What neurological conditions cause neuropathy?

Peripheral Neuropathy

Neuropathy, also called neuralgia, means nerve disease or damage. Nerves are made of fibers that affect pain sensation, movement, and balance. Peripheral nerves take messages from the brain and spinal cord to muscles, organs, and other body tissues. Damage may mean being more sensitive to things that are painful (such as pinpricks) or not painful (such as light touch). The first is called hyperalgesia; the second, hyperesthesia. Allodynia is pain caused by something that’s not normally painful. From 1.6% to 8.2% of the general population have neuropathy.

What Causes Peripheral Neuropathy?

Many causes exist, including direct injury and pressure on nerves. Metabolic causes include diabetes mellitus, malnutrition, and porphyria. Others are vitamin B deficiencies. Inflammatory causes are lupus, Sjögren’s syndrome, polyarteritis nodosa, acute and chronic inflammatory demyelinating polyneuropathy, sarcoid, and multiple sclerosis. Infectious causes are HIV/AIDS, herpesvirus, varicella-zoster virus (postherpetic neuralgia), Lyme disease, leprosy, and syphilis. Rare cancer of nerves can also cause neuropathy. Alcohol, chemotherapeutic drugs, isoniazid, metronidazole, and heavy metals (arsenic) are other causes of neuropathy.

What Are the Signs and Symptoms of Peripheral Neuropathy?

Symptoms depend on the nerves and fibers affected. Numbness and tingling in feet and hands may start slowly and spread to legs and arms. People may have burning, hot or cold, “icy hot,” pins and needles, stinging, shooting (lancinating), or sharp feelings. Extreme sensitivity to even light touch can occur. Affected limbs may be numb and weak. Muscle tissue may be lost (muscle atrophy) if the neuropathy has been present for a prolonged period. Spinal cord involvement may mean the urinary bladder and bowel problems.

How Is Peripheral Neuropathy Diagnosed?

The health care provider makes a preliminary diagnosis from the medical history and physical examination. Laboratory tests, magnetic resonance imaging (MRI) of the brain and spinal cord and special tests including nerve conduction studies and electromyography (EMG), nerve biopsy, and lumbar puncture may be done to confirm the diagnosis and determine the cause. The health care provider may suggest seeing specialists (neurologist, physical therapist, pain management specialist) for additional evaluation and treatment.

How Is Peripheral Neuropathy Treated?

Symptoms often improve with time, especially if causes can be treated. For example, better control of blood sugar (glucose) can lower the risk of diabetic neuropathy. Vitamin B₁₂ supplements can help with vitamin B₁₂ deficiency. Medicines used for treatment of painful neuropathy include antidepressants, antiepileptics, and analgesics. Counseling may help deal with psychologic issues that make pain worse. Physical therapy helps, especially for chronic neck and low back pain. Acupuncture and biofeedback can also be tried. Surgery and nerve blocks are options mostly for people having pain from spinal cord injury. Surgery is usually used when other treatments don’t work.

DOs and DON’Ts in Managing Peripheral Neuropathy:

• DO take care of your feet, especially if you have diabetes.
• DO keep healthy. Exercise, eat healthy meals, lose weight, and quit smoking.
• DO avoid repetitive movements, cramped positions, toxic chemicals, and too much alcohol—things that cause nerve damage.

• DON’T ignore symptoms. Call your health care provider if your symptoms don’t get better or they get worse with treatment. Call if you have new symptoms.
• DON’T stop taking your medicine or change the dosage because you feel better unless your health care provider tells you to.
• DON’T use any medicines (including over-the-counter and herbal products) without asking your health care provider.

FOR MORE INFORMATION

Contact the following source:

• Neuropathy Association
  Web: www.neuropathy.org
• American Academy of Orthopedic Surgeons
  Phone:847-823-7186
  Web: www.aaos.org
• North American Spine Society
  Phone 708-588-8080
  Web: www.spine.org
• American Physical Therapy Association
  Phone 800-999-2782
  Web: www.apta.org
• National Institute of Neurological Disorders and Stroke
  Tel: (800) 787-6537
  Website: www.ninds.nih.gov

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor

Peripheral Neuropathy

Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves — motor, sensory, or autonomic — that are damaged. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, medical procedures, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations.

