Neuropathy is formed by the combination of the words "Neuron" (nerves) and "Pathos" (disease). So by definition, it is simply the disease of nerves.


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.

Dry Skin
  • Because one of the signs of neuropathy is a loss of feeling, feet should be checked daily for cuts, sores, blisters, bruises and cracked or dry skin.[]
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  • urogenital
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  • Ears
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  • musculoskeletal
    Leg Pain
    • Ease foot and leg pain by not walking great distances or standing for long periods.[]
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  • gastrointestinal
    Abdominal Fullness
    • If you have any of these symptoms, neuropathy may be the culprit: inability to adequately empty the bladder of its contents, resulting in frequent infections; nausea, vomiting, abdominal fullness or bloating, diarrhea, or constipation; low blood pressure[]
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  • respiratoric
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  • neurologic
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  • Entire body system
    • Those signs include fatigue, abdominal pain, weakness, neuropathy and Raynaud’s disease, a reaction to cold temperatures or stress that can result in a narrowing of blood vessels.[]
    • The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression[]
    • Side effects were modest and included light-headedness, mild difficulties in concentration and memory, tachycardia, and fatigue.[]
    • That’s when you start to see things like neuropathy, anemia, severe fatigue, and other symptoms that develop with B12 deficiency.[]
    • , nausea, sweating, ejaculatory dysfunction Antiepileptics Gabapentin 300-3600 mg Sedation, dizziness Pregabalin 150-300 mg Sedation, dizziness Carbamazepine 200-1200 mg Sedation, dizziness, nausea, bone marrow suppression Oxycarbazepine 600-2400 mg Fatigue[]
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  • Workup

    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


    • MRI
    • CT
    • Doppler studies
    • Nuclear imaging

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


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  • Treatment

    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.


    • […] disease A — Lyme titers Lymphoma M Mainly axonal CBC, imaging Monoclonal gammopathy Usually chronic Urine and serum protein electrophoresis with immunofixation Amyloidosis A Usually sensory Multiple myeloma M Axonal damage predominates after treatment Plasmacytoma[]
    Leber's Hereditary Optic Neuropathy
    • One of these is Leber’s hereditary optic neuropathy , which causes vision loss, usually in young men.[]
    • Hereditary Optic Neuropathy Deafness-Dystonia-Optic Neuronopathy (DDON) syndrome (Mohr-Tranebjaerg syndrome) There are large individual differences among children with this hearing disorder.[]
    • Leber's hereditary optic neuropathy an inherited disorder of ATP manufacture, usually in males, usually as bilateral progressive optic atrophy and loss of central vision that may remit spontaneously. progressive hypertrophic neuropathy a slowly progressive[]
    • Post-herpetic neuralgia: Post-herpetic neuralgia, a complication of shingles ( varicella-zoster virus infection) is a form of neuropathy.[]
    • Hypothyroidism and pituitary disorders Autoimmune disorders such as Guillain-Barré syndrome , rheumatoid arthritis , and lupus Benign or cancerous tumors that exert pressure on nerves A wide range of infections, including herpes simplex virus (HSV) , shingles (varicella[]
    • Viruses such as herpes simplex , varicella-zoster virus, which causes chickenpox and shingles , and Epstein-Barr virus damage sensory nerves and cause intense episodes of shooting pain.[]
    Mononeuritis Multiplex
    • Polyneuropathy Peripheral neuropathy may affect: only one nerve (mononeuropathy) several nerves (mononeuritis multiplex) all the nerves in the body (polyneuropathy) Polyneuropathy is the most common type and starts by affecting the longest nerves first[]
    • Thus in vasculitis, multiple nerves may be affected by ischemic damage in different areas, which is called mononeuritis multiplex.[]
    • For example, some disorders involve single individual peripheral nerves— mononeuropathies —and some involve numerous individual peripheral nerves, the mononeuritis multiplex syndrome .[]
    • Vasculitis is an example of nerve damage called mononeuritis multiplex or multifocal mononeuropathy, in which isolated nerves in two or more areas are damaged.[]


    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.

    Sex distribution
    Age distribution


    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.

    Patient Information


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


    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 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 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.

    Other symptoms

    • Polyneuropathy Peripheral neuropathy may affect: only one nerve (mononeuropathy) several nerves (mononeuritis multiplex) all the nerves in the body (polyneuropathy) Polyneuropathy is the most common type and starts by affecting the longest nerves first[]
    • Thus in vasculitis, multiple nerves may be affected by ischemic damage in different areas, which is called mononeuritis multiplex.[]
    • For example, some disorders involve single individual peripheral nerves— mononeuropathies —and some involve numerous individual peripheral nerves, the mononeuritis multiplex syndrome .[]
    • Vasculitis is an example of nerve damage called mononeuritis multiplex or multifocal mononeuropathy, in which isolated nerves in two or more areas are damaged.[]
    No Renal Disease
    • Renal disease Here, the buildup of urea and other toxic wastes due to failure of filtration and excretion by the kidneys can affect nerve metabolism, and lead to permanent nerve damage.[]
    • […] albumin, and alkaline phosphatase levels Critical illness neuropathy A Usually acute or subacute No specific laboratory test Diabetes mellitus M Chronic; axonal may predominate Fasting blood glucose level, glucose tolerance test, A1C level End-stage renal[]
    • disease See Treatment and Medication for more detail.[]
    Refsum Disease
    • Sensorimotor Vitamin B 6 excess A Mainly sensory Genetic disorders † Charcot-Marie-Tooth disease Genetic testing Type 1 D Also called HMSN-I Type 2 A Also called HMSN-II Metachromatic leukodystrophy D — Neuropathy with liability to pressure palsies D — Refsum[]
    • Dejerine-Sottas disease) AD Rare, infantile onset, severe S/M, D CMT, X-linked XR Second-most common, S/M, earlier onset, more severe D D HNPP AD Variable onset, compression neuropathies, S/M D Familial amyloidosis AD Variable onset, autonomic and S/M A Refsum’s[]
    • Neuropathic pain due to HIV polyneuropathy can be treated with anti-seizure medications, antidepressants, or analgesics including opiate drugs.[]
    Diabetes Mellitus Type 1
    • Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2.[]


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    10. Modoni A, Mirabella M, Madia F, Sanna T, Lanza G, Tonali PA, et al. Chronic autoimmune autonomic neuropathy responsive to immunosuppressive therapy. Neurology. Jan 9 2007;68(2):161-2.


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