Peripheral Neuropathy: A Phenotype-Driven Review for Diagnosis and Management

Area of Science:

• Neurology
• Clinical Neuroscience

Background:

• Peripheral neuropathy encompasses diverse conditions affecting nerve function.
• Accurate diagnosis and management are crucial for patient outcomes.
• Contemporary understanding requires integrating new diagnostic and therapeutic advances.

Purpose of the Study:

• To provide a clinic-ready synthesis of current peripheral neuropathy concepts.
• To offer pragmatic tools for diagnosis and treatment applicable to daily practice.
• To highlight high-yield advances in peripheral neuropathy management.

Main Methods:

• Narrative review integrating contemporary concepts in peripheral neuropathy.
• Categorization into seven pathophysiologic phenotypes.
• Development of a diagnostic algorithm and management framework.
• Inclusion of novel therapeutic strategies like neuromodulation.

Main Results:

• A phenotype-first structure aids organized evaluation and management.
• A stepwise escalation algorithm improves diagnostic precision and test utilization.
• Emerging treatments like high-frequency spinal cord stimulation show promise for refractory pain.
• Disease-modifying therapies are advancing care for hereditary transthyretin amyloid polyneuropathy.

Conclusions:

• Current developments support earlier pattern recognition and precise phenotyping in peripheral neuropathy.
• Rational escalation of diagnostic and therapeutic strategies is key.
• Standardized outcome measures are essential for tracking treatment response.