N is for Neuropathy

Symptoms of neuropathy

Sensory Neuropathy

• Tingling and numbness.
• Pins and needles and hypersensitivity.
• Increased pain ,or the loss of ability to feel pain.
• Loss of ability to detect changes in heat and cold.
• Loss of co-ordination and proprioception.
• Burning, stabbing, lancing, boring, or shooting pains - which may be worse at night.
• Skin, hair or nail changes.
• Foot and leg ulcers, infection and gangrene.

Foot pain is the most common reason for people with diabetes to seek medical treatment for neuropathy, and loss of sensation can lead to injuries.

Motor Neuropathy

• Muscle weakness - causing unsteadiness and difficulty performing small movements, such as buttoning the shirt.
• Muscle wasting.
• Muscle twitching, and cramps.
• Muscle paralysis.

Autonomic Neuropathy

• Dizziness and fainting (because of sudden changes in blood pressure).
• Racing heart.
• Reduction in sweating.
• Inability to tolerate heat.
• Loss of control over the bladder function, leading to incontinence, or retention of urine.
• Bloating, constipation, or diarrhea.
• Difficulties in achieving, or maintaining an erection (impotence).

Examples of Mononeuropathies

• Postherpetic neuralgia - following shingles. Sensory neuropathy can last for many months, after the rash disappears.
• Ulnar nerve palsy - following an injury to the elbow.
• Carpel tunnel syndrome - caused by compression of the nerves, in the sheath of the wrist.
• Peroneal nerve palsy - caused by compression of a nerve in the leg, that runs by the neck of the fibular (the calf bone, between the knee, and ankle).
• Radial nerve palsy - caused by draping an arm over the back of a chair, for a long time during deep sleep.
• Bell's Palsy,is a single-nerve neuropathy, that affects the face.

Diagnosing neuropathy

History:

• Symptoms.
• General health.
• Any history of neuropathy in the family.
• Any current or recent medication.
• Any exposure to poisons (toxins).
• Alcohol consumption.
• Sexual history.

Examination:

• Looking at the skin thoroughly.
• Checking the pulses.
• Checking the sensation.
• Testing vibration sensation with a tuning fork.
• Tendon reflexes.

Nerve Conduction Studies:

• Nerve conduction studies check the speed with which nerves send messages.
• Special electrodes are placed on the skin over the nerve being tested.
• These electrodes give off very small electrical impulses, that feel a bit like a small electric shock, which stimulate the nerve.
• Other electrodes, record the electrical activity of the nerve.
• The distance that the impulses travel, to the other electrodes, and the time that this takes, allows the speed of the nerve impulse to be calculated.
• In peripheral neuropathy, this speed is reduced.

Electromyography:

Electromyography (EMG) is used to diagnose muscle weakness caused by neuropathy

• This test looks at the electrical activity of the muscles.
• A very thin needle with an electrode attached, is inserted through the skin into a muscle.
• This is connected up to a recording machine, called an oscilloscope.
• The way that the muscle responds when it is stimulated by nerves, can then be monitored using the oscilloscope, and recorded.
• In peripheral neuropathy, the electrical activity will be abnormal.

Nerve Biopsy:
This is the removal of a small part of a nerve, so that it can be examined under a microscope.
Skin Biopsy

• This is a new technique, that has been developed to examine the peripheral nerves.
• It can be used to look for early peripheral neuropathy, and also to monitor progression of neuropathy, and response to treatment.
• Amongst other things, the density of nerve fibres in the area of skin is measured.
• In peripheral neuropathy, the density of the peripheral nerves is reduced.

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