Our Neuropathy Services
At the Peripheral Neuropathy Center, our patients receive comprehensive diagnostic, therapeutic and consultative services, including the following:
- Evaluation and treatment of patients with neuropathy
- Clinical Consultations
- Electromyography and Nerve Conduction Studies
- Testing for small fiber neuropathy by punch skin biopsy
- Autonomic function testing – QSWEAT, Heart rate variability testing, tilt table testing (by referral)
Testing for Neuropathy
Following a detailed history and neurological examination, patients undergo comprehensive electrodiagnostic testing to determine the presence of a large fiber neuropathy, its distribution, severity, and whether it is primarily demyelinating or axonal. If the EMG and nerve conduction studies are normal, then a punch skin biopsy is done to determine whether the patient has a small fiber neuropathy. Autonomic functions are assessed using QSWEAT, heart rate variability testing, and tilt table testing where indicated.
Patients undergo blood testing for causes of acquired neuropathies, and where indicated, DNA testing for hereditary neuropathies. Tests for acquired neuropathies include those for autoimmune, infectious, metabolic, nutritional, toxic, and paraneoplastic causes. If no cause can be found, and the neuropathy is progressive, then a nerve and muscle biopsy is done, which occasionally reveals the presence of an occult cause such as non-systemic vasculitis, atypical CIDP, amyloidosis, or sarcoid that may be not be detected by the less invasive tests.
Diagnosis & Treatment
A diagnosis is made based on the history, clinical examination, electrodiagnostic or skin biopsy studies, blood tests, and nerve biopsy (if applicable). Therapy is individualized for each patient, and is directed at both the underlying cause and the symptoms. In addition to treatments provided by physicians at the center, we work in close collaboration with colleagues at the Pain Center to provide pain relief, Rehabilitation Medicine and Physical therapy to improve strength, gait, and coordination, and in Cardiology, Gastrointestinal Medicine, and Urology for treatment of the autonomic symptoms.