Sensory peripheral neuropathy: A disease in the news

Most people take the ability to walk for granted. But if you are afflicted with sensory peripheral neuropathy — one of the commonest nerve disorders, you will soon realise how difficult the simple act of walking can be.

Sensory peripheral neuropathy impedes your ability to feel or "sense" your feet, making it difficult to keep a steady gait. You may lose your balance and become more prone to falls.

National Neuroscience Institute (NNI) sees more than 100 cases of sensory peripheral neuropathy every year. As only the more severe or symptomatic cases are referred to NNI specialists, the number of cases in the whole of Singapore is presumably much higher.

The condition drew much attention recently, after it was revealed that former Minister Mentor Lee Kuan Yew suffers from it.

Sensory peripheral neuropathy tends to affect people aged over 60. "It is not life-threatening, but it can progressively lead to leg numbness or loss of sensation on the skin of the legs," says Dr Josiah Chai, senior consultant, Department of Neurology at National Neuroscience Institute.

What is the peripheral nervous system?

The body's nervous system has two parts: the central nervous system (comprising the brain and spinal cord) and the peripheral nervous system (rest of the nerves).

Damage to the peripheral nervous system can affect the sensory nerves, motor nerves or autonomic nerves.

When the peripheral sensory nerves are damaged, they fail to send sensory messages of pain, touch, heat or cold, vibration and position sense from your hands or feet to the brain, hence the loss of sensations and unsteady gait.

Related article: Fall prevention tips for caregivers

Symptoms of sensory peripheral neuropathy

The following symptoms may be present:

• Gradual numbness and tingling in the hands or feet (may spread to arms and legs)

• Burning pain

• Impaired ability to sense the position of one's limbs

• Loss of balance and coordination

• Extreme sensitivity to touch

What causes sensory peripheral neuropathy?

About a third of peripheral neuropathy cases have no known causes. Another third is caused by diabetes. Physical injuries or trauma to the nerves, such as carpel tunnel syndrome, can also lead to nerve disorders.

Related article: That tingling feeling (carpal tunnel syndrome)

Other causes may include infections, toxins (e.g. alcohol), metabolic or hormonal imbalance like hypothyroidism, autoimmune disorders, tumours pressing on the nerves, vitamin B-12 deficiency, and hereditary conditions like Charcot-Marie-Tooth disease.

How is sensory peripheral neuropathy diagnosed?

The doctor will first conduct a physical and neurological exam to test your body's reflexes, coordination, and ability to experience the different types of sensations.

A nerve conduction test, alongside an electromyography, may be carried out to evaluate how well electrical signals travel along the peripheral nerves. This helps to confirm the presence of a peripheral neuropathy, its severity and the type of nerve damage (e.g. demyelinating versus axonal). Any alternation of signals could indicate a nerve disorder.

Blood tests screening for diabetes, low thyroid hormone and vitamin B-12 deficiency may be carried out as well.

Treatment for sensory peripheral neuropathy

Doctors will first treat the underlying cause of sensory peripheral neuropathy.

Pain relief medications can be prescribed to relieve nerve pain. Physical therapy and exercise are recommended to restore strength and coordination to limbs.

"Patients with sensory peripheral neuropathy suffer from sensory loss in their feet. To prevent falls, they should walk on even grounds and avoid dimly lit areas," says Dr Chai. "Damaged peripheral nerves may regenerate with proper care, but symptoms will return unless the root cause is removed," he adds.

One last word of advice from the specialist: Don't walk bare-footed, especially if you suffer from diabetes.

Did you know? Diabetes, carpal tunnel syndrome and the whole neural network are just some of the topics featured in Beautiful Inside Out, Singapore's first-ever Women's Health Book.

This article was written by Teresa Cheong for Health Xchange, with expert input from the Department of Neurology at National Neuroscience Institute.

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