Peripheral neuropathy Health Article

Signs and tests

A detailed history will be needed to determine the cause of the neuropathy. A neurological exam may reveal problems with movement, sensation, or organ function. Changes in reflexes and muscle bulk may also be present.

Blood tests may be done to screen for medical conditions such as diabetes and vitamin deficiencies.

Tests that reveal neuropathy may include:

• EMG (a recording of electrical activity in muscles)
• Nerve conduction tests
• Nerve biopsy

Tests for neuropathy are guided by the suspected cause of the disorder, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, scans, or other tests and procedures.

Treatment

Treatmet involves:

• Identifying and treating any underlying medical problem (such as diabetes) or removing the cause (such as alcohol)
• Controlling symptoms
• Curing the disorder, if possible
• 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 example, one may not notice if water in a bathtub is too hot. 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 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:

• Installing railings
• Removing obstacles on floors such as loose rugs

Safety measures for people having difficulty with sensation include:

• Adequate lighting (including night lights)
• Testing water temperature before bathing
• Use of protective shoes (no open toes, no high heels)

Shoes should be checked often for grit or rough spots that may cause injury to the feet.

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

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. 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 may be difficult to treat or respond poorly to treatment.

• Use of elastic stockings and sleeping with the head elevated may help treat low blood pressure that occurs when standing up (postural hypotension). Fludrocortisone or similar medications may also be helpful.
• Medications that increase gastric motility (such as metoclopramide), eating small frequent meals, sleeping with the head elevated, or other measures may help.
• Manual expression of urine (pressing over the bladder with the hands), intermittent catheterization, or medications such as bethanechol may be necessary for those with bladder dysfunction.
• Impotence, diarrhea, constipation or other symptoms are treated as appropriate.