Neurological Symptoms in Peripheral Neuropathies

Introduction to Numbness and Paresthesia

Numbness and paresthesia are related neurological symptoms that often co-occur in peripheral neuropathies, with numbness referring to decreased or absent sensation and paresthesia referring to abnormal sensations such as tingling, burning, or prickling that occur spontaneously without stimulation 1

Peripheral neuropathies, such as diabetic neuropathy, chemotherapy-induced peripheral neuropathy, and vitamin B12 deficiency, commonly present with both numbness and paresthesia 1
Amyloid neuropathy typically begins symmetrically with numbness, paresthesia, or pain in the toes and feet, often worse at night, as reported by the American College of Cardiology 2
Medication-induced neuropathies, such as those caused by chemotherapeutic agents like bortezomib, can cause painful small fiber damage with both numbness and paresthesia 3
Certain chemotherapeutic agents, including vinca alkaloids, taxanes, and platinum compounds, are associated with painful small fiber damage and autonomic involvement, as reported by the American Society of Clinical Oncology 4
Other medications, such as certain antibiotics and antiretroviral agents, can also cause peripheral neuropathy, according to the American Academy of Neurology 5, 6

The American College of Cardiology recommends assessing the distribution pattern of numbness and paresthesia to help determine the underlying pathology, with symmetrical vs. asymmetrical and proximal vs. distal patterns providing important clues 2
Monitoring changes in the pattern of symptoms, such as progression from paresthesia to numbness, may indicate worsening of the underlying condition, according to the American College of Cardiology 2
Clinicians should assess the distribution pattern of numbness, including symmetrical vs. asymmetrical, proximal vs. distal, and focal vs. diffuse, and perform key clinical tests, including small-fiber function tests and large-fiber function tests, according to the American Academy of Neurology 5, 7
The diagnostic workup for numbness typically includes a detailed history and neurological examination, laboratory studies, and imaging studies when indicated, as recommended by the American College of Radiology 8, 9
Management depends on the underlying cause, but generally includes treating the underlying condition, symptom management with medications for neuropathic pain, protective measures to prevent injury to numb areas, and patient education about the significance of numbness and when to seek urgent care, according to the American Diabetes Association and the American College of Radiology 8, 5

The following grading system can be used to assess CIPN:
Grade Symptoms
1 Mild symptoms not interfering with daily activities
2 Moderate symptoms affecting activities of daily living
3 Severe symptoms preventing normal activities
4
Treatment options for CIPN include:
Patient education is essential, emphasizing the importance of reporting symptoms early and monitoring for potential drug interactions, particularly with anticoagulants like warfarin, as recommended by the American Society of Clinical Oncology 4
Early recognition of medication-induced peripheral neuropathy is critical, as continued exposure may lead to irreversible damage, emphasizing the need for prompt identification and discontinuation of the offending medication, as recommended by the American Academy of Neurology 4
The American Academy of Neurology suggests that patients with suspected medication-induced small fiber neuropathy should be monitored for improvement after discontinuation and considered for symptomatic treatment, such as duloxetine or gabapentin for neuropathic pain, with Level I, Grade B evidence for reducing neuropathic pain 4

Grade	Symptoms
1	Mild symptoms not interfering with daily activities
2	Moderate symptoms affecting activities of daily living
3	Severe symptoms preventing normal activities