Treatment

No medical treatments exist that can cure inherited peripheral neuropathy. However, there are therapies for many other forms. In general, adopting healthy habits — such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption — can reduce the physical and emotional effects of peripheral neuropathy. Systemic diseases frequently require more complex treatments.

Prognosis

In acute neuropathies, such as Guillain-Barré syndrome, symptoms appear suddenly, progress rapidly, and resolve slowly as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. Some people may have periods of relief followed by relapse. Others may reach a plateau stage where symptoms stay the same for many months or years. Some chronic neuropathies worsen over time, but very few forms prove fatal unless complicated by other diseases. Occasionally the neuropathy is a symptom of another disorder.

Research

The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct research related to peripheral neuropathies in laboratories at the NIH and also support additional research through grants to major medical institutions across the country. Current research projects funded by the NINDS involve investigations of genetic factors associated with hereditary neuropathies, studies of biological mechanisms involved in diabetes-associated neuropathies, and investigations exploring how the immune system contributes to peripheral nerve damage. Neuropathic pain is a primary target of NINDS-sponsored studies aimed at developing more effective therapies for symptoms of peripheral neuropathy. Some scientists hope to identify substances that will block the brain chemicals that generate pain signals, while others are investigating the pathways by which pain signals reach the brain.

View research on this topic.
View articles about this condition.
View studies being conducted about this condition.
View NINDS publications on this topic.

Organizations

American Chronic Pain Association (ACPA)
Provides self-help coping skills and peer support to people with chronic pain. Sponsors local support groups throughout the U.S. and provides assistance in starting and maintaining support groups.

P.O. Box 850
Rocklin, CA 95677-0850
ACPA@theacpa.org
http://www.theacpa.org
Tel: Rocklin
Fax: 916-652-8190

Neuropathy Association
The Neuropathy Association is the leading national nonprofit organization providing peripheral neuropathy patient support and education, advocating for patients’ interests, and promoting critical research. We have 50,000 members and supporters, and a nationwide network of 135 support groups and 12 Neuropathy Centers of Excellence at prominent medical institutions.

110 West 40th Street
Suite 1804
New York, NY 10018
info@neuropathy.org
http://www.neuropathy.org
Tel: New York
Fax: 212-692-0668

National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

3 Information Way
Bethesda, MD 20892-3580
nkudic@info.niddk.nih.gov
http://www.niddk.nih.gov
Tel: Bethesda

Charcot-Marie-Tooth Association (CMTA)
Provides education and support to persons with Charcot-Marie-Tooth disorders, their families, and the health professionals who treat them.

P.O. Box 105
Glenolden, PA 19036
info@cmtausa.org
http://www.cmtausa.org/
Tel: Glenolden
Fax: 610-499-9267

Content Provided By

NINDS Disorders is an index of neurological conditions provided by the National Institute of Neurological Disorders and Stroke. This valuable tool offers detailed descriptions, facts on treatment and prognosis, and patient organization contact information for over 500 identified neurological disorders.

Peripheral Neuropathy

Millions of Americans have a peripheral neuropathy, a form of nerve damage that can cause pain, numbness and other symptoms. It’s important to know:

• These disorders are rarely life-threatening but can lead to disabling symptoms if left untreated.
• Early diagnosis and treatment is important. A “wait and see” approach can lead to permanent nerve damage.
• Nerves can become injured by disease, infection, accidents and other causes.

• Diagnosing nerve disorders
• Nerve disorder treatments
• Care for inherited, illness-related and other neuropathies at our ALS and Neuromuscular Disease Center

What are peripheral neuropathies?

Peripheral neuropathies are nerve disorders that affect the peripheral nerves. Peripheral nerves branch throughout the body, radiating to your fingers and toes. They carry sensory data, instructions and other messages to and from the central nervous system (the brain and spinal cord).

Peripheral neuropathies can range from mild to severe. They may weaken muscles or limit sensation in the arms, hands, legs or feet. Mild forms may go undiagnosed. More serious types can affect walking, breathing, swallowing and talking.

