What is the relevant history to determine the etiology of neuropathy?

From the Guidelines

When evaluating a patient for neuropathy, a comprehensive history should focus on potential causes including diabetes duration and control, alcohol consumption patterns, vitamin deficiencies, medication history, toxic exposures, family history of hereditary neuropathies, autoimmune conditions, infectious diseases, malignancies, kidney or liver disease, and thyroid dysfunction, as recommended by the most recent guidelines 1. The history should also cover the onset, progression, and distribution of symptoms, noting whether they follow a length-dependent pattern typical of metabolic causes or an asymmetric pattern suggesting inflammatory or compression etiologies. Some key points to consider in the history include:

• Diabetes duration and control, as diabetic peripheral neuropathy is a common complication of diabetes 1
• Alcohol consumption patterns, as alcohol can cause toxic neuropathy 1
• Vitamin deficiencies, particularly B12, folate, and vitamin E, as these can cause neuropathy 1
• Medication history, especially chemotherapeutic agents and certain antibiotics, as these can cause neurotoxicity 1
• Toxic exposures, such as heavy metals and organic solvents, as these can cause neuropathy 1
• Family history of hereditary neuropathies, as some neuropathies are inherited 1
• Autoimmune conditions, such as rheumatoid arthritis and lupus, as these can cause neuropathy 1
• Infectious diseases, including HIV and Lyme disease, as these can cause neuropathy 1
• Malignancies, such as multiple myeloma and bronchogenic carcinoma, as these can cause neuropathy 1
• Kidney or liver disease, as these can cause neuropathy 1
• Thyroid dysfunction, as this can cause neuropathy 1 It is also important to ask about sensory symptoms, such as numbness, tingling, and pain, as well as motor symptoms, such as weakness and atrophy, and autonomic symptoms, such as orthostatic hypotension and sweating abnormalities, as these can help guide diagnostic testing and treatment approaches 1. Additionally, the history should include questions about the patient's sleep patterns, as sleep disturbances are common in patients with neuropathy, and can have a significant impact on quality of life 1. Overall, a comprehensive history is essential for determining the etiology of neuropathy and guiding appropriate diagnostic testing and treatment approaches.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Etiology of Neuropathy

The etiology of neuropathy can be determined by considering the relevant history of the patient, including:

• Systemic diseases such as diabetes, rheumatoid arthritis, and thyroid disease, which can cause symptoms of peripheral nerve dysfunction 2
• Family and medical history, which can provide clues to the cause of the neuropathy 2
• Onset and progression of symptoms, which can help identify the underlying cause of the neuropathy 3

Common Causes of Neuropathy

Some common causes of neuropathy include:

• Diabetes mellitus, which is the most common cause of peripheral neuropathy 3, 4, 5, 6
• Nerve compression or injury 4
• Alcohol use 4
• Toxin exposure 4
• Hereditary diseases 4
• Nutritional deficiencies 4

Diagnosis and Evaluation

Diagnosis and evaluation of neuropathy require:

• A comprehensive history and physical examination 2, 4, 6
• Judicious laboratory testing, including nerve conduction studies and electromyography 2, 4, 6
• Evaluation for potential underlying etiologies, including treatable causes 4

Types of Neuropathy

Different types of neuropathy include:

• Distal symmetrical polyneuropathy, which is the most common form of diabetic neuropathy 6
• Isolated nerve involvement, such as tibial or sural nerve involvement 6
• Pure sensory neuropathy 6