Symptoms of neuropathy depends on the nerves affected.

• If it is peripheral, there could be tingling sensation, pain, numbness, loss of function of affected limb amongst others.
• If it affects the cranial nerves, there is loss of sensation to the area supplied like blindness in optic nerve neuropathy or deafness and loss of balance and coordination in auditory nerve neuropathy.
• The autonomic neuropathy also manifests with symptoms affecting the particular organs supplied. Such symptoms may include erectile dysfunction, anhydrosis, and tachycardia amongst others.

• Falling

  Falls. Weakness and loss of sensation may be associated with lack of balance and falling. [mayoclinic.org]

  Ways to Prevent or Manage Problems Related to Nerve Changes You may be advised to take these steps: Prevent falls. Have someone help you prevent falls around the house. Move rugs out of your path so you will not trip on them. [cancer.gov]

  Put no-slip bath mats in your tub or shower to avoid falling. Clear areas where you frequently walk of objects such area rugs, cords, toys, and other clutter, to reduce your risk of tripping and falling. Consider using a cane to steady yourself. [breastcancer.org]

• Amyloidosis

  Amyloidosis. Pregnancy - associated with carpal tunnel syndrome. [ 1 ] Other generalised neurological conditions - eg, hereditary neuropathy with liability to pressure palsies (HNPP), multifocal motor neuropathy and neuralgic amyotrophy. [patient.info]

  Common conditions include: Blood vessel diseases such as polyarteritis nodosa Connective tissue diseases such as rheumatoid arthritis or systemic lupus erythematosus (the most common cause in children) Diabetes Less common causes include: Amyloidosis, [nlm.nih.gov]

  […] hormone level Leprosy A Usually sensory Phenolic glycolipid-1 antibody, skin biopsy Lyme disease A — Lyme titers Lymphoma M Mainly axonal CBC, imaging Monoclonal gammopathy Usually chronic Urine and serum protein electrophoresis with immunofixation Amyloidosis [aafp.org]

  […] neuropathy – genetic conditions that cause nerve damage, particularly in the feet having high levels of toxins in your body, such as arsenic, lead or mercury Guillain-Barré syndrome – a rare condition that causes rapid onset of paralysis within days amyloidosis [nhs.uk]

• Fatigue

  Many patients with HNPP complain of diffuse pain and severe fatigue. HNPP may cause severe limb paralysis when asymptomatic patients with unknown diagnosis of HNPP are challenged by strenuous physical activities. [orpha.net]

  Another side of neuropathy, and probably the worse, is "fatigue." For months it was difficult to function. [spacedoc.com]

  Epilepsy मिर्गी, मिरगी, मिरगी, अपस्मार, Suresh is suffering from epilepsy / Narcolepsy has been mistaken for epilepsy, chronic fatigue syndrome, and schizophrenia. [studysite.org]

  Specific symptoms before the onset of peripheral neuropathy include paleness, weakness, fatigue, faintness, or breathlessness. The skin may turn yellow, and the mouth and tongue may be sore. [healthcentral.com]

  CIDP can come with pain, fatigue, numbness and tingling. It’s a type of autoimmune neuropathy, occurring when the immune system attacks the covering (myelin sheath) that protects nerves. [ohsu.edu]

• Short Stature

  Other common physical characteristics are due to orthopedic problems such as severe kyphoscoliosis and short stature (Figure 3 ). Facial features. Facial features of a patient with HSAN over time. Note flattening of upper lip. [ncbi.nlm.nih.gov]

• Leg Pain

  Efficacy of anticonvulsants for low back pain with or without radiating leg pain Three trials investigated a gabapentinoid (gabapentin) versus placebo for chronic low back pain with or without radiating leg pain. 26, 31, 32 There was no effect for pain [doi.org]

  For calculation of effect size (see appendix tables A and B on bmj.com), we pooled leg pain and overall pain, as leg pain is usually worse than pain in the back. [bmj.com]

• Numbness of the Feet

  Numbness in the feet can lead to skin sores that do not heal. In rare cases, numbness in the feet may lead to amputation. There is no cure for most neuropathies that are passed down in families. [nlm.nih.gov]

  If you've noticed numbness or tingling in your feet and muscle weakness that's been going on for a while, it's possible you have a problem with your peripheral nervous system. [honorhealth.com]

  You might not feel temperature changes or pain on parts of your body that are numb. Infection. Your feet and other areas lacking sensation can become injured without your knowing. [mayoclinic.org]

• Polyneuropathy

  There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. [oadoi.org]

