Neuropathy refers to damage to the peripheral nerves that carry information from the brain and spinal cord to the rest of the body. It can result in numbness, tingling, pain, and weakness in the extremities and other parts of the body. There are many potential causes of neuropathy, including diabetes, chemotherapy, HIV/AIDS, autoimmune disorders, and hereditary conditions. While neuropathy cannot always be cured, a neurologist can provide significant relief through a variety of treatments.
What are the symptoms of neuropathy?
The most common symptoms of neuropathy include:
– Numbness and tingling in the hands, feet, arms, or legs
– Burning or shooting pain
– Loss of balance and coordination
– Muscle weakness, especially in the feet and ankles
– Increased sensitivity to touch
– Lack of sensation/inability to feel hot and cold
– Difficulty with fine motor skills like buttoning clothes
These symptoms usually start gradually in the toes and fingers before spreading upward. The severity can range from mild to disabling.
What causes neuropathy?
There are many potential causes of peripheral neuropathy:
– Diabetes: High blood sugar from diabetes can damage nerves over time, resulting in diabetic neuropathy. This is the most common cause.
– Chemotherapy drugs: Certain chemotherapy medications used to treat cancer are toxic to nerves.
– Autoimmune diseases: Disorders like rheumatoid arthritis, lupus, and Guillain-Barré syndrome can cause inflammation that damages nerves.
– Infections: Viruses and bacteria like HIV, hepatitis C, Lyme disease, shingles, and leprosy increase neuropathy risk.
– Inherited disorders: Charcot-Marie-Tooth disease and other genetic conditions affect peripheral nerves.
– Trauma/injury: Broken bones, dislocations, and repeated stress or motion can injure nerves.
– Kidney disease: Kidney dysfunction allows nerve toxins to build up.
– Alcoholism: Chronic alcohol use is associated with neuropathy.
– Vitamin deficiencies: Lack of B vitamins like B12, B1, B6, and folate can damage nerves over time.
In about 30% of neuropathies, no specific cause can be identified (idiopathic neuropathy).
Why see a neurologist for neuropathy?
A neurologist is a medical doctor who specializes in diagnosing and treating diseases of the nervous system, including neuropathy. There are several advantages to seeing a neurologist:
– Identifying the underlying cause: Neurologists conduct comprehensive testing to pinpoint the root cause of neuropathy, whether it is diabetes, chemotherapy, an autoimmune disorder, or another condition. Determining the cause is crucial for proper treatment.
– Accurate diagnosis: There are many types of neuropathy with complex names like peripheral, focal, proximal, and autonomic neuropathies. A neurologist can diagnose the specific type based on symptoms, distribution, and nerve testing results.
– Advanced testing: Neurologists have access to specialized diagnostic tools like nerve conduction studies (NCS), electromyography (EMG), and skin biopsy to evaluate nerve damage. This helps guide treatment approaches.
– Prescribing medications: Neurologists can provide medication to help manage neuropathic pain, regulate blood sugar levels, treat infections, or slow progression based on the individual case.
– Providing a holistic approach: Neurologists consider how neuropathy impacts daily life and develop a multifaceted treatment plan. This may involve physical/occupational therapy, braces, foot care, emotional support, and referrals to other specialists.
What treatments can a neurologist provide?
The treatments a neurologist may provide for peripheral neuropathy include:
Medications
– Pain relievers like gabapentin (Neurontin), tricyclic antidepressants, SNRI medications, lidocaine patches, and NSAIDs to alleviate neuropathic pain and discomfort.
– Capsaicin cream to reduce pain signals.
– Steroids like prednisone to reduce nerve inflammation.
– Plasma exchange to remove blood proteins attacking nerves in autoimmune disorders.
– Anti-seizure drugs like lamotrigine to stabilize nerve cell membranes.
– Immunosuppressants to modulate overactive immune systems in autoimmune neuropathies.
Nutritional Supplements
– Vitamin B12, B1, B6, and folate supplements to address deficiencies.
– Alpha lipoic acid to protect nerves from injury.
– Acetyl-L-carnitine to improve nerve regeneration.
– Vitamin D for its neuroprotective benefits.
Lifestyle Changes
– Diet and exercise modifications to improve diabetes and weight management.
– Physical and occupational therapy to improve strength, balance, and coordination.
– Orthotics like ankle-foot braces to stabilize gait and prevent falls.
– Instruction on proper foot care to prevent ulcers and infections.
Procedures
– Infrared therapy to stimulate circulation and nerve regeneration.
– Transcutaneous electrical nerve stimulation (TENS) for pain relief.
– Plasma exchange to filter out autoantibodies in autoimmune diseases.
– Immunoglobulin therapy to modulate immunity.
Surgery
– Carpal tunnel or cubital tunnel release surgery to decompress pinched nerves.
– Spinal cord stimulation implants to block neuropathic pain signals.
Referrals
Neurologists may refer patients to other specialists like podiatrists, orthopedists, physical therapists, mental health professionals, and pain management clinicians to fully address the diverse impacts of neuropathy.
What tests are used to diagnose neuropathy?
Neurologists have multiple tools to evaluate and diagnose peripheral neuropathy:
Medical History and Physical Exam: Asking about symptoms, medical conditions, family history, diet, medications, and lifestyle provides important clues. A neurological exam assessing reflexes, sensation, strength, and balance is key.
