Neuropathy

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Overview

Peripheral neuropathy is a general term referring to disorders of peripheral nerves. The peripheral nervous system is made up of the nerves that branch out of the spinal cord to all parts of the body.

Peripheral nerve cells have three main parts: cell body, axons, and dendrites (nerve/muscle junctions). Any part of the nerve can be affected, but damage to axons is most common. The axon transmits signals from nerve cell to nerve cell or muscle. Most axons are surrounded by a substance called myelin, which facilitates signal transmission.

Peripheral neuropathy can be associated with poor nutrition, a number of diseases, and pressure or trauma. Many people suffer from the disorder without ever identifying the cause.

Incidence and Prevalence

Peripheral neuropathy affects at least 20 million people in the United States. Nearly 60% of all people with diabetes suffer from peripheral neuropathy.

Types

Peripheral neuropathy can be broadly categorized by the type of nerve that has been damaged. The peripheral nervous system is made up of three types of nerves:

• motor nerves (responsible for voluntary movement)
• sensory nerves (responsible for sensing temperature, pain, touch, and limb positioning); including large and small fibers
• autonomic nerves (responsible for involuntary functions such as breathing, blood pressure, sexual function, digestion)

Peripheral neuropathy also can be classified by where it occurs in the body. Nerve damage that occurs in one area of the body is called mononeuropathy, in many areas, polyneuropathy. When the disorder occurs in the same places on both sides of the body, the condition is called symmetric neuropathy.

It also can be categorized by cause, such as diabetic neuropathy and nutritional neuropathy. When a cause cannot be identified, the condition is called idiopathic neuropathy.

Risk Factors and Causes

Peripheral neuropathy can be caused by disease; nerve compression, entrapment, or laceration; exposure to toxins; or inflammation. In many cases, especially in people over the age of 60, no cause can be determined.

Conditions associated with peripheral nerve damage include the following:

• Alcoholism
• Amyloidosis (metabolic disorder)
• Autoimmune disorders (e.g., Guillain-Barre syndrome)
• Bell's palsy
• Cancer
• Charcot-Marie-Tooth disease
• Carpal tunnel syndrome
• Chronic kidney failure
• Connective tissue disease (e.g., rheumatoid arthritis, lupus, sarcoidosis)
• Diabetes mellitus
• Infectious disease (e.g., Lyme disease, HIV/AIDS, hepatitis B, leprosy)
• Liver failure
• Medications
• Radiculopathy
• Vitamin deficiencies (e.g., pernicious anemia)

Radiculopathy is the term for neuropathy that affects nerve roots. The nerve roots are extensions of spinal nerves. They exit the spinal canal through a space between vertebrae, called the neural foramen. Degeneration of vertebral bone, herniation of the pulpy disc between vertebrae, narrowing of the spinal column (spinal stenosis), or trauma can compress or cut nerve roots and cause neuropathy.

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