Download PDF
Semin Neurol 2025; 45(01): 004-012
DOI: 10.1055/s-0044-1791721
Review Article

A Practical Approach to Diagnosing Peripheral Neuropathies

Nuri Jacoby
1   Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
2   Maimonides Medical Center, Brooklyn, New York
,
Yaacov Anziska
1   Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Polyneuropathies are common, with the incidence increasing with older age. The causes of polyneuropathies are diverse and numerous, and it can be challenging for clinicians to determine the etiology of a particular patient's neuropathy. In this article, we systematically detail a practical approach to polyneuropathies, beginning with the most important aspects of the workup, the history and physical. We then discuss the limited diagnostic approach required for patients who present with a distal symmetric polyneuropathy and the more comprehensive approach for patients who present with other neuropathy subtypes.

Keywords

Peripheral neuropathy - Polyneuropathy - Electrodiagnostic studies


Publication History

Article published online:
21 October 2024

© 2024. Thieme. All rights reserved.

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

 

  • References

  • 1 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
  • 2 Taams NE, Drenthen J, Hanewinckel R, Ikram MA, van Doorn PA. Prevalence and risk factor profiles for chronic axonal polyneuropathy in the general population. Neurology 2022; 99 (20) e2234-e2240
    CrossrefPubMedSearch in Google Scholar
  • 3 Bromberg MB. An approach to the evaluation of peripheral neuropathies. Semin Neurol 2010; 30 (04) 350-355
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Freeman R. Autonomic peripheral neuropathy. Lancet 2005; 365 (9466): 1259-1270
    CrossrefPubMedSearch in Google Scholar
  • 5 Russell JA. General approach to peripheral nerve disorders. Continuum (Minneap Minn) 2017; 23 (Suppl. 05) 1241-1262
    PubMedSearch in Google Scholar
  • 6 Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score. Mayo Clin Proc 2012; 87 (12) 1196-1201
    CrossrefPubMedSearch in Google Scholar
  • 7 Zilliox L, Russell JW. Treatment of diabetic sensory polyneuropathy. Curr Treat Options Neurol 2011; 13 (02) 143-159
    CrossrefPubMedSearch in Google Scholar
  • 8 Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve 2020; 62 (01) 13-29
    CrossrefPubMedSearch in Google Scholar
  • 9 Coelho T, Marques Jr W, Dasgupta NR. et al; NEURO-TTRansform Investigators. Eplontersen for hereditary transthyretin amyloidosis with polyneuropathy. JAMA 2023; 330 (15) 1448-1458
    CrossrefPubMedSearch in Google Scholar
  • 10 Burgess J, Ferdousi M, Gosal D. et al. Chemotherapy-induced peripheral neuropathy: epidemiology, pathomechanisms and treatment. Oncol Ther 2021; 9 (02) 385-450
    CrossrefPubMedSearch in Google Scholar
  • 11 Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep 2019; 19 (10) 86
    CrossrefPubMedSearch in Google Scholar
  • 12 Dogiparthi SN, Muralidhar K, Seshadri KG, Rangarajan S. Cutaneous manifestations of diabetic peripheral neuropathy. Dermatoendocrinol 2017; 9 (01) e1395537
    CrossrefPubMedSearch in Google Scholar
  • 13 Kwok T, Ting PT, Wong EK, Brassard A. Peripheral neuropathy for dermatologists: what if not diabetic neuropathy?. J Cutan Med Surg 2013; 17 (Suppl. 01) S1-S5
    CrossrefPubMedSearch in Google Scholar
  • 14 Al-Geffari M. Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in primary health care setting. Int J Health Sci (Qassim) 2012; 6 (02) 127-134
    PubMedSearch in Google Scholar
  • 15 Takahara M, Fujiwara Y, Sakamoto F. et al. Assessment of vibratory sensation with a tuning fork at different sites in Japanese patients with diabetes mellitus. J Diabetes Investig 2014; 5 (01) 90-93
    CrossrefPubMedSearch in Google Scholar
  • 16 Xirou S, Kokotis P, Zambelis T, Anagnostou E. Vibratory testing with the 64 Hz Rydel-Seiffer tuning fork and its relation to the sural nerve action potential. J Peripher Nerv Syst 2020; 25 (04) 395-400
    CrossrefPubMedSearch in Google Scholar
  • 17 Lo YL, See S. Images in clinical medicine. Pseudoathetosis. N Engl J Med 2010; 363 (19) e29
    PubMedSearch in Google Scholar
  • 18 Callaghan BC, Price RS, Feldman EL. Distal symmetric polyneuropathy: a review. JAMA 2015; 314 (20) 2172-2181
    CrossrefPubMedSearch in Google Scholar
  • 19 Silsby M, Feldman EL, Dortch RD. et al. Advances in diagnosis and management of distal sensory polyneuropathies. J Neurol Neurosurg Psychiatry 2023; 94 (12) 1025-1039
    CrossrefPubMedSearch in Google Scholar
