Peripheral Neuropathies

Michelle Kaku, MD

Peter Siao, MD

Peripheral neuropathy is one of the most common disorders encountered by neurologists. The identification, workup, and management of peripheral neuropathy is often time consuming, costly, and complex. Clinical presentations can vary widely. While an algorithmic approach may be helpful for the workup of length dependent, sensorimotor peripheral neuropathy, the most common cause of neuropathy, often pattern recognition and maintaining a broad differential, is required for more atypical presentations. To date, hundreds of etiologies of neuropathy have been identified which allows for multiple avenues of potential intervention. Detailed history and physical examination remain the core of evaluation and can focus the workup and help to avoid a “shot-gun” method of obtaining a battery of potentially unnecessary tests. Diagnostic and electrophysiologic evaluations include nerve conduction studies/electromyography, skin and nerve biopsy, cerebrospinal fluid analysis, magnetic resonance imaging (MRI), and ultrasound imaging and autonomic testing.

In the current era of medicine, where heritable causes of neuropathy, such as Fabry's disease, and neuropathic hereditary transthyretin amyloidosis now have disease modifying therapies, it is imperative that we correctly identify the etiology of various neuropathies to halt and potentially reverse the course of disease. Targeted therapies, such as antisense oligonucleotides, small-interfering RNAs (SiRNAs), enzyme replacement therapy, and free radical scavengers, have revolutionized the field of neurology. In the following issue of Seminars in Neurology, we hope to provide a framework in which to approach peripheral neuropathy.

We have assembled a group of nationally and internationally renowned experts to review various topics in the field of peripheral neuropathy. We will highlight the initial clinical evaluation, laboratory, and diagnostic workup of peripheral neuropathy in the manuscripts approach to peripheral neuropathy, laboratory, and ultrasound evaluation of peripheral neuropathy. We will also address various etiologies and management of hereditary and acquired causes of large and small fiber neuropathy, including metabolic, toxic, infectious, vasculitic, immunemediated causes, and neuropathy associated with systemic diseases. Specifically, we will review entrapment neuropathies, diabetic neuropathy, neuropathies associated with amyloidosis, small-fiber neuropathy, HIV, and other infectious neuropathies, neuropathy of connective tissue disease and other systemic diseases, Guillain–Barre Syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, vasculitic neuropathies, and inherited neuropathies.

We hope this issue provides a comprehensive overview of the approach, recognition, workup, and management of peripheral neuropathy and addresses novel therapies that are changing the field of neuromuscular medicine. We thank the authors for their expertise and thoughtful reviews in their respective fields, and Dr. David Greer for inviting us to participate in this issue of Seminars in Neurology.