Advances in diagnosis and management of distal sensory polyneuropathies

Matthew Silsby, Eva L. Feldman, Richard D. Dortch, Alison Roth, Simon Haroutounian, Yusuf A. Rajabally, Steve Vucic, Michael E. Shy, Anne Louise Oaklander, Neil G. Simon*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Distal sensory polyneuropathy (DSP) is characterised by length-dependent, sensory-predominant symptoms and signs, including potentially disabling symmetric chronic pain, tingling and poor balance. Some patients also have or develop dysautonomia or motor involvement depending on whether large myelinated or small fibres are predominantly affected. Although highly prevalent, diagnosis and management can be challenging. While classic diabetes and toxic causes are well-recognised, there are increasingly diverse associations, including with dysimmune, rheumatological and neurodegenerative conditions. Approximately half of cases are initially considered idiopathic despite thorough evaluation, but often, the causes emerge later as new symptoms develop or testing advances, for instance with genetic approaches. Improving and standardising DSP metrics, as already accomplished for motor neuropathies, would permit in-clinic longitudinal tracking of natural history and treatment responses. Standardising phenotyping could advance research and facilitate trials of potential therapies, which lag so far. This review updates on recent advances and summarises current evidence for specific treatments.

Original languageEnglish
Pages (from-to)1025-1039
Number of pages15
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number12
Early online date30 Mar 2023
Publication statusPublished - 1 Dec 2023

Bibliographical note

Copyright © 2023, Author(s) (or their employer(s)). Published by BMJ. This article has been accepted for publication in the Journal of Neurology, Neurosurgery & Psychiatry, 2023, following peer review, and the Version of Record can be accessed online at: Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0)


  • Neurogenetics
  • Neuroimmunology
  • Neuromuscular
  • Neuropathy
  • Peripheral Neuropathology


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