Peripheral neuropathy, or damage of the peripheral nerves, is a common condition that affects at least 20 million people in the United States. The most common symptoms are pain, numbness, or tingling in the extremities, extremity weakness and difficulty walking. In some cases, the autonomic nervous system (the part of the nervous system which controls involuntary bodily functions) is affected leading to problems with blood pressure regulation—people will get light headed when arising from a seated position—and urinary incontinence.
There are many different types and causes of neuropathy, including:
- Polyneuropathy is damage to multiple nerves. In the United States the most common cause is diabetes. Other causes include infections, exposure to toxins, medications such as certain chemotherapy agents, nutritional deficiencies, inflammatory conditions, kidney and liver disease and auto-immune diseases such as rheumatoid arthritis.
- Compressive mononeuropathy occurs when an individual nerve is damaged from incessant pressure on it.
- Radiculopathy occurs when a nerve is compressed at its root (where it forms from the spinal cord) by a herniated disc or vertebrae.
- Guillain-Barrē Syndrome is a polyneuropathy that occurs when a person’s nerves are attacked by their own immune system, usually after an infection. This can result in progressive weakness and numbness, and in more serious cases difficulty breathing and swallowing due to damage to the nerves that operate the lungs and swallowing muscles.
The course of a neuropathy depends on the cause. In many cases the damage is permanent although some of the symptoms may improve with time. In others cases, the course is self-limited with varying degrees of recovery. Depending on the type of neuropathy medical and/or surgical intervention can improve recovery.
Diagnosing neuropathy requires a detailed history, physical and neurological exam. Frequently, this is enough to determine if symptoms are due to a neuropathy, and if so the type of neuropathy. Electromyography and nerve conduction studies (tests that measure the electrical impulses of muscles and nerves) are often necessary to confirm the diagnosis and can better delineate the type and extent of damage that has occurred. Blood-work is often necessary to look for causes of the nerve damage. Imaging of the spine and region of the affected nerve(s) can also help to evaluate for sources of compression and inflammation.
The treatment of a neuropathy will depend on its cause. Compressive neuropathies and radiculopathies may improve with limb rest/stabilization, physical therapy and if necessary surgery. Many of the polyneuropathies will improve simply by removal of an offending agent (such as a medication or toxin) or by treating an underlying disease. Some, like Guillain Barrē respond well to medications or a dialysis-like treatment called plasma-exchange. Unfortunately, it is often the case that neuropathies are irreversible. In those cases, treatment is focused on symptom management and halting the progression of the nerve damage.
The Neuropathy Clinic
at the Martha Jefferson Neuroscience Center provides a comprehensive, multidisciplinary approach to the evaluation and management of diseases of the nerves and muscles.