Peripheral neuropathy is a general term describing diseases of the peripheral nervous system. Peripheral nerves can get damaged from direct injury such as in cases of degenerative lumbar spine or autoimmune diseases affecting a component of peripehral nerves. Symptoms of tingling, burning, numbness and cramps can present in a symmetrical (in both limbs equally), or patchy (random) fashion. As the disease progresses, it can result in loss of balance or coordination. The prevalence of peripheral neuropathy in the general population is 2400 per 100,000 individuals, and this further increases to more than 8000 patients per 100,000 population in individuals over the age of 55.
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Do you have loss of sensation, tingling, burning or weakness involving your legs or arms? At night when you are about to go to bed, do you feel that your feet are on fire, you can't get comfortable, you have to constantly toss and turn, your calves cramp and are painful? If any of the above symptoms sound familiar to you then likely you are suffering from peripheral neuropathy.
Peripheral neuropathy is caused by various diseases, such as diabetes mellitus, exposure to toxins, metabolic disorders, vasculitis, malignancy, inherited disorders, autoimmune disorders or immune-mediated inflammatory polyradiculoneuropathy (dysimmune neuropathy), and can also be caused by selective medications and even as side effects to supplements.
Diagnosis of the cause of peripheral neuropathy requires several things: 1) an experienced and knowledgable neurologist, 2) examination of patient's history and clinical presentation, 3) neuroimaging, 4) thorough toxic-metablic blood and urine tests, 5) electrodiagnostic study (EMG-NCS), and 6) depending on the case, may need a spinal tap and muscle or nerve biopsy.
Laboratory Diagnosis of Peripheral Neuropathy
On case by case this may vary but typically for diagnosis of acquired peripheral neuropathy the following lab tests are performed: Blood glucose, glycated hemoglobin, Thyroid function tests, BUN, serum creatinine, Urine porphyrins, CBC, serum B12, Serum B6, Serum B1, Serum vitamin E, Serum folate, Urine heavy metals (lead, Arsenic and Mercury); Autoantibodies to Peripheral Nerve Antigens (Asialo-GM-1antibody, GD1a antibody, GD1b antibody, GM-1 antibody, GM-2 antibody, GQ1b antibody, MAG/SGPG antibody, Sulfatide antibody), Rheumatologic, Autoimmune, and Vasculitic Disease - (Cryoglobulins, immune complexes, CH50, hepatitis B and C serology, parvovirus serology, HIV-1 serology, ANA, dsDNA antibodies, Cyclic citrullinated peptide antibody, rheumatoid factor, Anti-neutrophil cytoplasmic antibody (ANCA), SS-A/Ro antibody, SS-B/La antibody, Gliadin, transglutaminase, and endomysial antibodies).
Treatment of peripheral neuroapthy requires first diagnosing and treating the underlying medical condition. Treatment can range from symptomatic treatment with medications and/or supplements that you take on a regular basis, to infusions (in the cases of dysimmune polyneuropathy, patients should be treated with intravenous immunoglobulin (IVIg) or plasma exchange).
To better understand the extent, severity and type of nerve injury of an individual patient, and to provide the patient with a working diagnosis, Dr. Ourmazdi performs all of the evaluation and workups, including the electrodiagnostic studies himself (instead of having technicians perform a standard test). After receiving his medical degree from Chicago Medical School, Dr. Ourmazdi did both his residency and fellowship at the University of Southern California (USC). His fellowship was in neuromuscular disorders under the guidance of one of the leading experts in the field of neuromuscular disorders. He specializes in diagnosing and treating peripheral neuropathy especially in patients with symptoms of neuropathy but who do not meet the standard criteria for the diagnosis of peripheral neuropathy.