Category: Neurology

Q&A with Dr. Mahajan on Peripheral Neuropathy

In certain cases of autoimmune disease, including rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), nerve damage can occur, which can lead to a condition known as peripheral neuropathy.

Symptoms of peripheral neuropathy typically include:

  • Numbness or tingling
  • Paresthesias – pricking sensations
  • Muscle weakness
  • Allodynia – abnormal sensitivity to certain areas of the body, leading to exaggerated perceptions of touch.
  • Muscle wasting

Attune Health neurologist and neuromuscular disease expert Shalini Mahajan, MD sits down to discuss some frequently asked questions on this condition.

Q&A WITH DR. MAHAJAN

What are some causes of peripheral neuropathy?

One of the most common causes of peripheral neuropathy is diabetes. Other causes include those associated with autoimmune conditions such as lupus and Sjogren’s disease. Neuropathies can also be caused due to certain vitamin deficiencies, heavy metal toxicities, or side effects from chemotherapy. Very often neuropathies are idiopathic, which means the cause is unknown. Neuropathies can be hereditary or genetic in origin as well.

Are there different types?

Yes, neuropathies can be classified based on the type of nerve fibers involved, such as sensory fibers, which carry sensory information, or involving the motor fibers, which carry nerve impulses to the muscles.

They can also be classified based on the part of the nerve that is affected, such as either involving the insulating cover around the nerve fiber that is responsible for nerve conduction (myelin sheath) or affecting the core of the nerve fiber (axon).

Other ways to classify neuropathies are based on the underlying cause, such as autoimmune neuropathies, diabetic neuropathy or toxic neuropathies.

How do you diagnose peripheral neuropathy?

Neuropathies are diagnosed by clinical assessment-based on patient’s symptoms and a detailed neurological examination. They are objectively assessed with an electrical study of the nerves- Nerve conduction study-Electromyography (NCS-EMG). Blood tests can also help determine the cause of such neuropathies. For example, by checking vitamin levels, autoimmune markers, etc. Sometimes a skin punch biopsy may be needed.

Although I have seen several physicians, so far they have not found a cause for my peripheral neuropathy. Can you reverse the effects or, at least, stop them from getting worse?

Depending on the cause of the neuropathy, some neuropathies can be reversed to an extent. Peripheral nerves do regenerate to compensate for the diseased nerves, which can help with the recovery as well. In other cases, progression can be slowed if the underlying cause is addressed or treated.

What kind of research is currently being done on this condition?

There is research being done on autoimmune inflammatory neuropathies examining immunomodulatory treatments that can help nerves recover. There is also considerable research done on hereditary neuropathies to develop genetic treatments that may help slow or reverse the effects of the genetic defects causing neuropathies.