Types of Peripheral Neuropathies
Amyloid Polyneuropathy
Amyloidosis may be associated with a neuropathy in about 20 percent of patients. Amyloidosis may occur with diseases such as multiple myeloma or may be inherited. Amyloid neuropathy may result in a variety of clinical conditions including carpal tunnel syndrome, neuropathic pain, an autonomic neuropathy, cranial neuropathy, and later on weakness. Diagnosis may include several tests including a nerve or muscle biopsy and genetic testing. There may be treatment for amyloid polyneuropathy and this will be discussed with you by your physician.
Diabetic Neuropathy
Diabetic neuropathy is caused by diabetes or impaired glucose intolerance. In both of these disorders, the body does not process sugar effectively, causing elevated sugar levels in your blood. The elevated sugar levels damage your nerves, leading to neuropathy. Patients often complain of burning, tingling, or numb feelings in their feet, legs, or hands. These symptoms may be more noticeable at night or when resting.
Diagnosis
Your health care provider may order an oral glucose tolerance blood test. This is a 2-hour fasting blood test that gives the provider information about how you process sugar. They may also order a nerve conduction study/electromyography, skin biopsy or nerve biopsy to further evaluate your nerves and muscles.
Treatment
Treatment for diabetic neuropathy focuses on pain management, sugar control and supportive services. There are several medications and other treatments that help alleviate tingling and burning pains. These pain medications do not alter the course of your neuropathy. Sugar control such as diet, exercise and diabetic medications work on keeping your sugar within normal limits. Normal sugar levels do not damage the nerves. If caught early and given treatment it is possible to slow and reverse the progression of diabetic neuropathy.
Other support services, such as physical therapy, and other medical specialists may be required for diabetic ulcers, muscle weakness and balance training.
Inflammatory Neuropathy
Inflammatory neuropathies can be caused by infections or an autoimmune process. There are several specific causes of this neuropathy. However, in most cases the immune system begins attacking the nerves, which causes neuropathy. Patients can complain of sensory symptoms like burning, tingling or numbness. They may also have motor symptoms like muscle weakness. It may be contained in the arms or legs or more widespread.
Diagnosis
Your health care provider may order many tests to look for causes of this neuropathy. This may include several blood studies looking for infectious causes and evidence of inflammation. They may also order a lumbar puncture or spinal tap. This test evaluates the fluid around your spinal cord for infections and inflammation. Finally, they may order a nerve conduction study/electromyography and if necessary a nerve biopsy to detect inflammation of the nerve.
Treatment
First your provider may treat your symptoms. If you have burning or tingling pain there are several medications that can lessen these sensations so they are more tolerable. Second your provider will treat the immune system attack. There are several oral (pill) medications that can be used to slow or reverse the progression of the neuropathy.
There are also intravenous medications that can be given as an outpatient in our infusion clinic. The infusion clinic is located in the same area where you see your health care provider. Intravenous immunoglobulins (IVIG) or plasmapheresis may be prescribed.
Painful Neuropathy
Painful neuropathies are caused by damage to the nerve tissue. This can be from an injury, metabolic disturbance or infection. Patients often complain of burning, tingling, pins and needles and electric or stabbing pains. Sometimes normal sensations can be uncomfortable, like the bed sheets touching your feet.
Diagnosis
Your health care provider may order several tests to find the cause of your nerve pain. This may include blood draws, nerve conduction study/electromyography, imaging (MRI or CT scan), or skin biopsy. Some patients may experience this neuropathy and have no known cause. Other patients my have an undiagnosed form of diabetic neuropathy.
Treatment
If a reversible cause for your neuropathy is found then it will be treated. In addition, you may benefit from medication to lessen the painful sensations. There are several types of medications that can be used and not every medication works for each person.
Toxic Neuropathy
Toxic neuropathies can be caused by medications like chemotherapy or environmental chemicals. These harsh substances cause damage to the nerves. Patients often complain of burning, tingling, pins and needles and electric or stabbing pains. Sometimes normal sensations can be uncomfortable, like the bed sheets touching your feet.
Diagnosis
Your health care provider may order several tests to find the cause of your nerve pain. This may include drawing blood, nerve conduction study/electromyography, skin biopsy, or nerve biopsy. Some patients may experience this neuropathy and have no known cause.
Treatment
The first goal is to complete a careful evaluation to determine the toxic agent. Once the agent is identified, a plan is created to remove or minimize exposure to the agent. In some instances there may be a specific treatment available.