Blood Tests: These measure glucose, kidney function, electrolytes, vitamin levels, and markers of autoimmune disorders.
Genetic Testing: DNA analysis helps diagnose hereditary neuropathies.
Nerve Conduction Study: Electrodes assess how fast nerves transmit electrical signals, pinpointing damage.
Electromyography: Needle electrodes detect issues with muscles innervated by particular nerves.
Quantitative Sensory Testing: This quantifies sensory thresholds for vibration, cooling, pain, and touch.
Skin Biopsy: Examining small skin samples under a microscope reveals nerve fiber density and health.
Autonomic Testing: Assessing heart rate, blood pressure, sweating, and digestive function evaluates autonomic neuropathy.
What is the role of nerve conduction studies?
Nerve conduction studies (NCS) are an important diagnostic tool frequently used by neurologists to evaluate peripheral nerve damage in neuropathy. Here’s how they work:
– Small electrodes are placed on the skin over specific nerves. Brief electrical pulses stimulate the nerves.
– Additional electrodes measure the speed and strength of resulting nerve signals as they travel to muscles.
– Results determine if nerve conduction is slowed, blocked, or diminished, pointing to a specific location of injury.
– Different nerves like motor, sensory, and mixed nerves are tested based on symptoms and suspected neuropathy type.
– Common sites include across the wrist, ankle, elbow, knee, and foot. Needle EMG electrodes may also be inserted into muscles to assess nerve-muscle connectivity.
– The studies are used to diagnose neuropathies like carpal tunnel syndrome, peripheral polyneuropathy, root/plexus neuropathies, and mononeuropathies.
NCS provide objective data about damage to specific nerves that informs the diagnosis, severity, treatment, and prognosis. It assists in monitoring the progression of neuropathy over time. The non-invasive test takes 30-60 minutes and may cause some mild tingling.
Can neuropathy be cured?
There is no definitive cure for most types of peripheral neuropathy. However, with proper treatment under a neurologist’s care, significant symptom relief and improvement in quality of life can often be achieved. The goals are:
– Treating any underlying condition to prevent further nerve damage
– Reducing pain, tingling, numbness to improve function
– Slowing the progression of neuropathy
– Addressing complications like foot ulcers
– Improving strength, balance, and safety through therapy
– Supporting emotional health and coping
While the nerves have limited ability to completely heal, a neurologist strives to maximize all treatment options to manage symptoms. With conditions like Guillain-Barre syndrome that reversibly damage nerves, recovery is possible. Regular follow up and vigilance of symptoms is key. While neuropathy can be challenging to live with, the right treatment makes it possible to maintain an active, fulfilling life.
When should you see a neurologist for neuropathy?
You should see a neurologist for neuropathy if you experience persistent numbness, tingling, burning, or pain in your feet, hands, arms, or legs. Neurological symptoms affecting your daily activities warrant an evaluation. Other reasons to see a neurologist include:
– You’ve been diagnosed with neuropathy but symptoms worsen or new ones develop
– Current treatments aren’t providing adequate symptom relief
– You need help managing medication side effects
– You have symptoms of muscle wasting or weakness
– You develop foot ulcers, infections, or walking difficulties
– You have symptoms of autonomic neuropathy like dizziness or digestive issues
– You need guidance on diet, exercise, braces, therapy, and home care
– You need specialized testing like NCS/EMG to determine neuropathy type and severity
– An underlying cause like diabetes or chemotherapy needs to be addressed
– You have a family history or symptoms of hereditary neuropathy
At the first sign of persistent neurological symptoms, see your primary care doctor. They will likely refer you to a neurologist for optimal diagnosis and treatment of neuropathy. Ongoing follow up is recommended to monitor and manage your condition.
What questions should I ask my neurologist?
When visiting a neurologist for neuropathy, consider asking the following questions:
– What type of neuropathy do I have?
– What diagnostic tests will I need and what can they tell us?
– What is the likely underlying cause based on my symptoms and test results?
– What treatments do you recommend, and what are the potential side effects?
– Are there any steps I can take with diet, exercise, foot care, braces, etc to help manage my condition?
– Should I see a podiatrist, physical therapist, or other specialist?
– What symptoms should I watch out for that need immediate attention?
– Will my neuropathy worsen over time? What can be done to slow progression?
– If medication or nutritional supplements are prescribed, when/how should I take them?
– Will I need periodic blood tests or follow-up nerve conduction studies?
– Are there any activity restrictions I should follow?
– Will neuropathy impact my work, driving ability, or other aspects of daily living?
– Where can I find information, support groups, and resources for coping with neuropathy?
Don’t hesitate to voice worries, questions, and concerns to your neurologist. They can provide guidance on what to expect with neuropathy and how to have the best possible outcome. Being informed and proactive is key.
Conclusion
Neuropathy can significantly impact quality of life but does not have to prevent you from enjoying daily activities. A neurologist has the skills and resources to accurately diagnose the type of neuropathy, uncover the root cause, slow the progression, and provide meaningful symptom relief. While neuropathy cannot always be cured, there are many effective ways a neurologist can help you manage it. With a combination of medications, lifestyle changes, therapy, and treatment of underlying conditions, many patients see a great improvement in their neuropathy symptoms and ability to function. Working closely with a neurologist provides the greatest chance of successfully living with this challenging condition.