• Mononeuropathy

  Multiple mononeuropathy is a nervous system disorder that involves damage to at least two separate nerve areas. Neuropathy means a disorder of the nerves. Multiple mononeuropathy is a form of damage to one or more peripheral nerves. [nlm.nih.gov]

  The most common cause of mononeuropathy is compression (as is the case in carpal tunnel syndrome), but direct injury and inflammation are also possible causes, and not part of the definition of mononeuropathy. [neuravite.com]

  […] palsy) foot or shin pain, weakness or altered sensation The most common type of mononeuropathy is carpal tunnel syndrome (CTS). [nhs.uk]

  Mononeuropathy Damage to a single peripheral nerve is called mononeuropathy. Physical injury or trauma such as from an accident is the most common cause. [webmd.com]

• Guillain-Barré Syndrome

  Unfortunately, none of these tests can diagnose Guillain-Barré syndrome. In suspected Guillain-Barré syndrome patients, lab tests are done mainly to rule out other possible causes. [medbroadcast.com]

  In acute neuropathies, such as Guillain-Barré syndrome, symptoms appear suddenly, progress rapidly, and resolve slowly as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. [news-medical.net]

  Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2001; (2):CD002063. 10. Raphaël JC, Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2001;(2):CD001798. 11. [aafp.org]

  syndrome (GBS) and muscular dystrophies. [pennmedicine.org]

  Guillain-Barré syndrome (GBS) respond to treatment with intravenous immunoglobulin, but it is not uncommon for some to continue to deteriorate for a period after treatment has been started. [dx.doi.org]

• Burning Sensation

  sensation in the hands and feet.— Sandra Blakeslee … neuropathy involving the seventh cranial nerve was caused by being hit in the face by the stick.— Clifton P. [merriam-webster.com]

  Those symptoms may include a burning sensation, shooting pain, numbness or muscle weakness. For some patients, Dr. DiCapua says, the symptoms are just an annoyance. But for others, the effects of neuropathy can be debilitating. [yalemedicine.org]

  This type of neuropathy is usually characterized by a stabbing or burning sensation or itching or tingling. [honorhealth.com]

  Pain Numbness Burning sensation Tingling Lancinating (shooting) pain Hypersensitive areas of the skin Hair loss on the affected part Shiny skin Weakness Muscle atrophy (loss of muscle tissue) A detailed medical history and physical examination can identify [doi.org]

• Ataxia

  Adult onset cerebellar dysfunction with neuropathy is a commonly encountered condition and is usually due to genetic causes such as spinocerebellar ataxia, gluten ataxia, alcohol related, toxic, degenerative, immune mediated, paraneoplastic causes and [ncbi.nlm.nih.gov]

  : Sporadic cerebellar ataxia associated with gluten sensitivity. Brain 2001, 124 :1013–1019. PubMed CrossRef Google Scholar 16. Sander HW, Magda P, Chin RL, et al. : Cerebellar ataxia and coeliac disease. Lancet 2004, 362 :1548. [doi.org]

  Ataxias, 2, 1, (2015). [dx.doi.org]

  Dominant SCA48 Ataxia, Recessive CONDSIAS 1996-2019 Revisions [neuromuscular.wustl.edu]

Laboratory studies

• Fasting blood glucose
• Hemoglobin A1c
• Complete blood count
• Liver function test
• Renal function tests
• Thyroid function test
• Erythrocyte sedimentation rate
• Vitamin B12 and folate levels
• Paraneoplastic antibodies
• Antinuclear antibodies
• Genetic screening

Imaging

• MRI
• CT
• Doppler studies
• Nuclear imaging

Other investigations that may be carried out are electromyography, nerve conduction tests, nerve biopsy, electrocardiogram, and microdialysis.

• Hyperglycemia

  Although the precise mechanisms underlying diabetic neuropathy remain unclear, there is evidence that hyperglycemia- induced formation of advanced glycation end products (AGEs) is related to diabetic neuropathy; AGE-modified peripheral nerve myelin is [doi.org]

  Although the cause of polyneuropathy in patients with diabetes is only partially known, it has been associated with chronic hyperglycemia suggesting the possible etiopathogenic implication of advanced glycosylation end products. [ncbi.nlm.nih.gov]

  #SelfManagementOfDiabetes #Hyperglycemia #DiabeticsInstitutePakistan #Diabetologist #DiabetesLifeStyle #DrImtiazHassan #DrAjazQureshi Watch every Thursday Live with Dr. [findglocal.com]

  The concept that peripheral neuropathy may be the first clinical sign of prolonged hyperglycemia was proposed more than 40 years ago but remains controversial ( 11 ). [care.diabetesjournals.org]

  In type 1 diabetes mellitus, distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia. [emedicine.medscape.com]

The treatment of neuropathy usually targets the underlying cause. For example, vitamin supplements in Vitamin B12 and folate deficiency. Also, if diabetes is diagnosed and managed early, the risk for developing peripheral neuropathy is greatly reduced.

