Handbook of Peripheral Neuropathy PDF

Preface

Peripheral neuropathies are common clinical problems. Foot numbness and pain are frequent complaints in the primary care setting. The complexity of nerve anatomy and pathology and the long list of causes of peripheral neuropathy may seem daunting and often lead primary care providers to refer patients to a neurologist. Even among neurologists, the evaluation can be challenging. All of these factors contribute to the general perception that the diagnosis and management of peripheral neuropathies is complex and mysterious. The goal of this text is to de-mystify the evaluation and treatment of peripheral neuropathies and to provide a practical guide to the management of common symptoms.

The diagnosis of peripheral neuropathy can be simplified by using a structured approach. One purpose of medical monographs is to bring order to apparent complexity. Accordingly, this book is designed around a diagnostic approach based on an understanding of the anatomy and pathophysiology of the peripheral nervous system. This approach involves asking a series of simple clinical and electrodiagnostic questions whose answers lead to a full characterization of the neuropathy. When knowledge of basic classes of neuropathies is added to this characterization, it can yield a reasonable differential diagnosis. At this point, a focused set of laboratory tests can be rationally selected that will maximize the diagnostic yield. Treatment and management of peripheral neuropathy also benefit from an approach that emphasizes an understanding of underlying pathophysiology of the neuropathy.

This book is divided into three broad sections. The first broad section provides an evaluation algorithm. This algorithm is based on the anatomy, physiology and pathology of peripheral nerves in the context of symptoms and signs. A similar algorithm is offered for designing and interpreting electrodiagnostic tests. The role of special diagnostic tests, including imaging, quantitative sensory testing, and nerve and skin biopsy is also reviewed in the first section. The second broad section presents classes of peripheral neuropathies. For each class, the clinical characteristics, electrodiagnostic features, examination findings, treatment options and outcome are reviewed. The third broad section discusses general treatment modalities and management issues which will improve the patient's well being.

We thank our many contributors who have provided their experience and expertise to make this a clinically useful book. The mechanics of editing a book on peripheral neuropathy are as daunting as the subject, and we could not have succeeded without the vii expertise of Ms. Becky Guertler. We also thank our publisher, especially Jinnie Kim the acquiring editor, for their patience, in preparing the book.

We want to acknowledge our mentor in neuromuscular diseases, James Albers M.D., Ph.D., who has provided an approach to the diagnosis and management of peripheral neuropathies that is reflected in the general outline of this book.