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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

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Overview of peripheral neuropathy l.jpg

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 l.jpg

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 l.jpg

Peripheral Neuropathy

Peripheral vs. Central

Neuro=nerve

‘pathy’=sickness


Types of peripheral nerves l.jpg

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 l.jpg

Symptoms(how can I be numb and hurt at the same time?)

  • Weakness

  • Pain

  • Burning

  • Thick soles

  • Walking on stones

  • Tingling

  • Imbalance


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Distribution of numbness or weakness in peripheral neuropathy


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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)


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Most common neuropathies

  • Diabetic

    • Distal sensory motor, painful

    • Autonomic

    • Proximal amyotrophy (usually legs)

    • Vasculitic

    • Cranial nerve


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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


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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


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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


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Peripheral NerveMyelinated vs. demyelinated


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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)


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Neuropathy mimics

  • Restless Leg Syndrome (RLS)

  • Erthyromelalgia

  • Entrapment neuropathies (carpal tunnel, ulnar neuropathy, tarsal tunnel syndrome)


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Treatment

  • Try to find cause of neuropathy and reverse it

  • Treat symptoms


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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


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Treatment of Symptoms

  • Alpha lipoic acid (?)

  • Stuff:

    • Good shoes

    • Practice balance

    • Rub feet

    • Watch weight


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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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Questions?


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