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Neurology (Expert Forum)
please help--progressing neuropathy
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
please help--progressing neuropathy
by skypeople, Oct 29, 2008 09:57AM
I am a sixty year old woman who was diagnosed with moderate to severe sensory-motor (plus axonal) neuropathy, positive Romberg, and abnormal visual evoked test in 1999 which at that times was thought to be due to B-12 definciency. After initial series of shots (which I am still one) it seemed that I was improving but things have slowly gotten worse over time.
I am now experiencing the feeling I am stepping in water (no water there) in my feet; severe itching (at times) on feet and legs and also hands and forearms; electrical shock sensation in feet/legs and hands,arms and sensation of tingling/crawling sensation from head and other parts of body, etc.
I have not sweated for at least several years. When I went out this summer to mow the yard (temperature less then 70 degrees), in less then forty five minutes my body temperature rose three degrees and feet, hands, and face brick red . Yet at times, I get so cold (no matter what temperature is), chills, brain get thick and foggy to where I have to lay down and sleep. I also get severe constipation or diarrhea and having problems with incotinence
My Mother was just dignosed last year with sensory motor neuropathy at the age of 80 (but had complained for years of being clumsy (so wonder if hers started long before she was diagnosed.).
Is it possible to have more than one kind of neuropathy? such as sensory-motor and small fiber neuropathy? Or are they be the same?
could long term exposure to off and on gas leak from natural gas cause neuropathy?
How hard is it to find cause of neuropathy as still taking B-12 shots so that cannot be cause as has not stopped progression of neuropathy?
I am having hard time adjusting to lack of energy, strength, and worry that I will not be able to last more than five years or so (if lucky) in my own home.
thank you for your help
I am now experiencing the feeling I am stepping in water (no water there) in my feet; severe itching (at times) on feet and legs and also hands and forearms; electrical shock sensation in feet/legs and hands,arms and sensation of tingling/crawling sensation from head and other parts of body, etc.
I have not sweated for at least several years. When I went out this summer to mow the yard (temperature less then 70 degrees), in less then forty five minutes my body temperature rose three degrees and feet, hands, and face brick red . Yet at times, I get so cold (no matter what temperature is), chills, brain get thick and foggy to where I have to lay down and sleep. I also get severe constipation or diarrhea and having problems with incotinence
My Mother was just dignosed last year with sensory motor neuropathy at the age of 80 (but had complained for years of being clumsy (so wonder if hers started long before she was diagnosed.).
Is it possible to have more than one kind of neuropathy? such as sensory-motor and small fiber neuropathy? Or are they be the same?
could long term exposure to off and on gas leak from natural gas cause neuropathy?
How hard is it to find cause of neuropathy as still taking B-12 shots so that cannot be cause as has not stopped progression of neuropathy?
I am having hard time adjusting to lack of energy, strength, and worry that I will not be able to last more than five years or so (if lucky) in my own home.
thank you for your help
Doctor's Answer
by Lama Chahine, MD, Oct 31, 2008 02:01PM
, Oct 31, 2008 02:01PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the cause of your symptoms are. however, I will try to provide you with some information regarding neuropathy.
There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, the EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems
The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy usually from an early age associated with other clinical features such as high-arched feet), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy, however to my knowledge gas leaks do not. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles ) are involved, leading to sensory symptoms as well as weakness.
The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required. A normal nerve biopsy does not exclude a neuropathy.
The same processes that affect large fibers can affect small fibers. For example, diabetes can typically do this. If your vitamin B12 is normal and there is still clinical signs of deficiency, ancillary testing such as an MMA and homocysteine level may also need to be checked because the vitamin B12 level can be normal but other chemicals related to it may show that it is not truly present in sufficient quanities. If all your levels are normal and yet you are found to have signs of a progressing neuropathy, it would be best for you to be re-evaluated by your neurologist so that other causes can be excluded.
Thank you for using the forum I hope you find this information useful good luck.
Without the ability to examine you and obtain a history, I can not tell you what the cause of your symptoms are. however, I will try to provide you with some information regarding neuropathy.
There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, the EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems
The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy usually from an early age associated with other clinical features such as high-arched feet), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy, however to my knowledge gas leaks do not. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles ) are involved, leading to sensory symptoms as well as weakness.
The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required. A normal nerve biopsy does not exclude a neuropathy.
The same processes that affect large fibers can affect small fibers. For example, diabetes can typically do this. If your vitamin B12 is normal and there is still clinical signs of deficiency, ancillary testing such as an MMA and homocysteine level may also need to be checked because the vitamin B12 level can be normal but other chemicals related to it may show that it is not truly present in sufficient quanities. If all your levels are normal and yet you are found to have signs of a progressing neuropathy, it would be best for you to be re-evaluated by your neurologist so that other causes can be excluded.
Thank you for using the forum I hope you find this information useful good luck.
