Experiencing numbness in hands and heat in feet? Seek guidance from the neurology expert in Rochester who specializes in identifying neuropathy.
New Guidelines for Neuropathy: A Step-by-Step Approach to Diagnosis
The American Academy of Neurology (AAN), the American Academy of Neuromuscular and Electrodiagnostic Medicine (AANEM), and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) have published new practice parameters for diagnosing neuropathy, a painful nerve condition that affects millions of people, particularly those with diabetes.
The guidelines, published in the journal Neurology, aim to help doctors diagnose the most common cause of neuropathy symptoms more quickly and efficiently. They recommend a stepwise approach to testing, starting with initial blood tests to screen for reversible and treatable causes such as diabetes, vitamin deficiencies, thyroid function abnormalities, and other metabolic or toxic causes.
For hereditary neuropathies, genetic testing is established as useful and recommended for accurate diagnosis and classification. Routine screening for common genetic abnormalities should include CMT1A (PMP22) duplication/deletion, Cx32 (GJB1) mutations, and MFN2 mutations. This genetic testing is particularly useful in patients with classic hereditary neuropathy phenotypes, while evidence is insufficient to recommend routine testing in cryptogenic polyneuropathy without such phenotypes.
For certain acquired neuropathies like multifocal motor neuropathy (MMN), blood tests may include detecting antibodies to GM1 ganglioside. However, a negative antibody test does not exclude the diagnosis, and other criteria are also important.
David Herrmann, MBBCh, director of the Peripheral Neuropathy Clinic at Strong Memorial Hospital, is one of the authors of the new guidelines. Herrmann is an expert in the use of skin biopsy to identify neuropathy and track its progression. He is also associate professor of Neurology and of Pathology and Laboratory Medicine.
Herrmann is currently developing a new technique using a specialized microscope to look beneath the skin to gauge the condition of a person's nerves in the fingers, potentially eliminating the need for a biopsy in some patients.
The new guidelines support the use of specialized tests, including skin biopsy, for some patients. They also suggest the use of genetic analysis in some cases to rule out or pinpoint a specific inherited form of neuropathy.
The symptoms of nerve damage include burning pain, tingling, numbness, and weakness. The guidelines for neuropathy recommend ordering three blood tests: measuring blood glucose levels, vitamin B12 levels, and serum protein electrophoresis and immunofixation.
The effort was led by neurologist John D. England, M.D., of Louisiana State University Health Sciences Center. The guidelines are designed to help patients by giving physicians the tools they need to arrive at a proper diagnosis efficiently. The guidelines focus on patients with distal symmetric polyneuropathy, a condition characterized by nerve damage in the hands and feet, and arms and legs.
The new guidelines aim to reduce the expense associated with testing for nerve damage. Charcot-Marie-Tooth disease is the most common inherited form of neuropathy. Symptoms in a majority of patients with neuropathy can be treated successfully, with pain lessened or reduced, feeling returning to numb areas, or even nerve damage being reversed.
- The new guidelines for neuropathy also suggest the incorporation of therapies and treatments, such as CBD, in managing certain neurological disorders associated with neuropathy.
- In addition to a step-by-step approach to testing for common medical conditions, the guidelines also emphasize the importance of a balanced diet and nutrition for maintaining overall health and wellness, including skin care, and fitness and exercise to support nerve health.
- Future research may focus on developing new therapies and treatments for neurological disorders, such as CBD, to address the underlying causes of neuropathy and improve patient outcomes.
- The guidelines acknowledge the role of various therapies and treatments, like CBD, in managing associated medical conditions, such as skin care and neurological disorders like multiple sclerosis or epilepsy, which can also present with neuropathy symptoms.
