• Michael Benatar


Peripheral neuropathies may be characterized as being focal, multifocal (asymmetric), or diffuse (symmetric). Polyneuropathy is the term used to describe a diffuse (symmetric) disorder of peripheral nerves. Polyneuropathy is typically considered a length-dependent or dying-back neuropathy in which symptoms begin in the feet and evolve symmetrically to affect more proximal aspects of the legs and eventually the hands as well. Most polyneuropathies affect sensory fibers earlier and more prominently than motor fibers, but this is certainly not uniformly so. Polyneuropathy is a disorder that is easily recognized by a neurologist when symptoms are accompanied by typical physical findings on examination (reduced or absent distal deep tendon reflexes, distal “stocking” pattern sensory loss, and/or distal muscle weakness and atrophy). Nerve conduction studies play an important role in defining the presence of a polyneuropathy and in terms of delineating the underlying pathophysiological process (i.e., primary axonal loss vs primary demyelination). Because nerve conduction studies only measure the activity of large fiber nerves, skin biopsy to determine the density of epidermal nerve fibers has been suggested as a useful test for the diagnosis of polyneuropathies that predominantly (or exclusively) affect small fiber nerve populations. Clinical examination and nerve conduction studies, however, will seldom facilitate an etiological diagnosis. Laboratory studies and nerve biopsy are the tests most commonly employed used to determine the cause of the polyneuropathy.


Diabetic Neuropathy Nerve Conduction Study Neuromuscular Disease Nerve Biopsy Quantitative Sensory Testing 
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© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Michael Benatar
    • 1
  1. 1.Department of NeurologyEmory University School of MedicineAtlanta

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