Peripheral neuropathy is a disorder of nervous system apart from the brain and spinal cord. It is often presented as tingling, pins and needles sensation and pain. There are associated features such as reduction or loss of sensitivity to temperature, proprioception, touch and vibration. These can lead to loss of balance and frequent falls. Peripheral neuropathy is associated with vast number of underlying pathologies and accurate diagnosis is needed for best outcome.
Symptomatic treatments (treat underlying condition first):
- Cap. Meganeuron OD + (Vitamin B complex) – one capsule per day
- Tab. Gabantin 300 (Gabapentin 300 mg) – one tablet once a day. Gradually increase till maximum dose of 600 mg thrice a day.
- In non-diabetic patients – 4 day course of steroid – Tab. Zempred 4 (Methylprednisolone 4 mg) – day 1 – four times a day; day 2 – thrice a day; day 3 – twice a day; day 4 – once a day.
Specific treatments (based on most common underlying conditions):
- For diabetic neuropathy – Tab. Epineuron SR (Epalrestat 150 mg, Methylcobalamine 1500 mcg) – one tablet once a day. In addition refer to our guidelines for diabetes type 1 or type 2.
- For hypothyroidism – Refer to our guidelines on hypothyroidism for thyroxine supplement.
- For renal failure – Correct electrolytes, urea, uric acid and ammonia level as needed.
- For vitamin supplement – Refer to out guidelines on vitamin deficiency
- For drug induced neuropathy – Stop intake of the drug
- For spinal radiculopathy – Tab. Dolokind MR (Aceclofenac 100 mg, Paracetamol 325 mg, Chlorzoxazone 250 mg) thrice a day for 3 days and Tab. Pantakind (Pantoprazole 40 mg) once a day for 5 days.
General advice:
- Ensure correct footwear to reduce foot injuries.
- Advice walking aids to reduce imbalance.
- Stop smoking and alcohol intake.
- Advice exercises to improve proprioception.
- Advice good skin care to avoid excessive dryness and skin breakage.
Investigations (based on underlying clinical diagnosis):
- Complete blood count
- Renal Function Test
- HbA1C levels
- Lyme’ disease antibody test
- Rapid Plasma Reagin (RPR) or Veneral Disease Research Laboratory (VDRL)
- Antinuclear Antibody (ANA) status
- P-ANCA and C-ANCA
- Serum Protein Electrophoresis (SPEP) and Urine Protein Electrophoresis (UPEP)
- Urine 24-hour collection for heavy metals
- Paraneoplastic syndrome testing
- Electromyography
- Nerve conduction study
- Nerve biopsy
- MRI brain and spine
- Lumbar puncture
Referral:
Consider referring patient to appropriate specialist depending on underlying pathology if patient fails to respond to treatment or presents with additional complications.