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Dr Balaji Kalband ( left ) Neurologist , Macquarie University Hospital , Sydney , NSW .
Dr Lakshmi Kalband ( right ) Advanced trainee in paediatric neurology , Sydney Children ’ s Hospitals Network , Sydney , NSW .
Dr Sanjeev Taneja ( left ) Neurologist , Bankstown- Lidcombe Hospital , Sydney , NSW .
Amit Chawla ( right ) BSc Medical Sciences , University of Technology , Sydney , NSW .
Copyright © 2022 Australian Doctor All rights reserved . No part of this publication may be reproduced , distributed , or transmitted in any form or by any means without the prior written permission of the publisher . For permission requests , email : howtotreat @ adg . com . au .
This information was correct at the time of publication : 1 April 2022
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INTRODUCTION
NEUROPATHIES are common and may
present in multiple practice settings , from ED and ICU to general practice . The manifestations range from asymptomatic to life-threatening . It is thus paramount to be familiar with common presentations , their diagnostic evaluation and treatment . This How to Treat discusses an approach to common neuropathies and aims to ensure the reader is familiar with the various aspects of management of this common neurological ailment .
EPIDEMIOLOGY
THE incidence and prevalence of neuropathies vary depending on the definitions and extent of diagnostic evaluation . 1-3 The prevalence ranges from 1 % to 3 % across all ages and increases to 5-7 % in those older than 50 years . 4 Some patients may not be aware of their condition , with one study noting that fewer than 15 % of patients with diabetes were aware of their neuropathy . 1 , 5
In patients with diabetes , the incidence of neuropathy changes with the duration of disease ; the prevalence of neuropathy increases from about 8 %
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at the time of diagnosis to as high as two-thirds of patients at 10 years from diagnosis . 3
It is difficult to accurately estimate the prevalence of the hereditary neuropathies , which is reported to range from as low as 0.3-3 % to as high as 30-42 % in various studies . 2 , 6
The prevalence of neuropathic pain can be as high as 7-10 % in the general population . 7
TERMINOLOGY AND CLASSIFICATION
TABLE 1 lists the terminology describing
neuropathies and neuropathic symptoms .
Classifying neuropathies allows a targeted diagnostic approach that drives treatment strategies and enables prognostication . Neuropathies are classified based on the predominant underlying pathophysiology , either axonal or demyelinating . These determine the pattern of evolution ( length dependant or non-length dependant ).
Neuropathies are also classified into acquired and inherited . Further classification of acquired or inherited , demyelinating or axonal neuropathies is made depending on the type of
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Table 1 . Descriptors of neuropathies and neuropathic symptoms
Terminology
Paraesthesia
Dysaesthesia
Hyperaesthesia
Hypoaesthesia
Hyperalgesia
Hypoalgesia
Analgesia
Allodynia
Neuropathy
Peripheral neuropathy
Polyneuropathy
Mononeuropathy
Mononeuritis multiplex
Description
Abnormal painless sensation , either spontaneous or provoked
Abnormal unpleasant sensation , either spontaneous or provoked
Increased sensitivity to stimulus
Decreased sensitivity to stimulus
Increased pain in response to painful stimulus
Diminished pain in response to painful stimulus
Loss of pain sensation
Pain in response to a non-painful stimulus
Disorder of cranial or peripheral nerves ( often used interchangeably with the term peripheral neuropathy )
Disorder of peripheral nerves
Relatively homogenous involvement of multiple nerves
Focal involvement of a single nerve
Focal involvement of multiple non-contiguous nerves
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