  • 20 Freeman R, Gewandter JS, Faber CG. et al. Idiopathic distal sensory polyneuropathy: ACTTION diagnostic criteria. Neurology 2020; 95 (22) 1005-1014
    CrossrefPubMedSearch in Google Scholar
  • 21 Callaghan BC. Test utilization and value in the evaluation of peripheral neuropathies. Continuum (Minneap Minn) 2020; 26 (05) 1384-1391
    PubMedSearch in Google Scholar
  • 22 England JD, Gronseth GS, Franklin G. et al; American Academy of Neurology. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of laboratory and genetic testing (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 2009; 72 (02) 185-192
    CrossrefPubMedSearch in Google Scholar
  • 23 Singleton JR, Smith AG, Bromberg MB. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Diabetes Care 2001; 24 (08) 1448-1453
    CrossrefPubMedSearch in Google Scholar
  • 24 Gallagher G, Rabquer A, Kerber K, Calabek B, Callaghan B. Value of thyroid and rheumatologic studies in the evaluation of peripheral neuropathy. Neurol Clin Pract 2013; 3 (02) 90-98
    CrossrefPubMedSearch in Google Scholar
  • 25 Lau KHV. Laboratory evaluation of peripheral neuropathy. Semin Neurol 2019; 39 (05) 531-541
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Gwathmey KG. Sensory neuronopathies. Muscle Nerve 2016; 53 (01) 8-19
    CrossrefPubMedSearch in Google Scholar
  • 27 Antoine JC. Sensory neuronopathies, diagnostic criteria and causes. Curr Opin Neurol 2022; 35 (05) 553-561
    PubMedSearch in Google Scholar
  • 28 Devigili G, Lombardi R, Lauria G, Cazzato D. The evolving landscape of small fiber neuropathy. Semin Neurol 2024 (e-pub ahead of print). DOI:10.1055/s-0044-1791823
    PubMed
  • 29 Callaghan BC, Kerber KA, Lisabeth LL. et al. Role of neurologists and diagnostic tests on the management of distal symmetric polyneuropathy. JAMA Neurol 2014; 71 (09) 1143-1149
    CrossrefPubMedSearch in Google Scholar
  • 30 Cho SC, Siao-Tick-Chong P, So YT. Clinical utility of electrodiagnostic consultation in suspected polyneuropathy. Muscle Nerve 2004; 30 (05) 659-662
    CrossrefPubMedSearch in Google Scholar
  • 31 AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy. Muscle Nerve 2018; 57 (02) 337-339
    CrossrefPubMedSearch in Google Scholar
  • 32 Sinnreich M, Klein CJ, Daube JR, Engelstad J, Spinner RJ, Dyck PJB. Chronic immune sensory polyradiculopathy: a possibly treatable sensory ataxia. Neurology 2004; 63 (09) 1662-1669
    CrossrefPubMedSearch in Google Scholar
  • 33 Davalos L, Watanabe M, Gallagher GW. et al. Diagnostic characteristics of nerve conduction study parameters for vasculitic neuropathy. Muscle Nerve 2023; 67 (01) 45-51
    CrossrefPubMedSearch in Google Scholar
  • 34 Preston D, Shapiro E. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic-Ultrasound Correlations. 4th ed.. Elsevier; 2020
    Search in Google Scholar
  • 35 Siao P, Kaku M. A clinician's approach to peripheral neuropathy. Semin Neurol 2019; 39 (05) 519-530
    Thieme ConnectPubMedSearch in Google Scholar
  • 36 Van den Bergh PYK, van Doorn PA, Hadden RDM. et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint Task Force-Second revision. J Peripher Nerv Syst 2021; 26 (03) 242-268
    CrossrefPubMedSearch in Google Scholar
  • 37 Breiner A, Bourque PR, Allen JA. Updated cerebrospinal fluid total protein reference values improve chronic inflammatory demyelinating polyneuropathy diagnosis. Muscle Nerve 2019; 60 (02) 180-183
    CrossrefPubMedSearch in Google Scholar
  • 38 Miller NJ, Meiling JB, Cartwright MS, Walker FO. The Role of Neuromuscular Ultrasound in the Diagnosis of Peripheral Neuropathy. Semin Neurol 2024 (e-pub ahead of print). DOI: 10.1055/s-0044-1791577
    PubMed
  • 39 Taneja AK, Chhabra A. Neuropathy Score Reporting and Data System (NS-RADS): a practical review of MRI-based peripheral neuropathy assessment. Semin Ultrasound CT MR 2023; 44 (04) 386-397
    CrossrefPubMedSearch in Google Scholar
  • 40 AANEM. AANEM's top five choosing wisely recommendations. Muscle Nerve 2015; 51 (04) 617-619
    CrossrefPubMedSearch in Google Scholar
  • 41 Devigili G, Tugnoli V, Penza P. et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain 2008; 131 (Pt 7): 1912-1925
    CrossrefPubMedSearch in Google Scholar
  • 42 Lauria G, Devigili G. Skin biopsy as a diagnostic tool in peripheral neuropathy. Nat Clin Pract Neurol 2007; 3 (10) 546-557
    CrossrefPubMedSearch in Google Scholar
  • 43 Nathani D, Spies J, Barnett MH. et al. Nerve biopsy: current indications and decision tools. Muscle Nerve 2021; 64 (02) 125-139
    CrossrefPubMedSearch in Google Scholar