Peripheral neuropathies: the rational diagnostic process

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Rev Med Interne. 2005 Dec 7;

Peripheral neuropathies: the rational diagnostic process.

Stojkovic T.

Clinique neurologique, service du Professeur Vermersch, hopital -

Salengro, CHRU de Lille, 59037 Lille cedex, France.

Purposes. - Neuropathies are defined as dysfunction of peripheral

nerves, which may show motor, sensory and autonomic symptoms.

Although most neuropathies are symmetric, it is important to

distinguish a polyneuropathy from a mononeuropathy, a multiple

mononeuropathy or a polyradiculoneuropathy. Electrophysiological

procedures are helpful in determining the pathological process which

may be either an axonopathy, a myelinopathy or a neuronopathy.

Main points. - Major progresses have been made in the ten past years

in the management and diagnostic approaches of peripheral neuropathy.

The history and the physical examination are the first steps to the

evaluation of patients with peripheral neuropathy. Electrodiagnostic

studies and then laboratory tests are the next step in the diagnostic

procedures of peripheral neuropathies. These will lead to a proper

identification of the cause of neuropathy, allowing to develop a

specific treatment for the patient. However, even after a careful

work-up of a patient with neuropathy, 25 to 40% of patients with

polyneuropathies remain undiagnosed.

Perspectives. - Further development are focused in better

understanding the pathogenesis and molecular mechanisms of peripheral

nerve diseases in order to provide a specific and adequate treatment

for each neuropathy.