Polyneuropathy

What is polyneuropathy?

Polyneuropathy refers to a disease of several peripheral nerves. The peripheral nerves connect the brain and spinal cord with the muscles, the skin and the internal organs. In polyneuropathy these nerves are damaged, which can lead to sensory disturbances, pain and muscle weakness.

The disease typically begins in the feet and hands and slowly spreads upward (stocking- and glove-shaped distribution).

Symptoms

Sensory symptoms (sensation disturbances)

  • Tingling, crawling sensations or burning in the feet and hands
  • Numbness
  • Reduced temperature and pain sensation
  • Unsteady gait, especially in the dark

Painful polyneuropathy

  • Burning, stabbing or shooting pain
  • Sensitivity to touch (allodynia)
  • Nighttime worsening of pain

Motor symptoms

  • Muscle weakness, especially in the feet (foot drop)
  • Muscle cramps
  • Muscle wasting (atrophy) in the advanced stage

Autonomic symptoms

  • Dry skin on the feet
  • Disturbances of sweat secretion
  • Digestive disorders
  • Disorders of circulatory regulation

Causes

The most common causes of polyneuropathy are:

  • Diabetes mellitus – most common cause (diabetic polyneuropathy)
  • Alcohol abuse – toxic nerve damage
  • Vitamin deficiency – especially vitamin B12 and folic acid
  • Medications – e.g. chemotherapy agents
  • Autoimmune diseases – e.g. Guillain-Barré syndrome, CIDP
  • Infections – e.g. Lyme disease
  • Kidney insufficiency – uremic polyneuropathy
  • Idiopathic – in some patients the cause remains unclear

Diagnostics

  • Neurological examination – reflex testing, sensation testing, strength testing
  • Nerve conduction velocity (electroneurography/NCV) – measures the conductivity of the peripheral nerves
  • EMG (electromyography) – assesses muscle function and the degree of nerve damage
  • Laboratory tests – blood sugar, HbA1c, vitamin B12, folic acid, liver and kidney values, thyroid values, immune diagnostics
  • Nerve ultrasound – ultrasound of the peripheral nerves for specific questions
  • Lumbar puncture – when an inflammatory cause is suspected

Treatment

Causal therapy

  • Optimal blood sugar control in diabetes
  • Alcohol abstinence
  • Supplementation of vitamins (B12, folic acid)
  • Treatment of the underlying condition

Pain therapy

  • Anticonvulsants (e.g. Pregabalin, Gabapentin)
  • Antidepressants (e.g. Duloxetine, Amitriptyline)
  • Topical therapy (e.g. Capsaicin patch)
  • Opioids only in exceptional cases

Supportive measures

  • Physiotherapy and balance training
  • Occupational therapy
  • Foot care and footwear provision in diabetic polyneuropathy
  • Fall prevention

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Last updated: 2026-07-04