Peripheral neuropathy Health Article

Signs and tests

A detailed history will be needed to determine the cause of the neuropathy. Neurologic examination may reveal abnormalities of movement, sensation, or organ function. (See also entries on the specific nerve dysfunction.) Changes in reflexes and muscle bulk may also be present.

Tests that reveal neuropathy may include:

• EMG (a recording of electrical activity in muscles)
• Nerve conduction tests
• Nerve biopsy
• Blood tests to screen for medical conditions, such as diabetes and vitamin deficiency, among others.

Treatment

The first steps of treatment are to identify and treat the underlying medical problem (such as diabetes) or remove the cause (such as alcohol). Other goals include controlling symptoms, curing the disorder if possible, and helping the patient gain maximum independence and self-care ability.

Physical therapy, occupational therapy, and orthopedic interventions may be recommended. For example, exercises and retraining may be used to increase muscle strength and control. Wheelchairs, braces, and splints may improve mobility or the ability to use an affected arm or leg.

Safety is an important consideration for people with neuropathy. Lack of muscle control and reduced sensation increase the risk of falls and other injuries. The person may not notice a potential source of injury because he or she can't feel it. For this reason, people with decreased sensation should check their feet or other affected areas frequently for bruises, open skin areas, or other injuries, which may go unnoticed (because there is no pain) and become severely infected. Often, a podiatrist can determine if special orthotic devices are needed.

Safety measures for people experiencing difficulty with movement may include railings, various appliances, removing obstacles such as loose rugs, and other measures as appropriate. Safety measures for people having difficulty with sensation include adequate lighting (including lights left on at night), testing water temperature before bathing, use of protective shoes (no open toes, no high heels, and so on) and similar measures. Shoes should be checked often for grit or rough spots that may cause injury to the feet.

People with neuropathy (especially those with polyneuropathy or mononeuropathy multiplex) are prone to new nerve injury at pressure points (knees and elbows, for example). They should avoid prolonged pressure on these areas from leaning on the elbows, crossing the knees, or assuming similar positions.

Over-the-counter or prescription pain medications may be needed to control nerve pain. Anticonvulsants (phenytoin, carbamazepine, gabapentin, and pregabalin), tricyclic antidepressants (duloxetine), or other medications may be used to reduce the stabbing pains that some people experience. Use the lowest dose possible to avoid side effects.

Adjusting position, using frames to keep bedclothes off tender body parts, or other measures may also be helpful to reduce pain.

The symptoms of autonomic changes will be treated. However, they may be difficult to treat or respond poorly to treatment.

• Postural hypotension (low blood pressure) -- use of elastic stockings and sleeping with the head elevated may help. Fludrocortisone or similar medications may be beneficial in reducing postural hypotension for some people.
• Reduced gastric motility -- medications that increase gastric motility (such as metoclopramide), eating small frequent meals, sleeping with the head elevated, or other measures may help.
• Bladder dysfunction -- manual expression of urine (pressing over the bladder with the hands), intermittent catheterization, or medications such as bethanechol may be necessary.
• Impotence, diarrhea, constipation or other symptoms are treated as appropriate.

Support Groups

Additional information can be obtained from the Neuropathy Association.

Expectations (prognosis)

The outcome greatly depends on the cause of the neuropathy. In cases where a medical condition can be identified and treated, the outlook may be excellent. However, in severe neuropathy, nerve damage can be permanent, even if the cause is treated appropriately.

For most hereditary neuropathies, there is no cure. Some of these conditions are harmless, while others progress more rapidly and may lead to permanent, severe complications.

Complications

The inability to feel or notice injuries can lead to infection or structural damage. Changes include poor healing, loss of tissue mass, tissue erosions, scarring, and deformity. Other complications include:

• Partial or complete loss of movement (or control of movement)
• Partial or complete loss of sensation
• Difficulty breathing
• Difficulty swallowing
• Cardiac arrhythmias (uncommon)
• Decreased self esteem
• Relationship problems related to impotence
• Recurrent or unnoticed injury to any part of the body