A Neuropathy Overview

National Neuropathy Week is celebrated this year from May 12–16, so to raise awareness about it, we are providing this overview. Neuropathy is typically used as a short form for "peripheral neuropathy," and as The Neuropathy Association says, "Peripheral neuropathy is one of the most common diseases most people have never heard of … in fact, upwards of 20 million Americans have it."

What is Neuropathy?

Neuropathy is a disorder of the peripheral nerve cells and fibers, that is, the motor, sensory, and autonomic nerves that connect the spinal cord to muscles, skin, and internal organs. Simply put, motor neurons control how your muscles move, sensory nerves allow a person to feel heat, touch, pain, etc., and autonomic nerves control bladder function, heart rate, etc.

Neuropathy can occur at any age, but it is most common in older people. It typically affects a person's hands and feet, causing weakness, numbness, tingling, or pain. Some find it harder to walk, due to heaviness in the legs or a diminished ability to sense the feet and legs and their positions. Some feel as if they have something on their feet when their feet are bare. A person's symptoms will vary depending on their neuropathy's underlying cause, the type of nerve(s) affected, their distribution, and the severity of the disorder. Neuropathy manifests in different forms – it can be periodic, it can slowly progress over years, it can be mild, or it can be severe and debilitating. More than 100 types of peripheral neuropathy have been identified.

What Causes Neuropathy?

There is no single cause. Approximately 30% of neuropathies are of an unknown cause, and about 30% of cases result from diabetes.

Diabetic neuropathy can occur in those with type 1 or type 2 diabetes, and results from decreased blood flow and increased blood sugar levels. That is, when blood sugar level is higher than normal for an extended period of time, the blood vessels and nerves start to degenerate, which causes the nerves to be less effective. Strict control of blood sugar levels prevents the development of neuropathy in 60% of type 1 diabetics, and can also decrease the severity of the symptoms. Symptoms usually develop 10 to 20 years after the initial diabetes diagnosis. However, an April 2008 article in Pediatric Diabetes, which looked at adolescents with type 2 diabetes, warned that, unlike in type 1 diabetes, peripheral neuropathy can be present soon after diagnosis.

Other causes include: autoimmune disorders, e.g., lupus, Guillain-Barré syndrome, also known as acute inflammatory demyelinating polyradiculopathy, or AIDP; trauma; tumors; heredity, e.g., amyloid polyneuropathy, Charcot-Marie-Tooth disease, also known as hereditary motor sensory neuropathy, or HMSN; nutritional imbalances, e.g., due to alcoholism, Crohn's, vitamin B deficiency; infections, e.g., Herpes zoster, HIV; or toxins/drug toxicity, e.g., heavy metals, chemo agents. An article published in Neurology in May 2003, concluded that celiac disease is commonly associated with sensory neuropathy and should be considered even in the absence of gastrointestinal symptoms.

When Should a Person Seek Medical Advice?

If a person experiences unusual tingling, weakness, or pain in their hands or feet, they should see a doctor. With early diagnosis, neuropathy can often be controlled. Neuropathy is typically diagnosed by a neurologist or physical medicine and rehabilitation physician who takes a complete history and performs a complete neurological exam to determine the type, distribution, and severity of the neuropathy. Tests performed can include blood tests, urine tests, nerve conduction studies, electromyography studies, evoked potentials, skin biopsies, autonomic tests, and nerve biopsies. (For more information, see the American Association of Neuromuscular & Electrodiagnostic Medicine's patient resources page.)

What Therapies or Treatments Are Available?

Therapy will depend on the diagnosis. In cases in which the neuropathy is related to an underlying medical condition, management is focused on that condition. For example, in the case of diabetic neuropathy, optimizing blood sugar control can stabilize or improve the condition, while in the case of toxic exposures, the drug or toxin should be removed from the patient's environment. Drugs to alleviate painful symptoms may be used, and drugs may include over-the-counter or prescription pain medications, as well as antidepressants or anti-seizure meds. A person may also be helped by occupational therapy and/or physical therapy modalities, such as exercises, orthotics, splinting, or ambulation aids. Self-care may include taking care of one's feet (particularly in the case of diabetic neuropathy), maintaining a healthy diet, exercising regularly, and massaging the hands and feet. There are also support groups in many locations.

For more information, see: • American Association of Neuromuscular & Electrodiagnostic Medicine's patient resources page • The Neuropathy Association • National Institute of Neurological Disorders and Stroke page on Peripheral Neuropathy

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