Pain management is also very important and because patients with neuropathy do not readily respond to regular analgesics, medication that target specific nerve cells are preferred. Drugs such as duloxetine hydrochloride is used. Other drugs include some anticonvulsants, antiarrhythmics, and local anesthetics. Topical analgesics can also be used in patients with focal neuropathy.

Physical therapy like massage also has a role in alleviating the pain of neuropathy. Surgery also has a role in the management of neuropathy. For example patients who have developed a gangrenous foot from a diabetic foot ulcer secondary to neuropathy may require amputation.

The prognosis depends on the type of neuropathy. However, if diagnosis is made early and treatment instituted, then the progression of the disease can be slowed or even reversed thereby giving the patient a better prognosis.

The cause of neuropathy can either be acute or chronic and they include diabetes, which is the commonest cause. Others are chronic alcoholism, vitamin B12 deficiency, autoimmune diseases, renal failure, hepatic failure, inherited disorders, toxins, infections, drugs, trauma and tumors. It could also be idiopathic, meaning that there could be no known cause.

The incidence and prevalence, along with the distribution amongst sex, race and age is largely dependent on the type of neuropathy.

Metabolic neuropathies like diabetes mellitus and uremia of renal failure occur more frequently in advancing age. There is not preference for any race and the incidence is slightly higher in males.

Neuropathy due to trauma is more likely to occur in the mid-life as this is when individuals are more prone to accidents. The incidence is predominantly higher in males as they are more at risks of trauma from falls or assault.

Neuropathies of hereditary origin usually start in childhood but may remain unnoticed until later in life. They have no clear age, sex or race predilection.

The pathophysiology of neuropathy is largely dependent on the underlying cause.

In diabetes mellitus, there have been different postulated theories about the pathway that leads to nerve damage. It is however agreed that many factors interplay in its pathophysiology, like the reaction of excess glucose with certain cellular bodies that leads to production of glycation end product which affects nerve function. Also, the accumulation of sorbitol and fructose from the metabolism of excess glucose in the polyol pathway can lead to nerve damage. Also, the increased production of free radicals in patients with diabetes has been implicated in its pathophysiology.

In neuropathy due to trauma, the major mechanism is shearing of nerves either by accidents or during surgeries to remedy other conditions like a brachial plexus injury following surgery on the axilla. The development is usually sudden

In other forms like Vitamin B12 deficiency and the inherited types, the major end result appears to be demyelination of nerves although the clear pathway by which this occurs is not clearly understood.

The mainstay of prevention is to prevent the root cause of neuropathy. Patients with diabetes should ensure adequate glycemic control. Also, a healthy diet prevents vitamin deficiency.

Neuropathy defines any type of disease that affects the nerves in the body. It is a broad term that defines injuries or diseases to many of the nerves in the body and there are various forms of neuropathy. This group of diseases is characterized by impaired nerve function which causes a problem with sensation, function and movement of the areas affected.

Neuropathy could be:

• Peripheral when it affects peripheral nerves. This nerves are mainly in the extremities.
• Cranial if it affects any of the cranial nerves that have their nucleus in the brain.
• Autonomic when it affects nerve of the autonomic (involuntary) nervous system, like nerves to the bowels or heart.
• Focal neuropathy is the fourth type, and like the name implies, it is when the damage is limited to a single nerve or nerve groups.

Definition

Neuropathy is a condition that refers to various diseases that affects the nerves of the body.

Cause

It is caused by a number of factors like diabetes, vitamin deficiency, infections and inherited disorders. Other causes include injuries, kidney disease, liver disease, drugs, poisons and long term use of alcohol.

Signs and symptoms

Common symptoms of neuropathy are pain, feeling of numbness, tingling sensation also known as ‘pins and needles’ sensation and in some cases, ulcers might develop like in diabetes. Other symptoms are erectile dysfunction, increased heart rate, constipation, nausea, vomiting, blurred vision, blindness and deafness depending on the nerves affected.

Diagnosis

Diagnosis involves a lot of laboratory tests to check the level of sugar and vitamins, to ascertain the kidney and liver function, to know the blood level and to screen for cancers. Some other tests will also be done to check the electrical activity of nerves and the blood supply to affected areas

Treatment

Treatment involves managing the cause of the neuropathy. It also involves reducing the pain felt by patients via a number of methods. In some patients, surgery might be indicated.

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