Types of Peripheral Neuropathies

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Diabetic Neuropathy Inflammatory Neuropathy Painful Neuropathy Toxic Neuropathy

Biopsies Nerve Conduction Study and Electromyography Infusion Services

Diabetic Neuropathy

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Neuropathy Team

Diabetic neuropathy is caused by diabetes or impaired glucose intolerance. In both of these disorders, the body does not process sugar effectively, causing elevated sugar levels in your blood. The elevated sugar levels damage your nerves, leading to neuropathy. Patients often complain of burning, tingling, or numb feelings in their feet, legs, or hands. These symptoms may be more noticeable at night or when resting.

Diagnosis

Your health care provider may order an oral glucose tolerance blood test. This is a 2-hour fasting blood test that gives the provider information about how you process sugar. They may also order a nerve conduction study/electromyography, skin biopsy or nerve biopsy to further evaluate your nerves and muscles.

Treatment

Treatment for diabetic neuropathy focuses on pain management, sugar control and supportive services. There are several medications and other treatments that help alleviate tingling and burning pains. These pain medications do not alter the course of your neuropathy. Sugar control such as diet, exercise and diabetic medications work on keeping your sugar within normal limits. Normal sugar levels do not damage the nerves. If caught early and given treatment it is possible to slow and reverse the progression of diabetic neuropathy.

Other support services, such as physical therapy, and other medical specialists may be required for diabetic ulcers, muscle weakness and balance training.

Inflammatory Neuropathy

Inflammatory neuropathies can be caused by infections or an autoimmune process. There are several specific causes of this neuropathy. However, in most cases the immune system begins attacking the nerves, which causes neuropathy. Patients can complain of sensory symptoms like burning, tingling or numbness. They may also have motor symptoms like muscle weakness. It may be contained in the arms or legs or more widespread.

Diagnosis

Your health care provider may order many tests to look for causes of this neuropathy. This may include several blood studies looking for infectious causes and evidence of inflammation. They may also order a lumbar puncture or spinal tap. This test evaluates the fluid around your spinal cord for infections and inflammation. Finally, they may order a nerve conduction study/electromyography and if necessary a nerve biopsy to detect inflammation of the nerve.

Treatment

First your provider may treat your symptoms. If you have burning or tingling pain there are several medications that can lessen these sensations so they are more tolerable. Second your provider will treat the immune system attack. There are several oral (pill) medications that can be used to slow or reverse the progression of the neuropathy.

There are also intravenous medications that can be given as an outpatient in our infusion clinic. The infusion clinic is located in the same area where you see your health care provider. Intravenous immunoglobulins (IVIG) or plasmapheresis may be prescribed.

Painful Neuropathy

Painful neuropathies are caused by damage to the nerve tissue. This can be from an injury, metabolic disturbance or infection. Patients often complain of burning, tingling, pins and needles and electric or stabbing pains. Sometimes normal sensations can be uncomfortable, like the bed sheets touching your feet.

Diagnosis

Your health care provider may order several tests to find the cause of your nerve pain. This may include blood draws, nerve conduction study/electromyography, imaging (MRI or CT scan), or skin biopsy. Some patients may experience this neuropathy and have no known cause. Other patients my have an undiagnosed form of diabetic neuropathy.

Treatment

If a reversible cause for your neuropathy is found then it will be treated. In addition, you may benefit from medication to lessen the painful sensations. There are several types of medications that can be used and not every medication works for each person.

Toxic Neuropathy

Toxic neuropathies can be caused by medications like chemotherapy or environmental chemicals. These harsh substances cause damage to the nerves. Patients often complain of burning, tingling, pins and needles and electric or stabbing pains. Sometimes normal sensations can be uncomfortable, like the bed sheets touching your feet.

Diagnosis

Your health care provider may order several tests to find the cause of your nerve pain. This may include drawing blood, nerve conduction study/electromyography, skin biopsy, or nerve biopsy. Some patients may experience this neuropathy and have no known cause.

Treatment

The first goal is to complete a careful evaluation to determine the toxic agent. Once the agent is identified, a plan is created to remove or minimize exposure to the agent. In some instances there may be a specific treatment available.

Biopsies

Skin Biopsy

A skin biopsy is an outpatient procedure that takes about 30 minutes. Your health care provider may recommend this procedure to further understand your neuropathy. This procedure is performed by a trained professional.

What to expect:

  • During this procedure the site of your biopsy will be numbed with a local anesthetic.
  • A small piece of skin, no bigger then the tip of a ball point pen, is taken from just above the ankle and just above the knee. A bandage is applied and the sample is sent to a lab for further processing.
  • After your procedure you may return to normal activities, but should keep the area clean and dry. This test provides the health care provider with information about the small nerves in your skin.

Nerve Biopsy

  • Sometimes a piece of nerve tissue needs to be examined to understand your neuropathy better. The sural nerve is usually used because of its location and minimal side effects.
  • This is an outpatient procedure and you are given medication to numb the area and make you sleepy. The sural nerve is located by your ankle. An incision is made and a small piece of nerve is removed.
  • The nerve is then sent to the lab for further processing. After the biopsy, you will have a small patch of permanent numbness where the nerve was removed.

Nerve Conduction Study and Electromyography

Nerve conduction study/electromyography is a two-part test completed by a trained professional. Your health care provider may recommend this procedure to further understand your neuropathy.

The nerve conduction study or NCS involves the nerves in your arms and legs. A tiny pulse of electricity is sent through your arm or leg and the nerve response is captured by a computer. This test allows the heath care provider to see how fast or slow your nerves react.

Electromyography or EMG gives important information about your muscles. During this test a very small needle is inserted into a specific muscle. You may be asked to relax or contract your muscles. During this test you may hear cracks, pops or static, which is your muscle working. The muscle activity is then captured by a computer. This test allows the health care provider to identify normal and abnormal muscle function.

Infusion Services

Your health care provider may recommend an infusion or intravenous (I.V.) medication for your neuropathy treatment.  At our Peripheral Neuropathy Center, the Department of Neurology organizes and facilitates the outpatient infusion center.

The infusion center provides patient monitoring in a calming and relaxing environment.  These infusions can be given through a small peripheral IV catheter.  Patients are encouraged to bring special music, reading material, videotapes or DVDs to enjoy while they receive their medication.  In case you forget, we have a large selection of movies at the clinic.