Peripheral Sensorimotor Neuropathy

Peripheral sensorimotor neuropathy is a condition that affects nerves throughout your body, causing problems with both movement and sensation. This nerve damage can develop slowly over years or appear suddenly within hours to days, impacting your ability to feel, move, and maintain balance.

Table of contents

• What is Peripheral Sensorimotor Neuropathy?
• What Causes This Condition?
• Symptoms and Warning Signs
• How is it Diagnosed?
• Treatment and Management
• Safety Measures for Daily Living

What is Peripheral Sensorimotor Neuropathy?

Peripheral sensorimotor neuropathy is a condition that causes decreased ability to move and feel because of nerve damage^[1]. The term “neuropathy” means disease of or damage to nerves. When this occurs outside of the central nervous system—meaning outside the brain and spinal cord—it is called a peripheral neuropathy^[1].

Your nervous system has two main parts. The central nervous system includes your brain and spinal cord. The peripheral nervous system consists of all the other nerves in your body that send signals between your brain and the rest of your body^[3]. When the word “peripheral” is used, it refers to nerves that are outside of or away from the central nervous system^[3].

Sensorimotor neuropathy specifically affects both types of nerve function. It damages nerves that provide feeling, which is called sensory neuropathy, and nerves that cause movement, which is called motor neuropathy^[1]. When both types are affected together, it is called a sensorimotor neuropathy.

This is a bodywide process that damages nerve cells, nerve fibers, and nerve coverings. Damage to the covering of the nerve cell causes nerve signals to slow or stop. Damage to the nerve fiber or entire nerve cell can make the nerve stop working completely^[1].

What Causes This Condition?

Many different conditions and factors can cause peripheral sensorimotor neuropathy. The nerve damage can be caused by several mechanisms including autoimmune disorders, conditions that put pressure on nerves, decreased blood flow to the nerve, diseases that destroy connective tissue, swelling of the nerves, metabolic disorders, and toxins^[1].

The most common treatable causes include diabetes mellitus, hypothyroidism, and nutritional deficiencies^[1]. Diabetes is particularly significant, as one study estimated that peripheral neuropathy affects about 26.4 percent of patients with type 2 diabetes^[12].

Other possible causes of sensorimotor polyneuropathy include^[1]:

• Alcoholic neuropathy
• Amyloid polyneuropathy
• Autoimmune disorders, such as Sjögren syndrome
• Cancer (called a paraneoplastic neuropathy)
• Long-term inflammatory neuropathy
• Chronic kidney disease
• Drug-related neuropathy, including chemotherapy
• Guillain-Barré syndrome
• Hereditary neuropathy
• HIV/AIDS
• Low thyroid
• Parkinson disease
• Vitamin deficiency (vitamins B12, B1, and E)
• Various infections

Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes, and exposure to toxins^[2]. Some neuropathies develop over years, while others can start and become severe within hours to days^[1].

Symptoms and Warning Signs

The symptoms of peripheral sensorimotor neuropathy can vary widely depending on which nerves are affected. Peripheral neuropathy happens when the nerves located outside of the brain and spinal cord are damaged. This condition often causes weakness, numbness, and pain, usually in the hands and feet^[2].

Symptoms may develop quickly, as in Guillain-Barré syndrome, or slowly over weeks to years. Symptoms usually occur on both sides of the body. Most often, they start at the ends of the toes first^[1].

Common symptoms include^[1]:

• Decreased feeling in any area of the body
• Difficulty swallowing or breathing
• Difficulty using the arms or hands
• Difficulty using the legs or feet
• Difficulty walking
• Pain, burning, tingling, or abnormal feeling in any area of the body (called neuralgia)
• Weakness of the face, arms, or legs, or any area of the body
• Falls due to lack of balance and not feeling the ground under your feet

People with peripheral neuropathy usually describe the pain as stabbing, burning, or tingling^[2]. The symptoms might include gradual onset of numbness, prickling, or tingling in your feet or hands, and these sensations can spread upward into your legs and arms. Sharp, jabbing, throbbing, or burning pain may occur, along with extreme sensitivity to touch and pain during activities^[2].

