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Peripheral Neuropathies

The terms “peripheral neuropathy” and “polyneuropathy” encompass a wide spectrum of disorders that affect peripheral nerves. These peripheral nerves travel from the spinal cord to innervate muscles, skin, internal organs, and glands. Peripheral neuropathies are a relatively common neurologic problem seen in the Neuromuscular Center. There are many causes for peripheral neuropathies; however, they often present with relatively uniform symptoms such as pain, numbness, paresthesias (abnormal sensations like tingling and burning), hypersensitivity, and weakness in the arms and legs. Some neuropathies may involve muscles of the eyes, swallowing, breathing, and the autonomic nervous system.

Peripheral neuropathies can be hereditary (passed within families) or acquired. Hereditary neuropathies often have characteristic clinical, electrodiagnostic, and genetic markers. An example of hereditary peripheral neuropathies is Charcot-Marie Tooth (CMT) disease or hereditary sensory and motor neuropathy (HSMN). Acquired neuropathies, on the other hand, are more common and can be more difficult to diagnose. The most common cause of acquired polyneuropathy is diabetes mellitus. Other causes include Guillain-Barre syndrome or acute inflammatory demyelinating polyradiculoneuropathy (AIDP), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), nerve compression, nutritional deficiencies, organ failure, tumors, and a variety of generalized disorders (including, but not limited to amyloidosis, connective tissue diseases, and vasculitis).

“Small fiber neuropathies” represent a subtype of acquired peripheral neuropathy. These peripheral neuropathies usually present burning-type pain in the feet and hands. Diabetes is the most common cause identified in this disorder. However, there are many other diseases that present with a small fiber neuropathy.

Diagnosis starts with a neurologic history and examination. Laboratory tests provide additional information. The EDX examination provides crucial information by determining the underlying type of peripheral neuropathy. The EDX examination is a technical test and reliable results depend on a skilled and experienced laboratory. The EDX laboratory at the Cleveland Clinic is world-renown for its excellence. In addition to the EDX examination, the diagnosis of certain types of peripheral neuropathies requires studying tissue specimens. Examples include vasculitis and amyloidosis. In these cases, nerve biopsy of sensory nerves may be indicated. The diagnosis of small fiber neuropathies may also require nerve biopsy; however, a variety of additional tests are often called upon to diagnosis this subtype of neuropathy. These include the quantitative sudomotor axon reflex test (QSART), cardio-autonomic tests, quantitative sensory test and sympathetic skin responses.

The treatment of peripheral neuropathies depends on the underlying cause. For instance, therapy for peripheral neuropathy caused by diabetes involves control of the diabetes. A multi-disciplinary approach is used for all peripheral neuropathies, including treatment of pain and maintenance of strength and flexibility. This is accomplished by using appropriate neuropathic medications, immune-modulating agents (such as corticosteroids, azathioprine, cyclosporine, cyclophosphamide, mycophenolate, and rituximab), IVIG, therapeutic apheresis, and physical and occupational therapy.

Cleveland Clinic takes a multidisciplinary approach to the treatment of peripheral nerve trauma and peripheral nerve tumors. The Cleveland Clinic Peripheral Nerve Injury Clinic utilizes expert neurologists and neurosurgeons who review each case to determine the tailored method of treatment that will ensure the best outcome for each patient.

Cleveland Clinic utilizes optimal electrodiagnostic testing and neuroimaging (including a specialized imaging technique known as MRI Neurography) and allows select patients to undergo a same-day evaluation by a neurologist and neurosurgeon with expertise in treating peripheral nerve disorders.

By using a combination of microsurgery and intraoperative mapping techniques, Cleveland Clinic specialists can facilitate safe and effective surgical treatment of the peripheral nervous system.

To schedule an appointment with a Cleveland Clinic peripheral nerve specialist, call 216.636.5860 or toll-free 866.588.2264.

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