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Peripheral neuropathies are a major cause of pain and disability worldwide. These conditions can be hereditary, complications of therapy (particularly chemotherapy) or complications of primary conditions, such as diabetes mellitus, traumatic injury, autoimmune disease or infection. The association of Zika virus infection with Guillain–Barré syndrome in the ongoing epidemic in Latin America highlights the importance of understanding how these diseases develop and how they should be managed. Beginning in the December 2016 issue, Nature Reviews Neurology will be publishing a series of articles looking at recent advances in our understanding of disease mechanisms, and in the diagnosis and management of a variety of peripheral neuropathies.
Although the most common neuropathy associated with diabetes mellitus is distal symmetric polyneuropathy, inflammatory neuropathies such as chronic inflammatory demyelinating polyneuropathy (CIDP) can also occur, and might be amenable to treatment. In this Review, Rajabally et al. consider the features of CIDP in diabetes, how this condition can be differentiated from other neuropathies, and management options for CIDP and other inflammatory neuropathies in diabetes.
The discovery that IgG4 autoantibodies against node of Ranvier proteins are linked to distinct subsets of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents a key advance in our understanding of the chronic inflammatory neuropathies (CINs). Here, Querol and colleagues discuss the clinical implications of these autoantibodies in patients with CIDP and other immune-mediated neuropathies.
Despite intensive investigation, the genetic basis of chemotherapy-induced peripheral neurotoxicity (CIPN) remains elusive. In this critical update, Argyriou and colleagues highlight strategies for overcoming the methodological flaws of pharmacogenetic studies and the inadequacy of current tools for assessing CIPN. As yet, however, genetic profiling cannot identify patients at risk of CIPN or guide their management.
Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves. In this Review, Collins and Hadden provide an update on the classification, diagnosis and treatment of NSVN, and propose definitions and an up-to-date differential diagnosis of multifocal neuropathy.
Gasparotti et al. provide an overview of new and emerging technologies for assessing a variety of peripheral neuropathies, including magnetic resonance neurography, diffusion tensor imaging and ultrasonography for large-fibre neuropathies, and corneal confocal microscopy, evoked potentials and microneurography for small-fibre neuropathies.
Research into the mechanisms of diabetic neuropathy have focused on neurons, but evidence is accumulating that Schwann cells have a central role. In this Review, the authors consider how Schwann cell dysfunction and the interactions of these cells with neurons and microvessels contribute to the pathogenesis of neuropathy in diabetes.
2016 has marked 100 years since the landmark description of what we now know as Guillain–Barré syndrome (GBS). Goodfellow and Willison chart the great progress we have made in understanding the pathogenesis of GBS, and developing established and emerging therapies.