Some peripheral neuropathies cannot be cured, but treatment can lessen pain, reduce symptoms and increase quality of life.

Who gets peripheral neuropathies?

Estimates of the number of people with peripheral neuropathy range from at least 20 million to about 30 million people in the U.S. They vary widely because so many cases go undiagnosed.

Risk factors include:

• Age: People older than 50 are at higher risk for most peripheral neuropathies.
• Family history: Some rare neuropathies are caused by genetic defects that are passed down in families.
• Having another condition: Peripheral neuropathy is often linked to other conditions, such as diabetes, HIV/AIDS, kidney failure or cancer.
• Certain jobs or activities: The same repetitive motion over a long time, such as working on an assembly line, can injure nerves.

What causes peripheral neuropathies?

Many conditions and circumstances can damage peripheral nerves. They include:

• Illnesses such as diabetes
• Autoimmune disease such as Guillain-Barré syndrome, lupus and rheumatoid arthritis
• Infections such as HIV and West Nile virus
• Injuries from accidents or repeated motions
• Tumors
• Chemotherapy
• Vascular problems
• Liver or kidney failure
• Genetic defects passed down in families
• Exposure to toxins
• Hormone imbalances, such as from an underactive thyroid
• Alcohol abuse
• Lack of vitamins

In many cases, though, the cause is unknown or can’t be pinned down. This is called idiopathic neuropathy.

Symptoms

If you have symptoms of peripheral neuropathy, it’s important to see a doctor. Some nerve conditions must be treated within a limited time for the treatment to be effective. Symptoms vary by the type of neuropathy but can include the following:

• Numbness
• Burning, stabbing, freezing or tingling pain
• Muscle weakness, especially in legs, feet, arms or hands
• Unusual or increased sensation, or extreme sensitivity to touch
• A feeling that you’re wearing socks or gloves when you’re not
• Difficulty walking, running or controlling arm movements
• Trouble with balance and coordination
• Difficulty holding things
• Foot dragging, also called foot drop
• Unusually high arches
• Curled toes (hammer toes)

Types of peripheral neuropathy

Scientists have identified more than 100 types of peripheral neuropathy. Neuropathies are classified in many ways, including:

Acquired or hereditary

Most neuropathies are acquired, meaning they develop sometime after birth as the result of infection, illness or injury.

Hereditary neuropathies are caused by genetic changes passed down in families. Though people who have a hereditary neuropathy were born with it, symptoms may not develop until the teen years or adulthood.

Nerve types affected

Neuropathies can be described by the type of nerve affected. Some types mainly affect one or two types of nerves, but most affect all three:

Motor nerves: These nerves control voluntary muscle movement.

Sensory nerves: These nerves carry information from the senses — vision, hearing, smell, taste, touch — to the brain .

Autonomic nerves: These nerves help regulate functions you don’t consciously control, such as heartbeat, digestion and breathing.

Number of nerves affected

Neuropathies are also described by how many nerves they affect.

Mononeuropathy: This type affects only one nerve. It’s usually caused by injury or repeated stress.

Multiple mononeuropathy: This type affects two or a few nerves or nerve areas in different parts of the body.

Polyneuropathy: This type affects many or most nerves. It is the most common type.

Neuropathies related to illness, injury and other conditions

Many neuropathies are defined by their underlying cause. Here is a sampling:

Brachial plexus injury: The brachial plexus is a network of nerves, one on each side of the body, that connects the spinal cord to the shoulder, arm and hand. If injured, most often in a traffic accident, a person can have paralysis in all or part of the affected limb. Learn more about brachial plexus injuries.

Charcot-Marie-Tooth disease: CMT is the most common hereditary neuropathy. It’s a group of at least 30 disorders named after the three doctors who discovered them. It affects about 1 in 2,500 people in the United States. CMT is classified into subtypes: CMT1, the most common subtype, affects nerves’ myelin sheath (protective covering). Learn more about our care for CMT.

