Clinical Review Regular review

Peripheral neuropathy

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7335.466 (Published 23 February 2002) Cite this as: BMJ 2002;324:466
  1. Richard A C Hughes (richard.a.hughes@kcl.ac.uk), professor of neurology
  1. Department of Neuroimmunology, Guy's Campus, Guy's, King's, and St Thomas's School of Medicine, London SE1 1UL

    Peripheral neuropathy is common, often distressing, and sometimes disabling or even fatal. The population prevalence is about 2400 per 100 000 (2.4%), rising with age to 8000 per 100 000 (8%).1 In Europe the commonest cause is diabetes mellitus, which can produce painful neuropathy, disabling foot ulcers, and death from autonomic neuropathy. Leprosy is still prevalent in Africa, India, and South East Asia. This review explains how general practitioners can approach the first level of diagnosis and warn patients about what lies ahead after referral to a specialist.

    Summary points

    Peripheral neuropathy can be into divided into acute and chronic forms, symmetrical polyneuropathy, and multiple mononeuropathy

    Acute neuropathies are diagnostic emergencies

    Neuropathy due to diabetes mellitus and alcohol misuse can be diagnosed in primary care

    Neurophysiological tests distinguish axonal from demyelinating neuropathies

    Demyelinating neuropathies are commonly inflammatory and treatable

    Axonal neuropathies have multiple causes

    Generic management includes foot care, ankle supports, and treatment of neuropathic pain

    Methods

    I searched Medline from January 1991 until September 2001 using the terms “peripheral neuropathy” and “guideline.” The search yielded 11 references, including useful guidelines for the diagnosis and management of diabetic peripheral neuropathy,2 but no guidelines on the diagnosis and management of generic peripheral neuropathy. This article offers a personal approach to the management of generalised peripheral neuropathy from the perspective of a neurologist with a special interest in the topic. The recommendations also take account of reviews published by authorities in peripheral neuropathy (see educational resources) and a recent audit of a Dutch departmental guideline that showed the value of investigating common causes before doing electrophysiological tests.3

    Diagnosis

    Patients with peripheral neuropathy may present with altered sensation, pain, weakness, or autonomic symptoms. The clinical features vary widely and may resemble myelopathy, radiculopathy, muscle disease, or even hyperventilation. Identifying a neuropathy in patients with …

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