St. Joseph’s/Candler Neurologist Dr. Jonas Vanags answers four questions about neuropathy

Aug 16, 2018


Some of the symptoms and causes of neuropathy may surprise you

Have diabetes? Drink a little too much alcohol? Then you should be aware of neuropathy.

Neuropathy is damage to the nerves that may result in weakness, numbness, tingling, pain or balance problems. It typically begins in the hands and feet but can also be found in other regions.

Neuropathy can be a broad term, says Dr. Jonas Vanags, neurologist with St. Joseph’s/Candler Physician Network – Neurology, because there are many different types of neuropathies. One of the most common forms of neuropathy is peripheral neuropathy, which is damage to multiple peripheral nerves. Peripheral nerves carry information to and from the brain and spinal cord to the rest of your body.

It is estimated that 10 to 15 percent of the population has some form of neuropathy. That number may be higher because so many people do not realize they have the condition or do not report it to their physician. As you get older, your chance of developing neuropathy increases.

Dr. Jonas Vanags, neurologist with St. Joseph’s/Candler Physician Network – Neurology“Peripheral neuropathy can be as common as 30 percent at age 80,” Dr. Vanags says. “You probably have a friend, family or neighbors with peripheral neuropathy.”

What are the symptoms of neuropathy?

There are different symptoms of peripheral neuropathy. Some you may expect, while others may surprise you. Symptoms can include:

  • Numbness or lack of feeling
  • Tingling or pins-and-needles sensations
  • Weakness in the arms/legs
  • Cold or warm sensations
  • Crawling sensations
  • Sharp, shooting pain in your extremities
  • Balance problems such as falling
  • Dizziness with standing
  • Dry eye or dry mouth
  • Constipation
  • Heat intolerance

“Nerves have many functions,” Dr. Vanags explains. “They control your sense of balance and position, muscle control, pain and temperature sensation. They also supply what are called autonomic functions, which are things like your heart rate, digestion or even your sweating.”

How do you test for neuropathy?

There are several ways to evaluate someone for peripheral neuropathy. It begins with a standard evaluation – asking about your medical history and symptoms, and an examination of the person and blood work.

Neurologists also can perform an EMG to determine if it is peripheral neuropathy. This is a two-part test. The first part is the nerve conduction study. The neurologist puts little stickers called electrodes over where the nerves and muscles are, Dr. Vanags explains. The nerves are stimulated and the technician records how fast and how strong the nerves are working.

The second part is called electromyography. The neurologist uses a tiny needle to see if the nerve to the muscle has been damaged.

Sometimes an EMG looks normal, but the patient may still have a form of neuropathy. Small fiber neuropathy affects the small fiber nerves. It can be diagnosed through a punch biopsy of the skin that is then sent off to a pathologist. The pathologist looks at the skin to see the density of the nerves and if neuropathy is present.

“If you feel you have symptoms, I do not think you should ignore it,” Dr. Vanags says. “A common misconception is there’s nothing we can do about peripheral neuropathy. If we figure out the underlying cause, we may be able to halt the progression of it or improve it.”

So what causes neuropathy?

There are a lot of different things that can cause neuropathy. In about two-thirds of cases, neurologists find the cause, Dr. Vanags says. However, in one-third of patients, an underlying cause cannot be identified.

Let’s take a look at five of the more common causes:

1. Diabetes is the most common cause of peripheral neuropathy in the United States, Dr. Vanags says. Once that is identified as the cause, controlling your diabetes through diet, exercise, weight loss – especially abdominal weight – can help with diabetic neuropathy.

Related Article: Peripheral neuropathy: Understanding diabetes effects on your feet

2. Neuropathy may also lead to the discovery that a patient is pre-diabetic. Often times, the first sign of pre-diabetes is symptoms of neuropathy, especially tingling in the feet. If this is discovered as the cause of neuropathy, lifestyle changes, including diet and exercise, can get a person’s blood sugar under control, reducing the symptoms of neuropathy and possibly preventing the person from developing Type II diabetes.

3. There also are toxic causes of neuropathy. The second most common reason for neuropathy is alcoholism. Alcohol abuse can damage the nerves, leading to alcoholic neuropathy. Abstaining from alcohol can help restore your nutritional health and your nerves.

Additionally, there are other toxic causes can that can cause neuropathy including chemotherapy. For patients undergoing chemotherapy and experiencing the symptoms of neuropathy, their oncologist may adjust their regime. Once a patient is done with chemotherapy, the symptoms of neuropathy may improve with time.

4. Some neuropathy patients may have a vitamin deficiency or vitamin toxicity. For example, vitamin B12 is a common vitamin deficiency that can cause peripheral neuropathy, Dr. Vanags says. Or, some people may take too much of a vitamin, such as vitamin B6, and that can cause neuropathy. This is commonly found in people who take too many vitamin supplements in addition to their diet or in someone who consumes a large amount of energy drinks which are fortified with vitamin B6. Vitamin deficiencies and toxicities can easily be corrected by lifestyle changes.

5. Unfortunately, even some cancers can cause neuropathy. When neurologists diagnose neuropathy and begin to look for the underlying cause, sometimes it is discovered the patient has a form of cancer. Certain cancers that may cause neuropathy include cancers of the bone marrow and breast cancer, which makes an antibody that can attack the nerves, Dr. Vanags says. Once the cancer is identified and treated, neuropathy symptoms may improve.

Can you treat peripheral neuropathy?

In the two-thirds of patients where the underlying cause of neuropathy is determined, neurologists can provide treatment recommendations for that cause. This may include lifestyle changes, such as diet and exercise, and/or medications. Some patients, especially those experiencing balance difficulties, may benefit from physical therapy.

Related Article: How physical therapy is treating vestibular disorders

Even if the cause is not determined, neurologists can prescribe medications that can treat the pain component of the condition.

The most important thing is not to ignore any symptoms you may be feeling, Dr. Vanags says. Talk to your primary care physician about these symptoms. He or she may be able to provide help or refer you to a neurologist.

For more information about Dr. Vanags and SJ/C Physician Network – Neurology, visit our website.

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