All about peripheral neuorpathy

Peripheral neuropathy is a condition that arises from damage to the peripheral nervous system, which transmits signals between the central nervous system (the brain and spinal cord) and the rest of the body. These include the sensory nerves (which transmit pain, temperature, touch and position sense) as well as the motor nerves with allow muscles to function.

The symptoms of peripheral neuropathy include numbness, tingling, and weakness in the extremities. Sometimes, pain may be a feature - burning, stabbing pain which may affect sleep. The signs of peripheral neuropathy, found on examination by a neurologist, include loss of pinprick sensation, and a position sense and vibration sense in the fingers and toes.

The loss of reflexes on examination is a clue to the neurologist that the problem may be a neuropathy. Some patients with neuropathy may fall over when they close their eyes or try and walk in the dark as they have lost position sense in the feet. In the hands, there may be a loss of dexterity due to lack of sensation or weakness, for example being unable to open bottles or turn door keys in the lock.

There may be wasting of muscles in the hands, feet and legs. It is important to try and find out the underlying cause of neuropathy in order to prevent progression of the condition ad if possible reverse the condition. In 30% of cases, the underlying cause may not be found by clinical history and examination carried out by a neurologist, baseline blood tests and nerve conduction tests which are electrical tests performed to find out which nerves are involved and which may give an indication of cause.

In these undiagnosed cases, it may be necessary to carry out more invasive tests such as a nerve biopsy where a sample of nerve is taken under local anaesthetic and examined in the pathology laboratory. The causes of neuropathy are numerous, with the commonest cause worldwide being diabetes.

Other causes include mechanical compression such as carpal tunnel syndrome (medium nerve) in the wrist or ulnar neuropathy at the elbow, nutritional or vitamin deficiencies such as vitamin B12 deficiency, medications e.g some antibiotics, infections, Lyme disease, hepatitis, HIV, leprosy - inflammation associated with condition such as lupus, asthma, rheumatoid arthritis, immunological causes such as chronic inflammatory demyelinating neuropathy (CIDP) and multifocal motor neuropathy with block, and certain cancers and blood disorders.

It is important to try and find out the cause of a neuropathy, as many causes are treatable.Treatments include CIDP, inflammation and even some genetic neuropathies are now treatable such as TTR amyloid neuropathy. Although diabetic neuropathy is not curable, progression can be halted by better control of blood sugars as well as controll of hypertension, cholesterol and triglycerides.

There are a number of neuropathic pain medications which can be helpful - gabapentin, pregabalin, duloxetine and nortryptyline. Some topical treatments such as a lidocaine patches may also alleviate symptoms in some patients. Physiotherapy can be life changing by helping maximise function in unaffected muscles and improve balance. If there is weakness around the ankles fitting an ankle foot orthotic (AFO) can make a huge difference to balance and stability. In conclusion, recognising the signs and understanding the risks associated with peripheral neuropathy are essential steps toward effective management. With appropriate treatment strategies tailored to individual needs, many people find relief from their symptoms and regain control over their lives.