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Overview of Peripheral Neuropathy. What is this? And what can I do about it?. Sara Austin, MD, FAAN Specialty: Neuromuscular disease Board Certified in Neurology and EMG. 711 F West 38 th Street Austin, TX 78705 512-637-5854. Peripheral Neuropathy. Peripheral vs. Central Neuro=nerve

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overview of peripheral neuropathy

Overview of Peripheral Neuropathy

What is this?

And what can I do about it?

sara austin md faan specialty neuromuscular disease board certified in neurology and emg

Sara Austin, MD, FAAN Specialty: Neuromuscular disease Board Certified in Neurology and EMG

711 F West 38th Street

Austin, TX 78705

512-637-5854

peripheral neuropathy
Peripheral Neuropathy

Peripheral vs. Central

Neuro=nerve

‘pathy’=sickness

types of peripheral nerves
Types of peripheral nerves
  • Motor nerves –from spinal cord to muscle
  • Sensory nerves – from sensory organelle to spinal cord
    • Small fiber (pain, temperature)
    • Large fiber (vibration, position, balance)
  • Autonomic nerves – control blood pressure, sweating, bladder function, heart rate, gut, etc. All the things you don’t have to think about
symptoms how can i be numb and hurt at the same time
Symptoms(how can I be numb and hurt at the same time?)
  • Weakness
  • Pain
  • Burning
  • Thick soles
  • Walking on stones
  • Tingling
  • Imbalance
causes of neuropathy
Causes of Neuropathy
  • Inflammatory (blood vessels or myelin)
  • Hereditary (Charcot Marie Tooth)
  • Metabolic (diabetes, liver, kidney)
  • Toxic (alcohol, chemical exposure)
  • Vitamin deficiency (B12, D, Thiamine…)
  • Drug related (chemo drugs)
  • Related to tumor (paraneoplastic)
most common neuropathies
Most common neuropathies
  • Diabetic
    • Distal sensory motor, painful
    • Autonomic
    • Proximal amyotrophy (usually legs)
    • Vasculitic
    • Cranial nerve
most common neuropathies11
Most common neuropathies
  • Hereditary – CMT type 1, CMT type 2
  • B12 deficiency
  • Hypothyroid
  • Chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Acute inflammatory demyelinating neuropathy (Guillian Barre syndrome)
  • Related to rheumatological diseases
  • Toxic – EtOH abuse
diagnosis
Diagnosis
  • History and physical exam
    • Weakness? Proximal or distal?
    • Sensory loss? Small fiber or large fiber
    • Autonomic symptoms? Sweat? BP? bladder?
  • EMG/NCS
  • Lab tests: CBC, liver, kidney, electrolytes, ESR, thyroid, inflammatory markers, protein study, Vit D, B12, 2 hour diabetes test
chronic inflammatory demyelinating neuropathy cidp
Chronic Inflammatory Demyelinating Neuropathy (CIDP)
  • Proximal and distal weakness and numbness
  • Usually responds to steroids or IVIG
  • Diagnosed by EMG/NCS
  • ICE study
  • Advice: calendar with dates, dose and drug maker
chemo neuropathies
Chemo Neuropathies
  • Most common with cisplatin, taxanes, ara-C, ifosfamide
  • Initial symptoms are numbness, paresthesias and pain in feet
  • Drug withdrawal, if possible, usually reverses symptoms- hard decision
  • Symptoms may continue to progress for weeks to months (coasting), then plateau and fade (hopefully)
neuropathy mimics
Neuropathy mimics
  • Restless Leg Syndrome (RLS)
  • Erthyromelalgia
  • Entrapment neuropathies (carpal tunnel, ulnar neuropathy, tarsal tunnel syndrome)
treatment
Treatment
  • Try to find cause of neuropathy and reverse it
  • Treat symptoms
treatment of symptoms
Treatment of symptoms
  • Tricyclic antidepressants and SNRI’s
    • Nortriptyline, Amitriptyline, Cymbalta, Effexor
  • Anti-seizure medications
    • Gabapentin, Lyrica, Topamax, …..
  • Topical agents-lidocaine patch, creams, capsacin
  • Narcotics
  • NSAID’s
treatment of symptoms19
Treatment of Symptoms
  • Alpha lipoic acid (?)
  • Stuff:
    • Good shoes
    • Practice balance
    • Rub feet
    • Watch weight
vitamins
Vitamins
  • If you are B12 deficient taking B12 helps
  • No proof that vitamins in general help/or hurt neuropathy except
  • B6 (pyridoxime) can cause neuropathy, don’t take more than 200mg per day
  • Vitamin D is getting some press recently, doesn’t hurt to take more
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