How is it Diagnosed?

The healthcare provider will examine you and ask about your symptoms. The diagnosis requires careful clinical assessment, judicious laboratory testing, and additional studies if the diagnosis remains unclear^[12].

A physical exam may show^[1]:

• Decreased feeling (may affect touch, pain, vibration, or position sensation)
• Diminished reflexes (most commonly the ankle)
• Muscle atrophy (muscle wasting or thinning)
• Muscle twitches
• Muscle weakness
• Paralysis

Initial blood tests should include a complete blood count, comprehensive metabolic profile, and measurement of red blood cell sedimentation rate and fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels^[12]. Your healthcare professional will look at your medical history, including your symptoms, lifestyle, exposure to toxins, drinking habits, and family history of nervous system diseases^[7].

Tests that may be ordered include^[1]:

• Biopsy of the affected nerves
• Blood and urine tests
• Electrical test of the muscles (EMG or electromyography)
• Electrical test of nerve conduction
• X-rays or other imaging tests, such as MRI
• Genetic testing
• Spinal fluid testing (lumbar puncture or spinal tap)

Electromyography measures and records electrical activity in your muscles to find nerve damage. A thin needle is inserted into the muscle to measure electrical activity as you contract the muscle. During an EMG, a nerve conduction study is typically also done, where flat electrodes are placed on the skin and a low electric current stimulates the nerves^[7].

Treatment and Management

The goals of treatment include finding the cause, controlling the symptoms, and promoting a person’s self-care and independence^[1]. Many causes, forms, or symptoms of this condition are treatable, but this can vary widely from person to person^[3].

Depending on the cause, treatment may include^[1]:

• Changing medicines if they are causing the problem
• Controlling blood sugar level when the neuropathy is from diabetes
• Not drinking alcohol
• Taking daily nutritional supplements
• Medicines to treat the underlying cause of the polyneuropathy

Treatment for peripheral neuropathy may include treating any underlying cause or symptoms. Treatment may be more successful for certain underlying causes. For example, ensuring diabetes is well controlled may help improve neuropathy or at least stop it from getting worse^[10].

For managing pain symptoms, common painkillers like paracetamol and ibuprofen do not usually work well for nerve pain. Other medicines are often used instead, which should usually be started at the minimum dose and gradually increased^[10]. The main medicines recommended for nerve pain include antiseizure medications such as pregabalin and gabapentin, antidepressants such as amitriptyline and duloxetine, and topical medications^[10].

To promote self-care and independence, treatments may include^[1]:

• Exercises and retraining to maximize function of the damaged nerves
• Job (vocational) therapy
• Occupational therapy
• Orthopedic treatments
• Physical therapy
• Wheelchairs, braces, or splints

Safety Measures for Daily Living

Safety is important for people with neuropathy. Lack of muscle control and decreased sensation can increase the risk of falls or other injuries^[1].

If you have movement difficulties, these measures can help keep you safe^[5]:

• Leave lights on to avoid walking in the dark
• Remove obstacles such as loose rugs that may slip on the floor
• Test water temperature before bathing
• Use railings
• Wear protective shoes, such as those with closed toes and low heels
• Wear shoes that have non-slippery soles
• Have a therapist assess your need for an assistive device such as a cane or walker

Other important safety tips include^[5]:

• Check your feet (or other affected area) daily for bruises, open skin areas, or other injuries, which you may not notice but can become infected
• Check the inside of your shoes for rough areas that can injure your feet
• Protect areas of decreased feeling from extreme heat or cold

Exercise has been found to improve balance, strength, walking speed, mobility confidence with reduced fear of falling, and increase endurance in people with peripheral neuropathy. Exercise can also improve nerve pain and sensory disturbances that often accompany these conditions^[17]. According to health guidelines, maintaining a healthy, active lifestyle means aiming for at least 150 minutes of moderate activity throughout the week^[17].