Neuropathy

What is neuropathy?

Neuropathy is disease of nerves.

Symptoms:

Patient feels numbness, tingling, pins and needles sensations, burning in his arms and/or legs. Patient can also have weakness in his arms and legs. He may have difficulty walking, problem with stairs, decrease in hand grip, weakness of his shoulders.

Causes:

Neuropathy is caused by many reasons including diabetes, kidney disease, viral and bacterial infections, nutritional deficiencies, multiple drugs, alcohol, toxins, thyroid disease, injury or prolonged pressure, hereditary and problems with immune system.

Diagnosis:

Neuropathy is diagnosed based upon the patient’s complaints, thorough examination, certain blood tests, special investigations like nerve connection studies/electromyography (NCS/EMG) and CSF analysis. In rare cases nerve biopsy is required.

Treatment:

Treatment depends upon the underlying cause. Sometimes the patient needs treatment for short time (few weeks) and sometimes treatment is for much longer period of time. Treatment usually involves drugs in the form of pills and capsules. Most of times, steroid pills are prescribed. Sometimes the disease.is severe enough that the patient requires daily injections. Few patients need plasmapheresis.

Disability:

Neuropathies can be disabling. The disability can be temporary or permanent depending upon the underlying disease process.

Physiotherapy:

As in other neurological disorders, physiotherapy is very fruitful for patients of neuropathies. Physiotherapy is as important as is drug treatment.

Frequently Asked Questions:

I have numbness and pins and needles sensations in my hands or feet; do I have neuropathy?

If these symptoms are present for more than a month and if you are not pregnant or postpartum then you may have neuropathy, see your doctor.

What are the dietary measures for neuropathy?

Dietary measures will depend upon the underlying cause. For diabetics, avoiding carbohydrates is a very good idea. Likewise patients with kidney disease should observe dietary restrictions as advised by the nephrologist. For general population, eating well balanced diet and staying active is recommended.

Does nerve compression occurs with sitting, sleeping or working in certain postures?

Yes patients who have carpal tunnel syndrome and other compressive neuropathies should avoid certain movements and postures. Please ask your doctor for details.

Do vegetarians have high risk of developing neuropathies?

Yes vegetarians have high risk of developing neuropathies. Please ask your doctor for vitamin supplements if you are a vegetarian.

What is nerve conduction studies/electromyography (NCS/EMG) test?

This test involves checking the nerves and muscles of the patient. It is the whole procedure and is usually done at specialized centers with prior appointment. Nerve conduction studies (NCS) involve attaching certain leads to limbs of patient. Patient may have unpleasant feeling of electrical currents during the test. Electromyography (EMG) involves insertion of needle in different muscle groups and patient may find this procedure painful. This procedure may take 30 to 40 minutes.

What is plasmapheresis?

It is special treatment for certain neuropathies, myopathies and other autoimmune conditions. It involves placement of special catheter in vein usually in neck of the patient. Plasmaphresis machine is attached to the catheter. Blood flows from the patient’s body to the machine where toxins are removed . Clean blood is then returned to body. This procedure usually takes 2 to 3 hours. The whole procedure needs to be repeated every other day for total of five sessions. After completion of five sessions, catheter from neck is removed and bandage is applied.

Can neuropathy reoccur?

Yes, some neuropathies are recurrent. Please ask your doctor for details.

I have carpal tunnel syndrome. Can I get help from local steroid injections or any surgery?

Yes, you can benefit from local steroid injection if medications are not working for you. Patients whose symptoms are not well controlled with drugs or injections, may get very good relief from carpal tunnel decompressive surgery. Please consult your doctor.

How to take care of bedridden or wheelchair bound patient?

Please see section on “taking care of paralyzed patients

Which doctor I should consult for neuropathy?

You should see neurophysician.

What is the commonest cause of neuropathy?

Commonest cause of neuropathy is diabetes mellitus.

What is the duration of treatment in neuropathy?

Duration of treatment depends upon the underlying cause. It may vary from few weeks to years.

Disclaimer:
The information given here is intended for use of general public . It should not be taken as standard medical reference.

About the Author:

One of the most well known neurologists in Lahore, he is serving as Assistant Professor of Neurology at Lahore General Hospital. He is a graduate of King Edward Medical College and did residency in general medicine & neurology at Mayo Hospital Lahore. He did FCPS in neurology and moved to Lahore General Hospital, and has been working there since.

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