Peripheral Neuropathy

Definition/diagnostic criteria Peripheral neuropathy is a condition characterised by damage or dysfunction of one or more peripheral nerves, leading to varied symptoms like numbness, tingling, pain and muscle weakness. Diagnosis is primarily clinical, based on patient history and physical examination. Confirmatory tests may include nerve conduction studies and electromyography.

Epidemiology The prevalence of neuropathy in the UK is not precisely known, but it is a common neurological disorder. Up to half of individuals with diabetes will develop some form of neuropathy, illustrating its widespread nature in certain populations.

Diagnosis
Clinical features: Neuropathy presents with diverse clinical manifestations, depending on the type and extent of nerve involvement. Symptoms include:

• Sensory changes (numbness, tingling).
• Motor symptoms (muscle weakness, cramps).
• Autonomic symptoms (altered sweating, bowel or bladder problems).
• Pain, often described as burning or shooting.

Investigations: Primary investigations for neuropathy involve:

• Blood tests to exclude common causes like diabetes, vitamin B12 deficiency, and thyroid dysfunction.
• Alcohol and medication should be remembered as potential causes.
• Nerve conduction studies and electromyography are instrumental in confirming the diagnosis and characterising the type of neuropathy.

These investigations typically reveal abnormalities like reduced nerve conduction velocity or denervation changes in affected muscles.

Treatment Treatment of neuropathy involves managing any underlying cause (e.g., vitamin supplementation, diabetes management) but otherwise is  largely symptomatic.

• Pain management, a primary concern, can be addressed with medications such as amitriptyline, duloxetine, or pregabalin.
• Physical therapy and occupational therapy play a significant role in managing motor symptoms and preventing complications.
• The use of transcutaneous electrical nerve stimulation (TENS) may be beneficial for some patients.

Prognosis The prognosis of neuropathy varies widely depending on its aetiology, type and severity. In many cases, especially those caused by reversible conditions like vitamin deficiencies, prognosis can be good with appropriate treatment. However, in chronic conditions like diabetic neuropathy, the focus is often on managing symptoms and preventing progression, as complete recovery is rare. Early diagnosis and treatment are key factors in improving outcomes.