Peripheral neuropathy (周围神经病) refers to a group of diseases caused by structural and functional disorders of peripheral motor, sensory, and autonomic nerves, mainly manifested as numbness in the limbs, weakened tendon reflexes, decreased muscle tone, ataxia, and vision decline. Depending on the course of the disease, it can be classified into acute, subacute, chronic, recurrent, and progressive neuropathies. The etiology of peripheral neuropathy is diverse and complex, leading to various clinical manifestations. Therefore, the main basis for diagnosis is the description of medical history, clinical physical examination, and necessary auxiliary examinations. Among them, the incidence of chronic peripheral neuropathy (慢性周围神经病) is increasing, and its early diagnosis is difficult, with a long course and poor prognosis, which severely affects patients’ physical and mental health and quality of life. Therefore, it is crucial to clarify the diagnosis and type of chronic peripheral neuropathy early, conduct necessary auxiliary examinations to determine the cause, and provide theoretical basis for subsequent diagnosis and treatment. This article summarizes the recent advances in the examination and diagnosis of chronic peripheral neuropathy based on domestic and international research reports.
1
Distal Symmetric Polyneuropathy
Distal symmetric polyneuropathy (远端对称性多发性神经病变, DSP) is one of the most common types of chronic peripheral neuropathy. When typical clinical manifestations appear: chronic, distal, slowly progressive, symmetric, primarily with sensory disturbances, it may not require neurophysiological examination for diagnosis, but clinical symptoms are often atypical. The causes of DSP are complex, such as metabolic disorders (diabetes), nutritional deficiencies (vitamin deficiency), autoimmune diseases (systemic lupus erythematosus and rheumatoid arthritis), etc. Detailed medical history inquiry and physical examination are the primary steps to narrow down the differential diagnosis.
1.1 Diabetes or Impaired Glucose ToleranceDSP is the most common type of diabetic peripheral neuropathy (糖尿病周围神经病变, DPN), accounting for about 75% of peripheral neuropathies. Currently, the incidence of diabetic peripheral neuropathy is increasing year by year, its typical manifestations are bilateral symmetrical numbness, pain, and sensory abnormalities in the limbs, but clinical symptoms and/or signs are often atypical or mild, making it difficult to attract attention. Clinically, besides five screening tests (pressure sensation, vibration sensation, ankle reflex, pain sensation, and temperature sensation), the Michigan Neuropathy Screening Instrument (密歇根筛查量表, MNSI) and the Toronto Clinical Scoring System (多伦多临床评分, TCSS) can be used for initial screening of DPN. More often, other auxiliary examinations are used to improve clinical diagnostic rates. Neurophysiological examinations are currently reliable methods for assessing DPN, including nerve conduction velocity (神经传导速度, NCV), somatosensory evoked potential (体感诱发电位, SEP), sympathetic skin response (皮肤交感反应, SSR), etc. Among them, NCV, although regarded as the