GuidelinesPrimary Care STG
Peripheral Neuropathy
Central Nervous System Conditions
E10.4/E11.4/G60.9/G62.0-1/G62.9
DESCRIPTION
- Initially sensory symptoms consisting of tingling, prickling, burning in the balls of the feet or tips of the toes or in a general distribution over the soles. The symptoms are symmetrical and with progression spread proximally.
- Later sensory loss over both feet and weakness of dorsiflexion of the toes may be present. Patients may experience difficulty in walking on their heels and foot drop becomes apparent.
- Common causes include HIV, diabetes mellitus, isoniazid, antiretrovirals, vitamin B12 deficiency and alcohol.
GENERAL MEASURES
- HIV testing
- Screen for diabetes mellitus, syphilis and vitamin B12 deficiency
- Avoid alcohol
- A balanced diet to prevent nutritional deficiency
MEDICINE TREATMENT
- Stop the offending medicine or give suitable substitute
- Patients on isoniazid (TB treatment or prophylaxis): increase pyridoxine to 25–50 mg 8 hourly for 3 weeks, followed by 25–50 mg daily
- Amitriptyline, oral, 25 mg at night (Doctor prescribed)
- Titrate at two weekly intervals to a maximum of 75 mg at night
REFERRAL
- All children.
- All patients to rehabilitation to improve postural control and gait as well as education for prevention of complications.
- Difficulty in walking or foot drop.
- Any limb weakness present.
- Unsteady/ataxic gait.
- Severe sensory loss.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.0_26 May 2025
Chapter 15: Central Nervous System Conditions_15.10 Neuropathy_15.10.3 Peripheral Neuropathy