Chemotherapy-induced peripheral neuropathy: Some chemotherapy medications can damage nerves, making neuropathy one of the most common side effects of cancer treatment. Radiation therapy for cancer can also damage peripheral nerves.

Chronic inflammatory demyelinating polyneuropathy (CIDP): This nerve disorder causes weakness in the arms and legs. It’s progressive, meaning it gets worse over time. CIDP can come with pain, fatigue, numbness and tingling. It’s a type of autoimmune neuropathy, occurring when the immune system attacks the covering (myelin sheath) that protects nerves.

Carpal tunnel syndrome: Repetitive movements or conditions such as rheumatoid arthritis can pinch or compress the median nerve on the inner wrist. Learn more about carpal tunnel syndrome.

Cubital tunnel syndrome: Repetitive movements or injury can press on the ulnar nerve, at the elbow. This nerve is commonly called the “funny bone” because of the jolt it sends through your arm when bumped. Cubital tunnel syndrome is also called ulnar nerve entrapment. Learn more about cubital tunnel syndrome.

Diabetic neuropathy: This the most common peripheral neuropathy, affecting a significant portion of people who have diabetes. It occurs when uncontrolled blood sugar levels damage nerves. Diabetic neuropathy often results in leg or foot numbness, which can leave ulcers or other infections to spread unnoticed. These uncontrolled infections are why people with diabetes sometimes end up needing a foot or lower-leg amputated.

Guillain-Barré syndrome: In this rare autoimmune neuropathy, the body ’ s immune system attacks nerves, often after an infection. Guillain-Barré causes weakness or a change in sensation in limbs at first, and can progress to paralyzing the entire body. Most patients make a full recovery with early treatment.

Hereditary neuropathy with liability to pressure palsies: HNPP is rare, affecting only two to five people out of 100,000. It occurs when one copy of the PMP22 gene is missing. This gene makes a protein that is a key part of myelin, the nerve sheath. People with HNPP are extremely sensitive to physical pressure. Even crossing the legs or carrying heavy bags can be a problem.

HIV-related neuropathy: The human immunodeficiency virus (HIV) and medications used to treat HIV/AIDS can damage nerves. About one-third of people who have HIV also have HIV-related neuropathy.

Hormone imbalances: Hormone imbalances, such as when your thyroid doesn’t make thyroid hormone, can cause tissues to swell and press on nerves.

Kidney and liver failure: The liver and kidneys remove waste and toxic substances from the body. When these organs aren’t working properly, these substances can build up and damage nerves, leading to neuropathy.

Sciatica: A pinched sciatic nerve can cause pain that starts in the lower back and runs down one or both legs. A burning, shooting pain often comes with tingling or leg weakness. Learn more about sciatica and about radiculopathy , or pinched nerves along the spine.

Thoracic outlet syndrome: This uncommon and often-missed condition is a compression of the nerves between the collarbone and first rib.

Toxins: Exposure to toxins such as lead, arsenic and other heavy metals can cause nerve damage that leads to peripheral neuropathy.

Tumors: Cancerous and noncancerous (benign) growths can invade or press on nerves. Learn more about nerve tumors.

Vasculitic neuropathy: A condition called vasculitis causes blood vessels to become inflamed, robbing nerves of the blood flow they need to work properly.

Learn more

• Peripheral Neuropathy Information Page, National Institute of Neurological Disorders and Stroke
• Peripheral Neuropathy Fact Sheet, National Institute of Neurological Disorders and Stroke
• What Is Peripheral Neuropathy? The Foundation for Peripheral Neuropathy
• What is Hereditary Neuropathy? Healthline
• Hereditary Neuropathies Information Page, National Institute of Neurological Disorders and Stroke
• Diabetic Neuropathy Information Page, National Institute of Neurological Disorders and Stroke
• Charcot-Marie-Tooth Disease Fact Sheet, National Institute of Neurological Disorders and Stroke
• Hereditary Neuropathy with Liability to Pressure Palsies, Hereditary Neuropathy Foundation
• Hereditary Neuropathy Disorders, The Foundation for Peripheral Neuropathy
• Guillain-Barré Syndrome Fact Sheet, National Institute of Neurological Disorders and Stroke