A peripheral neuropathy is a dysfunction of the peripheral nervous system. The central nervous system consists of the brain, brain stem, and spinal cord. The peripheral nerve system is the portion of the nervous system after the spinal cord. This includes neuronal cell bodies, axons, and myelin sheath. As an analogy to electrical wiring, the axon would be the central metal core to the wire that transmits signal, and the myelin sheath would be the outside rubber or plastic coating that protects and insulates the wiring. When the peripheral nervous system is damaged, it can result in problems with sensation (sensory), strength (motor), or with control over glands, blood flow, and heart rate (autonomic).
Similar to the “static” on a phone or radio line when there is interference, this is an additional signal being transmitted. It can feel like a “pins and needles” prickling sensation that is consistently present.
Balance can be affected in more severe peripheral neuropathy, due to both weakness and impairment in the brain to sense where the body is in space. This function is called proprioception, and it is impaired often with peripheral neuropathy.
A spasm or cramping sensation in muscles, especially in the feet or leg muscles can occur. Staying adequately hydrated with good electrolyte levels can help some with this.
When someone has significant peripheral neuropathy, it is important to take certain precautions to avoid other complications. As the peripheral nervous system is responsible for the sensation of proprioception (the sensation of where a part of the body is in space), it can affect balance significantly when there is no way to visually see where the legs and feet are. Therefore, people who have peripheral neuropathy may have significant balance problems and falls in the dark. For this reason, it is important to make sure that lights are on when someone gets up during the night, such as to use the restroom. A loss of sensation in the feet can also result in people stepping on sharp objects or getting injuries and not feeling it. This can lead to significant wounds and infections. For this reason, it is important to ensure that people with peripheral neuropathy visually inspect their feet multiple times per day and wear well-fitting shoes. Peripheral neuropathy is a common condition with many causes. A NeuroX expert can partner with you to care for your needs and help you live a full life.
Regardless of the cause, medications can be used to control any uncomfortable painful sensations that occur due to neuropathy. Medication options include antiepileptic medications such as gabapentin (Neurontin) or pregabalin (Lyrica). They also can include certain antidepressants such as nortriptyline (Pamelor), amitriptyline (Elavil), or venlafaxine (Effexor). Occasionally, creams containing numbing medicine lidocaine, gabapentin (Neurontin), clonidine, capsaicin, and/or ketamine may be used. These medications do not restore sensation that is completely lacking, but they can significantly ease any pain from the neuropathy, therefore improving quality of life and function. Opiate medications are not effective and should not be prescribed for peripheral neuropathy pain.
EMG is a neurodiagnostic test that can be used to test the health of aspects of the peripheral nervous system. This uses electrical current, electrodes, and small needles to test the conduction and function of the nervous system. In addition to testing the peripheral nerves, the EMG can also test the function of muscles.
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