Regular review: Peripheral neuropathy

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Abstract
Peripheral neuropathy is common, often distressing, and sometimes disabling or even fatal. The population prevalence is about 2400 per 100 000 (2.4%), rising with age to 8000 per 100 000 (8%).1 In Europe the commonest cause is diabetes mellitus, which can produce painful neuropathy, disabling foot ulcers, and death from autonomic neuropathy. Leprosy is still prevalent in Africa, India, and South East Asia. This review explains how general practitioners can approach the first level of diagnosis and warn patients about what lies ahead after referral to a specialist. #### Summary points Peripheral neuropathy can be into divided into acute and chronic forms, symmetrical polyneuropathy, and multiple mononeuropathy Acute neuropathies are diagnostic emergencies Neuropathy due to diabetes mellitus and alcohol misuse can be diagnosed in primary care Neurophysiological tests distinguish axonal from demyelinating neuropathies Demyelinating neuropathies are commonly inflammatory and treatable Axonal neuropathies have multiple causes Generic management includes foot care, ankle supports, and treatment of neuropathic pain I searched Medline from January 1991 until September 2001 using the terms “peripheral neuropathy” and “guideline.” The search yielded 11 references, including useful guidelines for the diagnosis and management of diabetic peripheral neuropathy,2 but no guidelines on the diagnosis and management of generic peripheral neuropathy. This article offers a personal approach to the management of generalised peripheral neuropathy from the perspective of a neurologist with a special interest in the topic. The recommendations also take account of reviews published by authorities in peripheral neuropathy (see educational resources) and a recent audit of a Dutch departmental guideline that showed the value of investigating common causes before doing electrophysiological tests.3 Patients with peripheral neuropathy may present with altered sensation, pain, weakness, or autonomic symptoms. The clinical features vary widely and may resemble myelopathy, radiculopathy, muscle disease, or even hyperventilation. Identifying a neuropathy in patients with …