Peripheral Neuropathy

Peripheral nervous system is comprised of the nerves that communicate between the brain and muscles, skin, internal organs and blood vessels. It also includes nerves in the face, arms, legs and torso. When damaged, nerves are unable to communicate properly, which can result in symptoms such as pain, numbness or weakness.  Neuropathy symptoms vary depending upon the type of affected nerve. Some nerves affect the senses, others affect movement and motor skills, and some carry vital information to organs.  

Peripheral neuropathies can be inherited (including Charcot-Marie-Tooth Disease) or acquired.  Common acquired peripheral neuropathies are caused by an underlined medical conditions such as diabetes, vitamin deficiency (particularly B12), collagen vascular disorders (Lupus, Rheumatoid arthritis), toxins (heavy metals, led) and  medications such as cancer therapy drugs. Some neuropathies are a result of inflammatory or immune process as seen in GBS or CIDP. Compressive peripheral neuropathies develop as a result of a peripheral nerve entrapment, as in the case of carpal tunnel syndrome. 

Diagnosing Peripheral Neuropathy

A detailed patient history and neurological examination are required to diagnose peripheral neuropathies. Successful treatment of peripheral neuropathy depends on identifying an underlying disorder, type and mechanism of nerve damage. Because of multiple causes of peripheral neuropathy, it is important to visit an expert specialist in the field for correct diagnosis.

Based on the results of patient's history, neurological exam and additional testing may be ordered to help determine the nature and extent of the neuropathy. These tests include blood work (when appropriate genetic testing), electrophysiology( Electromyography (EMG) and Nerve Conduction Studies (NCSs), Nerve and Skin Biopsy  as well as imaging studies such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT scan).

Peripheral Neuropathy Treatments

Treatment for peripheral neuropathy depends on its cause and is directed to correction of underlying reasons.  Neuropathies that are secondary to vitamin deficiencies can be treated with vitamin supplementation. Control of diabetes may not reverse, but frequently prevents progression of neuropathy.  Neuropathies associated with immune diseases can improve with treatment of the autoimmune disease. Depending on the particular type of neuropathy, a neurologist may provide treatment for autoimmune mediated process with Immunoglobulin. Neuropathies caused by nerve entrapment or injuries can be treated with surgery.  Our neurosurgeons, led by Dr. Nickolas Boulis who specializes in disorders of the peripheral nerves, offer a variety of surgeries to remove compression from nerves (Carpal Tunnel and Ulnar Neuropathy), remove tumors or attempt to repair damaged nerves.  

If a specific treatment isn't available, the pain of a neuropathy can usually be controlled with medications. If conservative approach is not effective for pain management, a neuromodulation treatment can be considered.  It consists primarily of electrical stimulation or lesioning of specific regions of the nervous system.  Electrical stimulators are surgically implanted devices such as Spinal Cord Stimulator or Nerve stimulator.

While all members of our medical staff are trained in multiple aspects of general neurosurgery, each neurologist and neurosurgeon also has a special area of interest, expertise, and training. In other words, our physicians sub-specialize in a particular condition and/or procedure--giving them the ability to only focus on one disorder (e.g., epilepsy or stroke) and/or one surgical procedure (e.g., electrical stimulation). This makes them remarkably knowledgeable and successful in what they do.

About the Peripheral Neuropathy Program

Neurological conditions are often multi-factorial, so it takes a team of doctors, trained in specific factors or areas of an individual condition, to provide optimal treatment. Our surgeons also work closely with neurologists, radiologists, physiatrist, nurses, and other staff members who are specifically trained in individual areas of neurological care, which helps to enhance efficiency and accuracy. A combined neurosurgery and neurology multidisciplinary Peripheral Nerve clinic at Emory provides expertise in most nerve disorders, including peripheral nerve injuries, nerve sheath tumors, neurofibromatosis, compressive neuropathies as well as pain syndromes. This team-centered organization translates to individualized care through every step of your peripheral neuropathy treatment.

The Emory Department of Neurological Surgery offers extensive research and education programs that are among the best in the world. We are a national leader in neurological research, generating new insight into brain-related diseases and disorders as well as developing new procedures and medications for their treatment. Our physicians and scientists examine the causes and workings of specific neurological disorders as they aim to find more effective treatments for these conditions.  

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