JAMA Clinical Reviews Diagnosis and Treatment of Peripheral Neuropathy
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Nov 17, 2025 Dr. Michelle Mauermann, a professor of neurology and chair at the Mayo Clinic, shares insights on peripheral neuropathy, a condition affecting 1% of adults globally. She discusses its common causes like diabetes and B12 deficiency, the mechanisms behind its debilitating symptoms, and the importance of early diagnosis through EMG testing. Treatment strategies range from conservative measures to tailored medications like gabapentinoids. Mauermann also highlights the role of physical therapy in managing symptoms and preventing falls.
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What Peripheral Neuropathy Is
- Peripheral neuropathy is any damage to peripheral nerves causing sensory, motor, or autonomic symptoms.
- Pathology may involve neuron death, axonal degeneration, altered excitability, or Schwann cell injury.
Common Causes To Prioritize
- Diabetes is the most common global cause of peripheral neuropathy, followed by B12 deficiency, toxic medications, alcohol, inherited causes, and monoclonal gammopathies.
- Clinicians should include monoclonal gammopathy testing in the differential workup.
Length-Dependent Pattern Explains Symptoms
- Length-dependent neuropathy affects the longest axons first, so symptoms begin in the toes and feet and progress proximally.
- Sensory symptoms dominate early, with mild distal weakness appearing later.