(mentions CMT) Tingling Hands, Burning Feet? Rochester Neurologist an Expert in

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Tingling Hands, Burning Feet? Rochester Neurologist an Expert in

Tracking Down Neuropathy

http://www.urmc.rochester.edu/pr/news/story.cfm?id=2334

Hands that feel like they're burning; feet that make it feel like

you're walking on pins and needles; numbness that spreads gradually

up the limbs. These are among the most vexing of symptoms for

patients and their doctors alike. Many patients spend years going

from doctor to doctor seeking a diagnosis, and many doctors order

test upon test, with no firm conclusion.

Now a Rochester neurologist has helped compile a national set of

guidelines that aim to help doctors better diagnose the most common

cause of such symptoms more quickly and efficiently and with less

expense.

Herrmann, MBBCh, director of the Peripheral Neuropathy Clinic

at Strong Memorial Hospital, is an author of the guidelines for a

painful nerve condition known as neuropathy, which affects millions

of people with diabetes and many other patients as well. The new

practice parameters were published last month in the journal

Neurology.

The symptoms of nerve damage vary greatly among patients: Burning

pain, tingling, numbness, and weakness are all common. The new

guidelines focus on patients with distal symmetric polyneuropathy,

which generally describes nerve damage that is most often in the

hands and feet, and arms and legs. The condition has a variety of

causes, including diabetes, poor nutrition, HIV, certain medications,

excessive alcohol consumption, or simply, genetics.

" Neuropathy can be very difficult to pin down, and there are dozens

upon dozens of tests that a doctor can order in an attempt to

properly diagnose the patient, " said Herrmann. " The new parameters

are designed to help patients by giving physicians the tools they

need to arrive at a proper diagnosis efficiently. "

Herrmann and colleagues recommend that doctors begin by ordering

three blood tests to identify the cause of neuropathy: measuring

levels of blood glucose and vitamin B12, as well a test known as

serum protein electrophoresis and immunofixation. The guidelines also

recommend the use of genetic analysis in some cases, to either rule

out or pin down a specific inherited form of the disorder. Charcot-

Marie-Tooth disease is the most common inherited form of neuropathy.

Guidelines also support the use of specialized tests, including skin

biopsy, for some patients. Herrmann is an expert in the use of skin

biopsy to identify neuropathy and track its progression. He is also

currently developing a new technique that uses a specialized

microscope to look beneath the skin to gauge the condition of a

person's nerves in the fingers, as a way to possibly eliminate the

need for a biopsy in some patients.

Herrmann notes that once identified, symptoms in a majority of

patients with neuropathy can be treated successfully – the pain is

lessened or reduced, for instance, or feeling returns to hands and

feet that had been numb. In some instances, the nerve damage can

actually be reversed.

" Anything we can do to improve the lives of these patients would be

tremendous, " said Herrmann, who is associate professor of Neurology

and of Pathology and Laboratory Medicine. " For a particular form

known as small fiber neuropathy, many patients are told that the

problem is all `in their head' and not real, because a doctor can't

find evidence of the condition. And so the patients search for

answers for years, all the while suffering needlessly. It's very

unfortunate. Skin biopsy can be helpful to identify neuropathy in

such patients. "

The new parameters are a result of a collaboration between the

American Academy of Neurology, the American Association of

Neuromuscular and Electrodiagnostic Medicine, and the American

Academy of Physical Medicine and Rehabilitation. The effort was led

by neurologist D. England, M.D., of Louisiana State University

Health Sciences Center.