Neuropathy

Neuropathy is a disorder of the nerves -- the body’s system for transmitting messages from the body to the spinal cord and brain, and vice versa. Common symptoms include tingling, numbness, weakness, changes in sensation, and pain. There are many different types of neuropathy, based on which nerves are affected and how many. These are the overarching categories:

• Autonomic neuropathy: Affects nerves that control involuntary, or autonomic, body functions
• Focal neuropathy: Also known as mononeuropathy, this affects one nerve
• Polyneuropathy / peripheral neuropathy: Generalized neuropathy that is symmetric (the same on both sides of your body)
• Multifocal neuropathy: Multiple mononeuropathies affecting different nerves

Neuropathies can be caused by many different conditions, including:

• Cancers, like multiple myeloma and paraneoplastic syndromes
• Diabetes and other endocrine disorders, like thyroid disease
• Infectious diseases, like herpes, leprosy, sarcoidosis, Lyme disease, HIV, and hepatitis
• Organ failure
• Toxins, like certain medications, chemotherapy, and heavy metals
• Trauma
• Vitamin deficiencies

Rare Neuropathies
Many of our neurologists have significant experience treating uncommon types of neuropathy, including:

• Acute and chronic immune-mediated neuropathies: Guillain-Barré syndrome (GBS), also known as acute inflammatory demyelinating polyradiculoneuropathy (AIDP), GBS variants, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• Amyloidosis neuropathy 
• Hereditary neuropathies: Charcot-Marie-Tooth disease, familial amyloid, mitochondrial disorders, hereditary sensory and autonomic neuropathies (HSAN), hereditary spastic paraplegia with neuropathy, and hereditary peripheral nerve channelopathies
• Vascular/ischemic neuropathy

During your initial exam, your neurologist will ask questions to learn about your symptoms and medical history. They will also perform physical and neurological exams to test muscle strength and sensation. Your doctor may also order one or more of these tests:

Blood Tests
Bloodwork can help identify genetic mutations, vitamin deficiencies, toxins, endocrine diseases, or other conditions that could be causing neuropathy. 

Imaging
Ultrasound, CT, or MRI scans can detect spine problems, enlarged nerves, and tumors that could be causing symptoms.

Nerve Conduction Study (NCS)
Small, flat electrodes are taped to the skin over a muscle or nerve. Nerves are then stimulated with small electrical shocks from a probe placed against the skin. These results are analyzed to help identified any nerve dysfunction. 

Electromyogram (EMG) Test
A thin, sterile needle electrode is inserted through the skin into a muscle. The needle measures how much electrical activity is generated by the nerve and sent to the muscle. This helps determine whether it’s the nerve or muscle that is malfunctioning.

Nerve Biopsy
A small piece of nerve is removed and examined under a microscope. This can help identify the underlying cause of a neuropathy. 

Neuropathy treatments vary widely based on type, cause, and symptoms. Treating contributing conditions is crucial to reducing neuropathy symptoms and possibly reversing nerve damage. Duke offers the full range of therapies, from traditional treatments to breakthrough options.

Pain Management
Our neurologists are experienced in treating neuropathic pain and partner with pain medicine specialists to reduce or eliminate debilitating pain caused by neuropathy. From medications to transcutaneous electrical nerve stimulation (TENS) therapy, we have an array of options so we can find what works best for you.

Peripheral Nerve Stimulators and Spinal Cord Stimulators
New surgically placed devices like peripheral nerve stimulators and spinal cord stimulators use electricity to relieve certain types of chronic pain. Spinal cord stimulators are FDA approved to treat diabetic neuropathy symptoms. Research shows they can help reduce pain and improve function.

Steroids
Oral or intravenous steroids treat neuropathies caused or worsened by inflammation. 

Intravenous Immunoglobulin (IVIG)
This IV medication can reverse nerve damage caused by autoimmune neuropathies like GBS and CIDP.

Amyloid-Reducing Medications
These medicines can stall or reverse symptoms of amyloidosis neuropathy by slowing down the production of defective proteins called amyloid that can cause neuropathy. 

Antibody Therapy
This infusion medication is administered every four to six months to help stabilize or reverse neuropathic nerve damage caused by vasculitis or inflammation. 

Plasma Exchange Therapy
Also called PLEX or plasmapheresis, this can treat neuropathies caused by inflammation and autoimmune disorders. Through a central line in your upper chest or an IV in your arm, a special machine withdraws your blood, removes cells that cause inflammation and destructive antibodies, and then returns the blood along with extra fluid. Duke is one of only a handful of centers in North Carolina that offers plasma exchange therapy.

Major risks of neuropathy include loss of feeling in your hands and feet and balance problems, which can lead to dangerous falls, injuries, and skin infections.

Our physical and occupational therapists evaluate your function and recommend lifestyle changes, orthotic shoes, and other assistive devices to help you maintain independence and avoid these complications. 

Center of Excellence
Duke was named a center of excellence by the GBS|CIDP Foundation International in recognition of our expertise, research capabilities, and available treatments for rare types of neuropathy. We take pride in caring for our patients and their families.

Team Approach
Our neurologists work with a range of other specialists to treat your neuropathy and its symptoms. We partner with pediatric experts and genetic counselors to monitor for inherited neuropathies in children, and we ensure they transition seamlessly to adult care.

Convenient Care
Our clinics are equipped with the latest diagnostic technology. In our hospital-based clinic, EMG and nerve conduction labs are located within our neuromuscular clinic, so patients can undergo nerve testing and see a doctor on the same day.

Advancing the Science
Many Duke neurologists attend yearly conferences to learn about new neuropathy diagnostics and treatments. We aim to move the field forward by sharing knowledge and participating in clinical trials studying new advances.