Peripheral Neuropathies

Referrals to evaluate distal pain, numbness, and tingling are one of the more common questions posed to me in the neuromuscular clinic and EMG laboratory. The spectrum of causes of peripheral nerve disease is very broad and the diagnostic challenge can be daunting. The organization of this issue of Seminars of Neurology reflects the framework that I have found to be rational and efficient. Rational in that I follow an algorithm during the history and examination that leads to a full understanding of the features and a reasonable set of laboratory tests. This approach has proven to be both efficient and effective with a high probability of reaching a diagnosis. It must be appreciated that despite an extensive search for causes, a significant percentage of peripheral neuropathies remain idiopathic or cryptogenic. Further, when a specific diagnosis is reached it usually emerges early in the investigation, and when a diagnosis does not emerge, a broad fish net search rarely nets an unsuspected diagnosis.

The goals for this issue are to provide an approach for evaluating clinical features, determining a cause, and treating the underlying disorder or at least the symptoms of a neuropathy. The first two articles focus on a structured way to understand and sort symptoms, to accurately assess signs, and to gain insight into underlying pathology through electrodiagnostic studies. This should lead to a full characterization of the neuropathy. At this point, a review of the past medical history, social history, family history, symptoms from other organ systems, and medications can be considered in the appropriate context. Most of the remaining chapters provide clinical and electrodiagnostic descriptions of major classes of neuropathies as aids to integrating pertinent features from the clinical and medical reviews. The final chapter reviews rehabilitative aspects of patient management that are often neglected.

While no monograph can cover all aspects of a disorder, it is hoped that this issue of Seminars will serve as a helpful guide.