthesias). Sometimes, these symptoms can be accompanied by pain, weakness, and loss of certain reflexes. These problems usually develop over several months to years, but some may arise more quickly and steadily worsen.

It’s important to understand that the severity and symptoms of peripheral neuropathies can vary greatly as they can impact motor nerves (controlling movements), sensory nerves (responsible for sensation), and autonomic nerves (managing automatic functions like heart rate and digestion).

What Causes Neuropathy?

Peripheral neuropathies are conditions that affect your nerves, causing symptoms like numbness or weakness. They can be due to several different factors, including:

* Diabetes
* Long-term alcohol misuse
* Nutrient deficiencies, specifically certain B vitamins and vitamin E
* Inflammatory conditions that cause your blood vessels to swell (vasculitis)
* Underactive thyroid (hypothyroidism)
* Autoimmune diseases, where your body’s own immune system attacks healthy cells, such as Sjögren’s syndrome, lupus, or rheumatoid arthritis
* Infections, like Lyme disease, Epstein-Barr virus, hepatitis C, shingles, leprosy and HIV
* Guillain-Barre syndrome, a rare disorder in which your body’s immune system attacks your nerves
* Exposure to toxins like heavy metals or certain chemicals
* Some chemotherapy drugs used to treat cancer
* Certain medicines, including some antibiotics and heart medications
* Tumors, either due to pressure on the nerves or related to cancer
* Inherited conditions, like Charcot-Marie-Tooth disease and genetic factors that lead to abnormal protein build-up (familial amyloidosis)
* Physical injury
* Multiple myeloma (a type of cancer) and its treatments
* A condition where there are abnormal proteins in your blood (Monoclonal gammopathy of undetermined significance or MGUS)

Sometimes, the exact cause of peripheral neuropathy remains unclear despite investigation.

Risk Factors and Frequency for Neuropathy

About 2.4% of people worldwide suffer from peripheral nerve disorders. This rate increases to 8% amongst older individuals. Diabetic neuropathy, a type of peripheral nerve disorder, affects roughly half of all the people with long-standing type 1 and type 2 diabetes. In regions like Southeast Asia, leprosy, still prevalent, often causes peripheral neuropathy.

Charcot-Marie-Tooth disease, particularly type 1a, is the most common genetically-triggered sensorimotor polyneuropathy.
The most frequent single-nerve disorder is carpal tunnel syndrome.

Signs and Symptoms of Neuropathy

Peripheral neuropathy is a condition that can cause a wide variety of symptoms depending on the underlying cause. People often experience initial symptoms in their fingers and toes, which then progress to their arms and legs. These symptoms can include changes in feeling, weakness, shrinkage in muscle size, pain, numbness, and even issues with automatic body functions. These symptoms might resemble those seen in conditions like spinal cord diseases, nerve root diseases, autoimmune diseases, and muscle diseases. If the disease advances, other symptoms such as diminished or absent reflexes, loses of sensation in a ‘stocking or glove’ pattern, muscle loss, and weakness may occur.

It’s important for doctors to get a detailed patient history to help determine the cause of the neuropathy. This should include a thorough review of the patient’s past medical history, as well as questions about exposure to harmful substances, current and past medication use, physical injuries, dietary and nutritional deficiencies, and alcohol use.

Initial symptoms in fingers and toes
Progression of symptoms to arms and legs
Changes in sensation
Weakness
Muscle shrinkage
Pain
Numbness
Issues with automatic body functions
Diminished or absent reflexes (in advanced disease)
Loss of sensation in a ‘stocking or glove’ pattern (in advanced disease)
Muscle loss and weakness (in advanced disease)

Testing for Neuropathy

When patients are being checked for neuropathy, which is a condition that affects the peripheral nerves, doctors take into account their detailed medical history and physical examination. This includes a review of their present and past medicines. There are no standard tests such as laboratory or imaging studies for neuropathy, but certain tests can help doctors make a more accurate diagnosis by identifying the cause of the neuropathy. The cause could range from inflammation, infections, to metabolic issues.

Here are some of the tests doctors might use:

An analysis of a full blood count can show if the patient has macrocytic anemia, a type of anemia characterized by larger than normal red blood cells, which could suggest a shortage of essential vitamins like B12 or folate, or even a history of alcohol abuse.

Metabolic panels are another type of tests which assess the balance of electrolytes in the body. Electrolytes are minerals that are crucial for nerve function, and an imbalance can contribute to neuropathy. These tests can also identify kidney failure as a potential cause because a buildup of waste products in the blood (uremia) can lead to neuropathy.

A test called Hemoglobin A1c is used to check blood sugar levels over several months. Diabetes, a condition that leads to high blood sugar levels, is commonly associated with neuropathy.

