Hereditary Neuropathies

The hereditary neuropathies are often missed by family physicians and even by those close to the affected patient. These indolent, slowly progressive polyneuropathies may present with motor, autonomic, and less often, sensory symptoms.

Box 42-22 Neuropathies Caused by Drugs and Toxins

Drugs

Toxins

Axonal

Demyelinating

Industrial

Amitriptyline

Amiodarone

Organophosphates

Chloroquine

Colchicine

Lead, arsenic, mercury

Cimetidine

Gold

Thallium, methyl bromide

Colchicine

Dapsone

Didanosine

Disulfiram

Ethambutol

Hydralazine

Interferon alfa

Neuronopathy

Cisplatin

Pyridoxine

Thalidomide

Plastics, synthetic fabrics Carbon monoxide Ethylene oxide

Euphoriants

Glue Solvents

Isoniazid

Lithium

Metronidazole

Nitrous oxide

Nitrofurantoin

Paclitaxel

Phenytoin

Pyridoxine

Procainamide

Vincristine

These include pes cavus, absent tendon reflexes, a high-stepping or slapping gait, footdrop, slowly progressive wasting and weakness of peroneal muscles, foot ulcers, joint arthropathy, and absence of sweating. Without a specific treatment for these neuropathies, efforts are focused on management of physical disabilities, education, genetic counseling, and reassurance. Hereditary neuropathies and CIDP can both have a familial pattern, the important difference being that CIDP is treatable.

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