Neuropathies are diseases of peripheral nerves, those that extend from the spinal cord to the rest of the body. There are many different types of peripheral nerves performing many different functions, and many different ways in which these nerves can be damaged. Because of this, neuropathies are a highly variable set of diseases, with different presentations and treatments.

Neuropathy causes different symptoms depending on which nerves are involved. Some neuropathies cause numbness, while others cause pain most typically described as burning or electrical. These symptoms are often, but not always, worse at night. Longer nerves are often affected earlier in the course of the disease, causing symptoms to appear first in the feet and then progress upwards with time. Other neuropathies cause disruption of the involuntary aspects of the nervous system, leading to irregularities in pulse  or blood pressure, reduced sweating, nausea, or other GI symptoms. One other common symptom is imbalance, especially in dark environments, caused by numbness in the feet.

Some neuropathies are caused by other diseases, most commonly diabetes, but also others including thyroid disease, vitamin deficiencies, or inflammatory disease such as lupus. Others are caused by dysfunction of the immune system which causes it to attack peripheral nerves. In some cases, a definitive underlying cause for the neuropathy is never able to be identified.

At Midtown Neurology, we use state of the art testing techniques to identify, characterize, and treat neuropathy, starting with a comprehensive history and physical examination to clarify the timecourse of the disease and to determine which nerve populations are affected. Laboratory testing can be used to look for underlying disease, and more specialized electrical testing can be used to clarify the distribution and severity of nerve dysfunction. In some cases, microscopic analysis of small nerve fibers in the skin (a procedure known as a punch biopsy) can be used to further investigate the neuropathy.

Treatment of neuropathy depends on the results of these investigations. If an underlying cause is identified, it can be treated; even in the cases in which the neuropathy cannot be reversed, this treatment can prevent progression of disease. Medications can also be used to reduce nerve irritability and counteract autonomic dysfunction, reducing the symptoms of neuropathy, even in cases where the neuropathy itself cannot be treated. Physical therapy is often helpful in cases where neuropathy causes loss of balance.