Intended for healthcare professionals

Clinical Review State of the Art Review

Diagnosis and management of sensory polyneuropathy

BMJ 2019; 365 doi: (Published 08 May 2019) Cite this as: BMJ 2019;365:l1108
  1. Kelly Graham Gwathmey, assistant professor of neurology1,
  2. Kathleen T Pearson, assistant professor of neurology1
  1. 1Virginia Commonwealth University, Department of Neurology, 1101 E. Marshall Street, PO Box 980599, Richmond, VA 23298, USA
  1. Correspondence to: K G Gwathmey Kelly.Gwathmey{at}


Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors.

  • Contributors: KGG and KP performed the literature review and prepared the initial draft of the manuscript. Both authors were involved in the conception, drafting, and editing of the manuscript. KGG is guarantor.

  • Competing interests: The authors have read and understood the BMJ policy on declaration of interests and have no competing interests.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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