Neuropathy

 

 Buy Article Permissions and Reprints

Peripheral neuropathy is a common cause of pain and reduced quality of life, and is among the most common reasons that patients seek medical care.[1] The global prevalence is 7% in those older than 65 years.[2] It is critical to teach both neurologists and nonneurologists how to diagnose this disorder, as underdiagnosis is still an issue.[3] [4] The vast range of neuropathies (over one hundred!)[2] intimidate nonneurologists and neurologists alike, thus requiring a framework for conceptualizing the diagnosis and managing this all-too-common condition.

Peripheral neuropathies encompass all disorders that directly affect peripheral nerves. Like other neurologic conditions, clinicians should first categorize neuropathies by the localization of the nerve injury. Broadly, peripheral neuropathies can be localized to nerve roots, the brachial or lumbosacral plexus, a single nerve, or multiple nerves. Once localized, the clinician needs to determine a pathologic diagnosis.

In this issue, we cover the spectrum of peripheral neuropathies. Two articles cover common and uncommon mononeuropathies, and another is dedicated to brachial and lumbosacral plexopathies. Many of the remaining articles discuss polyneuropathies. We begin the discussion of polyneuropathies by focusing on the basics in the first article of the issue—defining this syndrome and then elaborating on a systematic approach to diagnosis, titled “A Practical Approach to the Diagnosis of Polyneuropathies.”

Certain causes of polyneuropathies, including vasculitic, paraproteinemic, inherited, and immune-mediated, are particularly daunting for practicing clinicians. For these topics, we take a different approach from the traditional review article. These articles are organized around 10 clinical pearls that emphasize essential and practical information to the reader while providing a comprehensive review of the topic. We are thrilled with the results of this approach and are greatly indebted to the authors.

It is an exciting time for those treating peripheral nervous system disorders. In this issue, we highlight several significant advances in the diagnosis and management of peripheral neuropathies. Neuromuscular ultrasound has become an essential tool that complements electrodiagnostic studies when diagnosing mononeuropathies, plexopathies, and polyneuropathies. It provides visualization of the anatomy, and potentially reveals a specific etiology in cases in which electrodiagnostic studies cannot do so alone. Our colleagues Drs. Miller, Meiling, Cartwright, and Walker very clearly describe how to characterize peripheral neuropathies on ultrasound based on major morphologic patterns, with numerous figures that demonstrate the abnormalities. Unlike previous reviews of peripheral neuropathy, we include an article covering the management of traumatic nerve injury with autografts, allografts, and nerve transfers, with a focus on innovations from the past decade. Nerve repair is a topic less familiar to many neurologists, and Dr. Mackinnon and colleagues do a fantastic job explaining the neurosurgical approach. Finally, the rapid expansion in therapeutics is notable in the section on Hereditary Transthyretin Amyloidosis Polyneuropathy. Unlike in other neuropathies (for now), there have been many exciting advances in treatment, and the authors comprehensively review the new medications available for the treatment of this previously fatal disease.

Still, peripheral neurologists have a long road ahead, as most neuropathies are irreversible once significant axonal damage has occurred. We are not yet able to regenerate nerves, the “holy grail” of peripheral neuropathy research, and many neuropathy patients still suffer terribly from this all-too-common condition. One article in this issue, by Drs. Feldman and Weaver, provide a comprehensive review of the treatment of neuropathic pain. We hope that one day, however, we will be able to cure most neuropathies in addition to relieving symptoms.

We wish to thank Drs. Greer and Lewis for the opportunity to present this important topic, and we extend our deepest appreciation to the authors for their hard work and commitment to producing informative and well-researched articles.

Publication History

Article published online:
17 January 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Girach A, Julian TH, Varrassi G, Paladini A, Vadalouka A, Zis P. Quality of life in painful peripheral neuropathies: a systematic review. Pain Res Manag 2019; 2019: 2091960
  CrossrefPubMedSearch in Google Scholar
• 2 Hanewinckel R, van Oijen M, Ikram MA, van Doorn PA. The epidemiology and risk factors of chronic polyneuropathy. Eur J Epidemiol 2016; 31 (01) 5-20
  CrossrefPubMedSearch in Google Scholar
• 3 Ziegler D, Strom A, Lobmann R, Reiners K, Rett K, Schnell O. High prevalence of diagnosed and undiagnosed polyneuropathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study). J Diabetes Complications 2015; 29 (08) 998-1002
  CrossrefPubMedSearch in Google Scholar
• 4 Chaudhary UJ, Rajabally YA. Underdiagnosis and diagnostic delay in chronic inflammatory demyelinating polyneuropathy. J Neurol 2021; 268 (04) 1366-1373
  CrossrefPubMedSearch in Google Scholar