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Dr. Dr. Jitendra Prasad Yadav • Consultant Neurologist & Neuropathy Specialist • NMC 8029
Numbness, tingling, burning pain in your feet or hands? You may have peripheral neuropathy — nerve damage commonly caused by diabetes, vitamin deficiencies, or other systemic conditions. Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides neuropathy diagnosis, nerve conduction studies (NCS), and neuropathic pain management at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu.
Nepal Medical Council Reg. No. 8029 • 15+ years National Trauma Center, NAMS • Part of Clinics Tree Healthcare Network
What is Peripheral Neuropathy?
Peripheral neuropathy affects nerves outside the brain and spinal cord, causing sensory loss, neuropathic pain, and weakness, typically in a glove-and-stocking distribution.
Peripheral nerves carry signals between the brain/spinal cord and the rest of the body. They include sensory nerves (touch, pain, temperature, vibration, position sense), motor nerves (muscle control), and autonomic nerves (blood pressure, heart rate, digestion, bladder, sweating). Neuropathy occurs when these nerves are damaged, leading to abnormal sensation, pain, weakness, or autonomic dysfunction.
Patterns:
Clinical examination: Sensory testing (pinprick, light touch, vibration with tuning fork, proprioception), motor strength, reflexes (often reduced or absent), gait assessment, autonomic function (blood pressure lying and standing).
Nerve conduction studies (NCS) and EMG: NCS measures electrical conduction speed (velocity) and amplitude along motor and sensory nerves. Slowing suggests demyelination; reduced amplitude suggests axonal loss. EMG detects denervation in muscles and distinguishes neuropathy from myopathy or radiculopathy. See /nerve-conduction-studies-kathmandu for detailed explanation.
Blood tests: HbA1c (diabetes), fasting glucose, vitamin B12, methylmalonic acid (if B12 borderline), TSH, creatinine, liver function, complete blood count, ANA (lupus, Sjögren), ANCA (vasculitis), serum protein electrophoresis (paraprotein/myeloma). Additional tests based on clinical suspicion: Lyme serology (if exposure history), HIV, hepatitis B/C, heavy metals.
Skin biopsy: Quantifies intraepidermal nerve fiber density. Used when small-fiber neuropathy is suspected but NCS is normal (NCS only detects large-fiber dysfunction). Limited availability in Nepal; referral to specialized centers required.
Lumbar puncture: For suspected CIDP or Guillain-Barré syndrome — elevated CSF protein with normal cell count (albuminocytologic dissociation).
Genetic testing: For suspected hereditary neuropathy (CMT) when family history and phenotype suggest it. Limited availability and cost in Nepal; often sent to international reference labs.
Diabetes is the #1 cause of neuropathy worldwide and in Nepal. Three main types:
Diabetic foot care in Nepal: Lack of protective sensation → unnoticed foot injuries → ulcers → infection → amputation. Prevention requires patient education: daily foot inspection (use mirror for soles), avoid walking barefoot, proper footwear (closed-toe, cushioned), early treatment of minor injuries, regular podiatry/wound care access.
Neuropathic pain — burning, electric-shock, stabbing, or allodynia — does not respond well to simple analgesics (paracetamol, NSAIDs). First-line treatments:
Opioids are NOT first-line for neuropathic pain — limited efficacy, dependence risk, side effects (constipation, sedation). Reserved for severe refractory cases under specialist guidance.
Non-pharmacological: physiotherapy, gait training, orthotics, TENS (transcutaneous electrical nerve stimulation), temperature regulation (avoid extreme heat/cold).
Reversible causes: Vitamin B12 deficiency, hypothyroidism, alcohol cessation — treatment halts progression and allows partial recovery over months. Regeneration is slow (nerves regrow ~1mm/day); full recovery may not occur if axonal loss is severe.
Diabetes: Strict glucose control (HbA1c <7%) slows progression but existing neuropathy usually does not reverse. Symptom management and foot care prevent complications.
Chemotherapy-induced: May improve partially after cessation, but often persists.
Chronic axonal neuropathy: Generally irreversible; focus on symptom control, mobility aids, preventing complications (falls, ulcers).
Inflammatory neuropathies (CIDP, vasculitis): Treatable with immunotherapy — may stabilize or improve with IVIG, steroids, immunosuppressants.
Seek emergency care for: rapidly progressive weakness over days (Guillain-Barré syndrome), difficulty breathing or swallowing (respiratory/bulbar muscle weakness), severe pain with fever and skin changes (necrotizing infection), sudden severe asymmetric weakness with pain (vasculitis, ischemia). These represent neurological emergencies requiring hospital admission.
Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides:
Book Neuropathy Evaluation
Kathmandu Neurology Clinic & Cognitive Center
Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600, Nepal
Phone: 974-7736624 • +977 9747978200
Sun-Sat 9AM-7PM • By Appointment • Near Narayanhiti Palace Museum • 27.7172, 85.3240
Book Neuropathy Evaluation NowRelated Neuropathy & Nerve Pages
Emergency Red Flags
Seek emergency care for rapidly progressive weakness over days, difficulty breathing/swallowing, or severe pain with fever — these may represent Guillain-Barré syndrome, vasculitis, or infection requiring hospital admission.
Page Information
Peripheral neuropathy is damage to peripheral nerves (outside brain and spinal cord) causing numbness, tingling, burning pain, or weakness, typically starting in feet and progressing proximally (glove-and-stocking pattern). Causes include diabetes (most common), alcohol, vitamin deficiencies (B12, B1), toxins, infections, autoimmune diseases, hereditary conditions, and chemotherapy. Small-fiber neuropathy affects pain/temperature sensation and autonomic function; large-fiber neuropathy affects vibration, proprioception, and motor function.
Diagnosis combines clinical examination (sensory testing, reflexes, strength) with electrodiagnostic studies. Nerve conduction studies (NCS) measure electrical conduction speed and amplitude along motor and sensory nerves; slowing or reduced amplitude indicates large-fiber neuropathy. Electromyography (EMG) detects denervation in muscles. Blood tests identify causes: HbA1c (diabetes), vitamin B12, TSH (thyroid), ANA (autoimmune), SPEP (paraprotein), creatinine (kidney), liver function. Skin biopsy quantifies small nerve fiber density when NCS is normal but symptoms suggest small-fiber neuropathy.
Diabetes is the leading cause in Nepal, correlating with rising type 2 diabetes prevalence. Vitamin B12 deficiency is common, especially in vegetarians without adequate supplementation. Alcohol-related neuropathy occurs with chronic heavy use. Leprosy (Hansen disease), though declining, still causes peripheral nerve damage in Nepal. Medication-induced neuropathy (isoniazid for TB, chemotherapy) is seen. Hereditary neuropathies (Charcot-Marie-Tooth disease) are under-diagnosed due to limited genetic testing. Nutritional deficiencies (thiamine/B1) may occur in specific populations.
Depends on cause and severity. Correctable causes (vitamin B12 deficiency, hypothyroidism, alcohol cessation) can halt progression and allow partial nerve regeneration, though recovery is slow (months to years) and may be incomplete. Diabetic neuropathy progression slows with strict glucose control (HbA1c <7%), but existing damage is usually permanent. Chemotherapy-induced neuropathy may improve partially after treatment ends. Chronic severe neuropathy with axonal loss typically does not reverse; treatment focuses on symptom control and preventing further damage.
Sensory symptoms: numbness, tingling, burning pain (often worse at night), electric-shock sensations, hypersensitivity to touch (allodynia), loss of vibration/position sense, cold feet. Motor symptoms: weakness (foot drop, hand weakness), muscle cramps, atrophy. Autonomic symptoms: dizziness on standing (orthostatic hypotension), constipation, diarrhea, urinary retention, erectile dysfunction, reduced sweating. Pattern: usually starts in toes, progresses up legs symmetrically (glove-and-stocking); asymmetric onset suggests mononeuropathy multiplex (vasculitis, diabetes).
Diabetic neuropathy is nerve damage from chronic hyperglycemia. Distal symmetric polyneuropathy (most common) causes glove-and-stocking sensory loss, burning feet, neuropathic pain. Autonomic neuropathy affects heart rate variability, blood pressure regulation, GI motility, bladder function. Diabetic mononeuropathies affect single nerves (cranial nerve III palsy, femoral neuropathy). Prevention and management: strict glucose control (HbA1c <7%), foot care (daily inspection, proper footwear to prevent ulcers), neuropathic pain medications (gabapentin, pregabalin, duloxetine, amitriptyline), physical therapy.
First-line: gabapentin (start 300mg at night, titrate to 900-3600mg/day divided TID), pregabalin (75-600mg/day divided BID), or duloxetine (60mg daily). Second-line: tricyclic antidepressants (amitriptyline 10-75mg at night, avoid if cardiac disease). Topical: capsaicin cream, lidocaine patches for localized pain. Opioids are avoided due to dependence risk and limited efficacy for neuropathic pain. Combination therapy (e.g., gabapentin + duloxetine) for refractory pain. Non-drug: physiotherapy, TENS, proper footwear, temperature regulation.
Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600 — led by Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS). Services: neuropathy clinical evaluation, nerve conduction studies coordination, cause identification (diabetes, vitamin deficiencies, autoimmune), neuropathic pain management, diabetic neuropathy care, foot care guidance, referral for specialized testing. Book via /book-appointment or call 974-7736624, Sun-Sat 9AM-7PM by appointment. Bring prior blood tests (HbA1c, B12, thyroid) and medication list.
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