Confirm that the symptoms are caused by a polyneuropathy
Numbness, burning pain, imbalance and weakness can also come from spinal disease, focal nerve entrapment, muscle disease or central neurological disorders. Heidelberg's polyneuropathy pathway starts with clinical pattern recognition and electrophysiological confirmation before extending the work-up.
- Distribution and time course of numbness, pain and weakness
- Neurological examination including reflexes, strength, sensation and gait
- Motor and sensory nerve-conduction studies
- EMG when weakness or axonal loss needs clarification
- Review for autonomic symptoms such as orthostatic intolerance, sweating or gastrointestinal dysfunction
- Assessment for focal or asymmetric features that suggest a different pathway
Axonal versus demyelinating classification changes the differential diagnosis
Heidelberg's electrophysiology SOP explicitly uses nerve-conduction testing to confirm polyneuropathy and classify it as axonal or demyelinating. This distinction helps determine whether the next question is metabolic/toxic/hereditary disease, an immune-mediated neuropathy such as CIDP or another specific disorder.
Look systematically for common and treatable causes
A high-quality neuropathy work-up is targeted rather than a random panel of tests. Heidelberg lists glucose metabolism, serum and urine immunofixation, renal and liver parameters, thyroid testing and selected autoimmune tests in its basic program. The exact laboratory panel should still be individualized to the clinical pattern and history.
- Diabetes and impaired glucose metabolism
- Vitamin and nutritional deficiencies when clinically relevant
- Alcohol and medication or toxin exposure
- Kidney, liver and thyroid disease
- Monoclonal gammopathy and paraproteinemic neuropathy
- Autoimmune or vasculitic disease when the pattern suggests it
Hereditary neuropathy needs a separate genetic pathway
Charité has a dedicated CMT/HMSN clinic for inherited sensorimotor neuropathies. Family history, foot deformity, long-standing distal weakness and the electrophysiological pattern can trigger genetic counseling and targeted genetic testing. A hereditary neuropathy should not be treated as CIDP simply because nerve-conduction studies are abnormal.
Amyloid neuropathy should be considered when systemic clues fit
Charité's amyloidosis program explicitly includes hereditary transthyretin amyloid polyneuropathy and acquired amyloid neuropathies. Autonomic dysfunction, cardiomyopathy, bilateral carpal-tunnel history, unexplained weight loss or a family history can change the diagnostic pathway and may require interdisciplinary neurology, cardiology, hematology and genetics review.
Immune-mediated neuropathies belong in a specialist neuroimmunology pathway
Freiburg and Charité operate dedicated services for inflammatory peripheral nervous-system disease. IVIG, corticosteroids, plasma exchange or other immunotherapies are not generic treatments for every polyneuropathy; they are considered when an immune-mediated diagnosis such as CIDP, MMN or vasculitic neuropathy is supported. Patients with suspected CIDP can use the site's dedicated CIDP guide for the more specific treatment pathway.
Chemotherapy-induced neuropathy may need neuro-oncology coordination
Charité and Heidelberg both describe specialist pathways for neurological complications of cancer therapy, including chemotherapy-related neuropathy and neuropathic pain. The goal is usually to clarify the cause and severity, optimize symptom control and coordinate with oncology rather than assume that the nerve injury can be reversed by one procedure.
Pain treatment and rehabilitation are part of the plan
Even when the underlying cause cannot be reversed, treatment can target neuropathic pain, balance, strength, falls, foot protection and daily function. Freiburg specifically includes polyneuropathy in neurological physiotherapy and documents peripheral-nerve and neurophysiology expertise.
- Neuropathic-pain medication when appropriate
- Physiotherapy for gait, balance and strength
- Occupational therapy and assistive-device assessment
- Foot care and injury prevention when sensation is reduced
- Fall-risk assessment
- Local follow-up plan after the German specialist review
What to send for a German polyneuropathy second opinion
A useful second opinion starts with records that show the clinical pattern and what has already been excluded.
- Neurology reports and symptom timeline
- All nerve-conduction and EMG reports
- Relevant laboratory results including glucose/HbA1c and immunofixation if performed
- Medication, chemotherapy, alcohol and occupational toxin history
- Family history and previous genetic results
- MRI or nerve-ultrasound reports and images if performed
- Current pain medication and rehabilitation plan
- A specific question: confirm the cause, assess hereditary/amyloid/immune neuropathy, review treatment or plan further diagnostics
Official sources
Sources last checked 2026-09-01. Clinical pathways, eligibility and hospital procedures can change; confirm current requirements directly with the treating center.
- Polyneuropathies – disease overview — Heidelberg University Hospital ↗
- Electrophysiology SOP – diagnostic work-up of polyneuropathies — Heidelberg University Hospital ↗
- Inflammatory diseases of the peripheral nervous system — University Medical Center Freiburg ↗
- Neurological outpatient clinics including CMT and immune-mediated neuropathies — Charité – Universitätsmedizin Berlin ↗
- Amyloidosis and amyloid polyneuropathies — Charité – Universitätsmedizin Berlin ↗