Neuropathy

What is Neuropathy?

Neuropathy or peripheral neuropathy refers to the damage or abnormal function of one or more nerves in the body. Nerves allow us to feel different sensations such as touch, pressure, vibration and pain. They also allow us to move by causing muscles to contract. Nerves also serve to control other functions such as sweating, heart rate, breathing, vision, hearing and digestion. The damage of one or more nerves typically results in numbness, tingling sensation or weakness and pain in the affected area.

What are the signs and symptoms of neuropathy?

Common signs and symptoms of neuropathy include the following:

• Numbness, tingling, or pricking sensations which may start on the hands or feet and spread upward towards arms and legs, respectively
• Burning, sharp or jabbing sensations on hands and feet
• Excessive sensitivity to touch or light objects that do not normally cause painful sensation
• Gait imbalance and falling
• Weakness of the muscles of the hands and feet
• Thinning or reduction in the muscle bulk of affected limbs

Other rare features of neuropathy include:

• Digestive and bowel abnormalities such as constipation or diarrhea
• Urinary problems
• Fluctuations in blood pressures and heart rate which may cause dizziness and lightheadedness
• Hearing and visual problems if nerves of the eyes and ears are affected

What are the causes and risk factors for development of neuropathy?

Neuropathy can be caused by various conditions and risk factors. Some of the most common are:

• Diabetes mellitus. About 60-70% of patients with diabetes suffer from neuropathic symptoms. Diabetes mellitus is one the most common causes of neuropathy in adults.
• Physical injury or trauma. Aside from accidents causing direct nerve damage, compression of nerves in certain areas of the body such as the wrist, elbow and neck causes neuropathy.
• Autoimmune systemic diseases. Some examples of autoimmune diseases wherein the body’s immune system directly attacks the nerves are lupus and rheumatoid arthritis

• Acquired systemic diseases such as chronic kidney and liver diseases cause accumulation of toxic substances that directly injure the nerves.
• Drugs such as chemotherapeutic medications and antibiotics may also affect the nerves.
• Cancers and tumors may also cause neuropathy directly by compressing nerves or indirectly through production of substances that attack the nerves.

How is neuropathy diagnosed?

Neuropathy is diagnosed first by clinical history. The presence of signs and symptoms such as numbness, tingling sensations and weakness should be noted. The presence of other concomitant diseases, exposure to certain drugs and medications, infection and family history are also asked by the physician. Physical examination is performed to support these findings and to determine the extent of the damage. Physicians do maneuvers to test for pain, vibration, positional senses, motor strength and reflexes.

Depending on the results of the clinical examination performed, certain blood tests may be requested to check for the presence of possible causes of neuropathy. This includes blood sugar to check for diabetes mellitus; blood chemistry for kidney and liver function; vitamin levels to determine nutritional imbalances; genetic testing if inherited diseases are suspected; and antibody levels in cases where autoimmune causes are entertained.

Other laboratory tests done like nerve conduction studies, electromyography (EMG-NCS), nerve ultrasound, and nerve biopsy can help confirm and support a definite diagnosis. MRI and CT scan imaging may also be done in cases where nerve compression is suspected such as in spine diseases.

What are the complications of neuropathy?

If neuropathy is not detected and treated early, it may lead to certain complications. Among these complications are burns and skin trauma due to inability to feel pain and numbness in affected parts, most commonly the feet. This is common among patients with uncontrolled diabetes mellitus. In some instances, these skin complications can get infected and bacterial infections may extend to the bones warranting amputation of the affected part. In limbs where muscles are affected, it may lead to inability to move these parts effectively causing difficulty in walking and performing activities of daily living.

How is neuropathy treated?

The treatment for neuropathy will depend on the identified cause by the attending physician. For instance, patients with diabetic neuropathy should achieve adequate sugar control. Those with autoimmune etiology are usually started with immunosuppresants such as steroids or may undergo treatment with immunoglobulins depending on the extent and exact etiologies. Patients with neuropathy from nutritional and vitamin deficiencies should receive vitamin supplementation.

Changing of certain drugs like antibiotics that are suspected to cause the symptoms may be prudent. Systemic diseases like kidney and liver diseases and cancer also warrant appropriate treatment to relieve neuropathic symptoms.

Symptomatic treatment is also important to improve the quality of life of the patients. Painful neuropathy can be started with effective medications such as NSAIDs and some drugs that are also used to treat epilepsy. Narcotics may also be given if the pain is not responsive to the usual medications. Motor symptoms can be addressed with use of mechanical aids such as hand or foot braces, orthopedic shoes and splints, depending on the nature of the motor abnormality.

Surgery is performed in cases where neuropathy is caused by nerve compression such as severe carpal tunnel syndrome, protruding disks in the back or neck causing nerve impingement, and other nerve entrapment or compression syndromes. The treatment for neuropathy may involve a team of healthcare workers consisting of internists, surgeons and physical therapists.

The treatment for neuropathy may involve a team of healthcare workers consisting of internists, surgeons and physical therapists.

What can I do to prevent and avoid development of neuropathy?

Healthy lifestyle and balanced diet with regular exercise will help prevent neuropathy by reducing risk of nutritional and vitamin deficiencies and preventing development of diabetes mellitus. Reduction and avoidance of excessive alcohol intake is also important. Maintaining a good posture and awareness of limb positions that cause nerve compression may also help to avoid development of nerve damage.