Peripheral Neuropathy

Peripheral neuropathies are a class of disorders that occur when nerves in the arms and legs are damaged, irritated, and/or not working properly.

The first symptoms most patients experience are usually related to problems in sensory nerves (nerves that let us feel things) and include numbness, tingling, and/or discomfort (which may be a buzzing, vibration, burning, or pins-and-needles feeling), usually beginning in the feet. However, many patients experience other symptoms, which can include weakness of the arms and legs, difficulty holding onto things, difficulty maintaining balance, or dizziness upon standing (Orthostatic hypotension).

There are numerous causes of peripheral neuropathies.

  • In developed countries, diabetes and impaired glucose tolerance (or prediabetes) represent the most common cause.  Often neuropathy is the first sign of prediabetes, and early control of blood sugar is the best way to improve neuropathy. Reduction of sugars later after development of neuropathy is less likely to improve neuropathy.
  • The second most common cause is alcohol; anything more than one drink a day increases risk of neuropathy.
  • There are numerous other causes, including medications (especially chemotherapy), vitamin deficiencies (most commonly vitamin B12), and medical conditions (including over- or underactivity of the thyroid gland and autoimmune conditions such as Lupus).
  • Two other broad categories include autoimmune neuropathies, in which the immune system makes proteins (antibodies) that irritate nerves, and genetic neuropathies, in which there is usually a family history.

There are two stages in the process of diagnosing neuropathies.

The first is to determine if symptoms are indeed from a neuropathy. This includes a careful discussion of symptoms, one’s personal medical history and that of family members, and a review of current and prior medications.  We conduct a detailed physical exam, testing coordination, reflexes, strength, balance, and especially one’s ability to feel temperature, light touch, and other forms of sensation.

Secondly, based on the information gathered, physicians will probably order a number of tests, including blood work and, sometimes, nerve and muscle function tests called electromyograms and nerve conduction studies (EMG/NCS).

As radiculopathies and spinal stenosis (pinched nerves in the neck and back) can often present with similar symptoms. In these cases our specialists will likely also order imaging tests of the spine, usually magnetic resonance imaging (MRI).

In many instances, an easily correctable cause can be found and remedied with a simple solution, such as supplementation for low vitamin levels. If diabetes is found, avoidance of sugars and simple carbohydrates (such as white breads and rices), increased exercise, and working with one’s primary doctor would be the treatment. Our neurologists can work with a number of specialists, including rheumatologists and endocrinologists to correct other medical conditions that predispose to neuropathy.

There are some forms of neuropathy that can be treated with intravenous treatments, usually corticosteroids or intravenous immunoglobulin gamma (IVIG).

Regardless of the cause, physicians are also able to manage and treat the symptoms created by neuropathy.

  • For treatment of neuropathy pain, there are a number of oral and topical medications that are effective and well established for relief. These have various combinations of additional benefits and/or side effects, so your physician can work with you on tailoring a plan that is best suited for your individual situation.
  • For difficulty with hand control from neuropathy, occupational therapy can be helpful, and for balance trouble and leg weakness, physical therapy is recommended.  In both instances, participation in the home exercises the therapist recommends is essential. Providence Saint John’s Performance Therapy.