neuropatioista

Neuropathy is a broad term for disorders of the peripheral nervous system, which can affect sensory, motor, and autonomic nerves. When multiple nerves are involved, the condition is often called polyneuropathy; if a single nerve or nerve trunk is affected, it is referred to as mononeuropathy. Symptoms vary with the type of nerve fibers damaged and may include numbness, tingling, burning pain, weakness, and autonomic changes such as dizziness, abnormal sweating, or digestive problems. Onset can be acute or chronic.

Causes are diverse. The most common in adults is diabetes mellitus, leading to diabetic polyneuropathy. Other factors include alcohol misuse, vitamin deficiencies (notably B12 and thiamine), autoimmune and inflammatory diseases (Guillain-Barré syndrome, CIDP), infections (HIV, Lyme disease), toxins (certain chemotherapy agents, heavy metals), kidney or liver disease, and inherited neuropathies such as Charcot-Marie-Tooth disease. In many cases no cause is identified (idiopathic).

Pathophysiology involves axonal degeneration and demyelination. Small fiber neuropathy primarily affects pain and temperature and autonomic fibers, while large fiber involvement impairs vibration and proprioception. Diagnosis relies on clinical evaluation supported by tests such as nerve conduction studies and electromyography to classify nerve injury as axonal or demyelinating. Laboratory workup may include glucose and A1c, vitamin levels, thyroid tests, and other relevant panels; nerve or skin biopsy can be used in select cases.

Management focuses on treating the underlying cause when possible, alleviating symptoms, and preventing complications. Good glycemic control is central in diabetes; pharmacologic options for pain include gabapentinoids, SNRIs, TCAs, topical agents, and, in some situations, opioids. Physical and occupational therapy, patient education, foot care, and avoidance of neurotoxins are important. Prognosis varies with etiology and fiber involvement, with some neuropathies stabilizing or improving after treatment of the underlying cause.