Symptoms and Signs of Neuropathy

Medical Author:
Medically Reviewed on 2/17/2022

Doctor's Notes on Neuropathy

Neuropathy means any diseases or malfunctions of the nerves. The four main types of neuropathies are

  • Peripheral (nerves outside the brain and spinal cord),
  • Cranial (the 12 cranial nerves),
  • Autonomic (nerves of the involuntary nervous system) and
  • Focal (neuropathy restricted to one area of the body).

General signs and symptoms of neuropathy for all four types of show

  • a gradual loss of feeling,
  • numbness,
  • tingling and/or
  • pain that may progress over time.

For peripheral neuropathy, signs and symptoms can also include the inability to determine joint position of the extremities and/or extreme sensitivity to touch by the arms and legs. Cranial neuropathy can evolve one or more of the 12 cranial nerves; the general symptoms of neuropathy may localize mainly to the face and eyes; however, other cranial nerves may show similar symptoms. For autonomic neuropathy, because autonomic nerves control the function organs and glands, they usually produce many different symptoms and signs, depending upon what organs or glands are involved.

Signs and symptoms may be one or more of the following:

Signs and symptoms of focal neuropathy may be any of the above signs or symptoms but usually affecting a localized body site like pain, numbness and/or tingling to the right big toe.

The main underlying cause any neuropathy is damage to one or more nerves. Damage to nerves can come from many different sources such as

  • injuries,
  • infections,
  • vitamin deficiencies,
  •  toxins,
  • autoimmune problems,
  • diabetes,
  • alcoholism,
  •  genetic or inherited disorders,
  • drugs and/or medications,
  • tumors and
  • many others.

What are the treatments for neuropathy?

The many different treatments for neuropathy depend on the underlying causes and the type of neuropathy. This summary will present some treatments for each of the 4 major types. 

  • Peripheral (nerves outside the brain and spinal cord)
    • Pain relievers
    • Anti-seizure medications
    • Topical treatments
    • Antidepressants
    • Electrical nerve stimulation
    • Immune system suppression
    • Plasma exchange
    • Surgery (release of pressure on nerves)
  • Cranial (the 12 cranial nerves) treatment options 
    • Medications (pain control, anti-convulsant, for example)
    • Decompression (brain surgery to reduce pressure on nerves)
    • Radiosurgery (gamma knife to ablate tumors)
    • Orbital peripheral nerve stimulation (electrodes and unit placed beneath the skin for pain control)
    • Rhizotomy (partial disruption of nerves to reduce pain)
  • Autonomic (nerves of the involuntary nervous system) 
    • Treat underlying disease (for example, diabetes, GI tract problems but note that about half of underlying problems are never found)
    • Treat symptoms as needed (for example, diarrhea, sexual dysfunction) 
  • Focal neuropathy (neuropathy restricted to one area of the body)
    • Pain control (topical capsaicin cream, gabapentin, NSAIDs, or prescription pain medicines, for example)
    • Antidepressants like amitriptyline, duloxetine
    • TENS unit – electrodes placed on skin with adjustable current flow
    • Plasma exchange (replace blood plasma)
    • IV immune globulin (IV placed immunoglobulins)

See your neurologist to help determine your individual treatments.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.