Tests for deficiencies in certain vitamins and minerals such as copper, thiamine, pyridoxine, folate, B12, and vitamin E are also done. These nutrients play significant roles in the development and maintenance of the nervous system. The presence of heavy metals like mercury, lead, and arsenic in the body can also affect the peripheral nerves and cause disturbances in the central nervous system (brain and spinal cord).

Tests for infectious diseases like Lyme disease, Epstein-Barr virus, hepatitis C, HIV, and syphilis may be performed because these long-term illnesses can cause neuropathy and abnormal body sensations (paresthesias).

Doctors may also conduct a thyroid function test and check for antibodies related to certain autoimmune diseases known to cause neuropathy, such as Sjögren syndrome, lupus, and rheumatoid arthritis.

Additional tests may include nerve conduction study and electromyography, MRI or CT scans – particularly if nerve compression is a concern, nerve biopsy, genetic testing – in cases of inherited neuropathies, and urine test to check for a type of protein known as Bence-Jones as conditions like multiple myeloma and its treatments can lead to neuropathy.

Treatment Options for Neuropathy

For treating peripheral neuropathies, or damage to your peripheral nerves that often causes weakness, numbness, and pain, the initial focus is on addressing the root cause of the issue. This might involve regulating blood sugar levels in cases where diabetes is causing the nerve damage, or stopping alcohol consumption when alcoholism is the culprit. Eating a well-balanced diet to avoid nutritional deficiencies, or taking dietary supplements to replenish depleted vitamins or minerals, can also help in managing the condition.

However, there are instances where peripheral neuropathies cannot completely return to normal. In such cases, physical and occupational therapy can assist patients to improve their overall muscle strength and functional capabilities. A specific type of peripheral neuropathy, known as chronic inflammatory demyelinating neuropathy, is often initially treated using corticosteroids, and can also be managed using intravenous therapies, plasma exchange, or some immunosuppressant drugs.

If a patient is struggling with neuropathic pain, it might be helpful to consult with a pain specialist. Neuropathic pain, which is especially common among those with small-fiber neuropathies, doesn’t usually respond well to over-the-counter painkillers. Instead, more specialized treatments, including the use of medications that help stabilize the nerve cell membrane, certain anti-seizure drugs, or specific types of antidepressants, may effectively reduce this type of pain. Additionally, Transcutaneous Electrical Nerve Stimulation (TENS), a therapy that uses low-voltage electrical currents for pain relief, can be a noninvasive option to explore.

The symptoms of certain medical conditions can often overlap and can be confusing to diagnose. For example, the symptoms of peripheral neuropathies, a condition which refers to nerve damage in the peripheral nervous system, might look similar to several other medical situations.

Myelopathies – problems related to the spinal cord
Radiculopathies – nerve or nerve root illnesses
Autoimmune diseases – where the body’s immune system attacks healthy cells
Diseases of muscles – various illnesses that affect the muscles

Therefore, it’s crucial to distinguish between these possibilities accurately for proper treatment.

What to expect with Neuropathy

In certain diseases that cause damage to the peripheral nerves – important cables of communication that connect different parts of the body to the brain and spinal cord – through a process called Wallerian or axonal degeneration, the chances of getting better are not as high because the nerves have a tough time repairing themselves. Here, the nerve fibers known as axons need to regrow and re-establish their connections to the impacted muscle or organ for noticeable improvements.

However, if the nerve condition has developed due to a process known as segmental demyelination – which is the loss of an insulating layer around the nerve fibers – the prognosis is usually more optimistic. This is because the process of remyelination, which involves creating a new insulating layer, happens at a quicker pace, and this allows the nerve fibers to regain their function more rapidly.

Possible Complications When Diagnosed with Neuropathy

Peripheral neuropathies can result in several issues like pain, changes in feeling, muscle shrinking, and weakness. A specific type of this called Diabetic peripheral neuropathy can have even more severe consequences. For instance, it can cause foot ulcers that can get so bad that they lead to gangrene in the fingers and limbs, which may necessarily result in amputation.

Pain
Altered sensation
Muscle atrophy (shrinkage)
Weakness
Foot ulcers (in the case of Diabetic peripheral neuropathy)
Gangrene in digits and limbs (in severe cases)
Amputation (in extreme circumstances)

Preventing Neuropathy

Patients need to understand the warning signs and symptoms of peripheral neuropathy, a condition where nerves outside the brain and spinal cord are damaged. If you have this condition, your sensation might be affected, making you more prone to injuries. So, it’s important to pay close attention to any new cuts or damages to your skin. Healing might take longer than normal and there’s also a higher likelihood of getting an infection.

It’s a good idea to always wear socks with closed-toed shoes as this can help lower the risk of infection. Be very careful when you’re in areas with high or low temperatures to avoid getting burns or frostbite.

If you have diabetes, it’s crucial to learn how to manage your condition effectively. If your neuropathy is due to alcohol, you should be provided with information on how to stop drinking. All of these precautions can help minimize the risks associated with peripheral neuropathy.