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Polyneuropathy is a common neurologic condition with an overall prevalence in the general population of about 1%–3%, increasing to roughly 7% among people older than 65 years. Polyneuropathy has many causes, and can present in many different ways; thus, it requires a logical clinical approach for evaluation, diagnosis and management. We review the approach to evaluating a patient with polyneuropathy by highlighting important aspects of the history and neurologic examination. We focus on the role of diagnostic investigations for distal symmetric polyneuropathy (DSP), the most common subtype, and an approach to the symptomatic treatment of painful diabetic polyneuropathy (PDN). We draw on practice based guidelines, meta-analyses and systematic reviews, where
possible, as they represent the highest levels of evidence (Box 1).
Peripheral nerve disorders are common and often treatable. The ‘default’ presentation of a polyneuropathy is a chronic, length- dependent, sensorimotor axonopathy. Recognizing deviations from this default, informed by the clinical features and investigations, can help identify the cause of a neuropathy in most cases. For inflamma- tory causes, such as GuillaineBarre syndrome and chronic inflamma- tory demyelinating polyradiculoneuropathy, there are effective immunomodulatory treatments. For other neuropathies, management consists of supportive care and treatment of the underlying cause, to prevent or limit progression.
