The VA presumes that veterans' early-onset peripheral neuropathy is related to their exposure to Agent Orange or other herbicides during service. The VA presumes that early-onset peripheral neuropathy in veterans is related to exposure to Agent Orange or other herbicides during military service, when the disease appears within one year after exposure to a degree of at least 10% disabling according to VA classification standards. From headaches to muscle cramps to insect bites, we're no strangers to the various causes of sudden, albeit temporary, pain. But what happens when pain is an ongoing feeling that doesn't go away or comes and goes without warning? Could it be a nervous system problem?Peripheral neuropathy, a common neurological problem encountered by family physicians, can be clinically classified according to the anatomical pattern of presentation of symptoms and, if indicated, based on the results of electrodiagnostic studies for axonal and demyelinating disease.
The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among people over 50 years of age. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol consumption, exposure to toxins, inherited diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25 to 46% of cases. The diagnosis requires a complete medical history, a physical exam, and judicious laboratory tests.
Early peripheral neuropathy may present as sensory disorders that are usually progressive, such as sensory loss, numbness, pain, or burning sensation in the extremities shaped like a stocking and glove. More advanced stages may include proximal numbness, distal weakness, or atrophy. The physical exam should include a comprehensive neurological and musculoskeletal evaluation. If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation of possible underlying etiologies should initially focus on treatable causes.
The initial laboratory evaluation includes a complete blood count; a complete metabolic profile; the levels of fasting blood glucose, vitamin B12 and thyroid-stimulating hormone; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, referral to a neurologist for additional testing (e.g., treatment of peripheral neuropathy focuses on controlling the underlying etiology).Several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain. Early peripheral neuropathy may present as sensory disturbances that are usually progressive, such as sensory loss, numbness, pain, or burning sensation in the distribution of limbs “with socks and gloves.” 3 Later stages may include proximal numbness, distal weakness, or atrophy, 3 one-third of patients with peripheral neuropathy have neuropathic pain, 1 Other common symptoms that occur include a stinging sensation or electric shock, allodynia, hyperalgesia, and hyperesthesia, 1,4,13,14 The patients may also have autonomic symptoms, such as orthostatic intolerance, gastroparesis, changes in bowel and bladder function, erectile dysfunction and blurred vision, or vasomotor symptoms such as dry eyes, mouth or skin and burning or redness, 1.There are many signs and symptoms of neuropathy, which affects peripheral nerves and their function. In the early stages of neuropathy, some people have few or no symptoms or mild symptoms, while in the later stages, symptoms are more debilitating and can lead to nerve damage and, in some cases, loss of mobility.
Peripheral nerves are the furthest from the central nervous system and often show the earliest and most serious effects of these conditions. Early diagnosis and treatment provide the best chance of managing symptoms and preventing further damage to peripheral nerves. Peripheral neuropathy affects 25 to 50% of patients with diabetes, depending on factors such as the patient's age, the number of years with diabetes and the level of diabetes control. Rarely, procedural studies, such as autonomic tests and nerve biopsies, may be necessary to aid in the diagnosis and treatment of peripheral neuropathy.
Peripheral nerves comprise sensory, motor and autonomic fibers, which have different lengths, diameters, conduction characteristics and specialized functions. For the evaluation of peripheral neuropathy, the nerve conduction of sensory and motor nerves, delayed responses (F response and H reflex) and needle electromyography (EMG) are studied. The effects of peripheral neuropathy depend on the cause, the nerves it affects, your medical history, the treatments you receive, etc. The possible side effects and complications of treatments for peripheral neuropathy depend on many factors.
Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM); Lewis Summer syndrome) should be considered in an appropriate clinical setting. Diabetic peripheral neuropathy and other terms that focused on a specific diagnosis or system were excluded. Initial tests in patients with suspected peripheral neuropathy should include a complete blood count, a complete metabolic profile, and fasting blood glucose, thyroid-stimulating hormone and vitamin B12 levels. Peripheral neuropathy is a sign of a problem in the nerve signals that travel between parts of the body and the brain.
The difference between radiculopathy and neuropathy is that radiculopathy is caused by a pinched nerve in the spinal cord, while neuropathy is caused by nerve damage in the peripheral nervous system. Based on this evidence, VA presumed that there was an association between exposure to herbicides during service and acute and subacute peripheral neuropathy.
