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Peripheral Neuropathy

Common Disorder of Peripheral Nerves with Sensory, Motor and Autonomic Manifestations

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Peripheral Neuropathy?

Peripheral neuropathy is a heterogeneous disorder affecting peripheral nerves with sensory, motor and/or autonomic manifestations; affects 7–10% of the general population.

Pathophysiology: damage to peripheral nerve axons (axonal neuropathy) or myelin sheaths (demyelinating neuropathy); ischemia, immune-mediated, metabolic, toxic or genetic mechanisms.

Anatomical classification: mononeuropathy (single nerve, e.g., carpal tunnel), mononeuropathy multiplex (multiple nerves, e.g., vasculitis), polyneuropathy (symmetrical, distal predominance), radiculopathy (nerve root level).

Etiological classification: diabetes (most common, 30–60% of patients), alcohol-related, idiopathic (15–25%), genetic (Charcot-Marie-Tooth), inflammatory (CIDP, GBS), nutritional (B12, B6 deficiency), medication-related, infectious (HIV, leprosy).

Symptoms

Sensory symptoms: numbness, tingling, burning, electric shock-like sensations, often in 'glove and stocking' distribution
Loss of proprioception leading to gait imbalance, falls, especially in dark or uneven surfaces
Allodynia (painful response to non-painful stimuli) and hyperalgesia (increased pain response)
Motor weakness: distal > proximal (foot drop, hand weakness), gait disturbance, muscle wasting
Cramps, muscle twitching, restless legs
Autonomic dysfunction: orthostatic hypotension, bowel/bladder dysfunction, erectile dysfunction, abnormal sweating
Skin and nail changes: trophic changes, hair loss, dystrophic nails, ulcers (especially in diabetic neuropathy)
Neuropathic pain: burning, sharp, electric, often worse at night
Cardiovascular autonomic neuropathy: silent myocardial infarction, sudden death risk
Charcot foot in advanced diabetic neuropathy: bone destruction, deformity

Risk Factors

Diabetes mellitus (30–60% of diabetic patients develop neuropathy)
Chronic alcohol use
Vitamin B12 deficiency (atrophic gastritis, vegan diet, pernicious anemia)
Chronic kidney disease, liver disease
Autoimmune diseases: rheumatoid arthritis, lupus, Sjögren syndrome, sarcoidosis
Chemotherapy: cisplatin, paclitaxel, vincristine, bortezomib
Other medications: amiodarone, isoniazid, statins, metronidazole
Genetic disorders: Charcot-Marie-Tooth, hereditary amyloidosis
Infections: HIV, leprosy, hepatitis C, Lyme disease
Toxin exposure: heavy metals (lead, mercury, arsenic), industrial solvents
Older age (>60 years)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent numbness, tingling or burning sensations in hands or feet
  • Progressive weakness or unsteady gait
  • Foot ulcers, calluses or deformity, especially in diabetic patients
  • Symptoms of autonomic dysfunction: orthostatic dizziness, gastroparesis, sexual dysfunction
  • Severe nocturnal pain affecting sleep
  • Acute or rapidly progressive sensory or motor symptoms (urgent — consider GBS)
  • Worsening of known neuropathy
  • New chemotherapy with neurological symptoms

Treatment Methods

01
Diagnostic workup: detailed history (timeline, distribution, associated diseases, medications, family history), comprehensive neurological examination
02
Laboratory tests: fasting glucose, HbA1c, B12, folate, TSH, complete blood count, comprehensive metabolic panel, ESR/CRP, ANA, paraproteins (SPEP, immunofixation), HIV, hepatitis C
03
Specialized tests for selected cases: heavy metals, anti-MAG antibodies, anti-GM1, anti-sulfatide antibodies, genetic testing (CMT, hereditary neuropathies)
04
Electrodiagnostic testing (EMG/NCS): demonstrates axonal vs demyelinating, distinguishes mononeuropathy from polyneuropathy, identifies severity and distribution
05
Skin biopsy with intraepidermal nerve fiber density: gold standard for small-fiber neuropathy
06
Nerve biopsy (rare): selected cases (vasculitis, amyloidosis, inflammatory neuropathies)
07
Imaging: MRI for nerve root or plexus pathology; ultrasound for entrapment neuropathies
08
Treatment of underlying cause: glycemic control in diabetes (HbA1c <7%), abstinence in alcohol-related, B12/B6 replacement in nutritional, immunomodulation in CIDP
09
Diabetic neuropathy management: tight glycemic control, blood pressure and lipid management, foot care, ulcer prevention
10
Neuropathic pain treatment — first-line: gabapentinoids (gabapentin 300–3600 mg/day, pregabalin 75–600 mg/day), TCAs (amitriptyline, nortriptyline 10–150 mg), SNRIs (duloxetine 30–120 mg, venlafaxine 75–225 mg)
11
Topical agents: capsaicin patch (8%), lidocaine patch (5%); useful for localized pain
12
Other agents: tramadol, opioids (limited use due to dependence), tapentadol, methadone (for refractory pain)
13
CIDP treatment: IVIg (2 g/kg loading, then maintenance), plasmapheresis, corticosteroids; long-term immunosuppression for refractory cases
14
Vasculitic neuropathy: corticosteroids, cyclophosphamide, rituximab; treat underlying vasculitis
15
Hereditary transthyretin amyloidosis: tafamidis, patisiran (RNA interference), inotersen (antisense oligonucleotide); novel disease-modifying therapies
16
Foot care education: daily foot inspection, proper footwear, podiatry care, ulcer prevention; particularly critical in diabetic neuropathy
17
Physical therapy and rehabilitation: balance training, fall prevention, strength training, gait aids
18
Occupational therapy: adaptations for daily activities, hand function rehabilitation
19
Bracing and orthotics: ankle-foot orthosis for foot drop, custom orthotics for foot deformities
20
Lifestyle modifications: smoking cessation, alcohol limitation, exercise, weight management
21
Long-term outcomes: variable based on etiology; diabetic neuropathy often progressive without glycemic control; CIDP highly responsive to treatment; hereditary forms slowly progressive
22
Multidisciplinary follow-up: neurology, endocrinology (for diabetes), pain management, physical and occupational therapy, podiatry, psychology

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.