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At the Peripheral Neuropathy Center, our patients receive comprehensive diagnostic, therapeutic and consultative services, including the following:

  • Evaluation and treatment of patients with neuropathy
  • Clinical Consultations
  • Electromyography and Nerve Conduction Studies
  • Testing for small fiber neuropathy by punch skin biopsy
  • Autonomic function testing – QSWEAT, Heart rate variability testing, tilt table testing (by referral)
Testing for Neuropathy

Following a detailed history and neurological examination, patients undergo comprehensive electrodiagnostic testing to determine the presence of a large fiber neuropathy, its distribution, severity, and whether it is primarily demyelinating or axonal. If the EMG and nerve conduction studies are normal, then a punch skin biopsy is done to determine whether the patient has a small fiber neuropathy. Autonomic functions are assessed using QSWEAT, heart rate variability testing, and tilt table testing where indicated.

Patients undergo blood testing for causes of acquired neuropathies, and where indicated, DNA testing for hereditary neuropathies. Tests for acquired neuropathies include those for autoimmune, infectious, metabolic, nutritional, toxic, and paraneoplastic causes. If no cause can be found, and the neuropathy is progressive, then a nerve and muscle biopsy is done, which occasionally reveals the presence of an occult cause such as non-systemic vasculitis, atypical CIDP, amyloidosis, or sarcoid that may be not be detected by the less invasive tests.

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Electrodiagnostic Studies & Testing For Small Fiber Neuropathy

Electrodiagnostic (EDX) studies are essential for the proper evaluation of patients with suspected neuropathy or other neuromuscular diseases. Some types of neuropathy, such as chronic inflammatory demyelinating polyneuropathy (CIDP) can only be diagnosed by comprehensive EDX studies.

Electrodiagnostic tests include EMG and Nerve Conduction studies that evaluate the electrical properties of nerve and muscles, repetitive stimulation studies to evaluate the neuromuscular junctions, and QSWEAT and Heart Rate Variability studies that evaluate autonomic functions. In patients with small fiber neuropathy, the EDX studies are normal, but punch skin biopsy with determination of the epidermal nerve fiber can reveal the presence of small fiber neuropathy.

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Diagnosis and Treatment

A diagnosis is made based on the history, clinical examination, electrodiagnostic or skin biopsy studies, blood tests, and nerve biopsy (if applicable). Therapy is individualized for each patient, and is directed at both the underlying cause and the symptoms. In addition to treatments provided by physicians at the center, we work in close collaboration with colleagues at the Pain Center to provide pain relief, Rehabilitation Medicine and Physical therapy to improve strength, gait, and coordination, and in Cardiology, Gastrointestinal Medicine, and Urology for treatment of the autonomic symptoms.

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Diabetic Neuropathy Center

The Diabetic Neuropathy Center is a collaborative service, formed by neurologists and endocrinologists at Weill Cornell Medicine that offers comprehensive evaluation and treatment for patients with diabetes and peripheral neuropathy. Approximately one-half of the 18 million people in the US with diabetes experience peripheral neuropathy, and neuropathy can be an early manifestation, in association with pre-diabetes or the metabolic syndrome. In some patients the neuropathy it can remain undiagnosed for years.

Diabetic neuropathy can have diverse manifestations including pain, loss of sensation, weakness, gastroparesis, changes in pulse or blood pressure, and skin ulcerations, among others. It is thought to result from multiple factors including metabolic abnormalities, inflammation, vascular insufficiency, microvasculitis, and impaired immunity. Early intervention can prevent progression and disability. At the Weill Cornell Medicine Diabetic Neuropathy Center, expert neurologists and endocrinologist work together to care for patients with diabetic neuropathy and to develop new treatments.

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