The small unmyelinated nerve fibres carry temperature and pain sensation signals and help control autonomic function, and when damaged can cause sensations and sharp/dull pain sensations or autonomic symptoms (abnormal sweating, dry eyes and mouth, lightheadedness, diarrhea etc.). As opposed to large fibre neuropathy, routine nerve conduction studies are normal in this condition. This is an under diagnosed condition in the community. Autonomic studies and small fibre testing (Quantitative sensory testing, Quantitative sudomotor axon reflex testing), and sometimes skin biopsy tests can be helpful in the diagnosis. It is essential to exclude some predisposing causes of this neuropathy, which can be reversed or treated. With successful treatment, the functional outcome can significantly improve on selected patients.

This is a condition affecting the junction between the nerve and muscle (Neuro Muscular Junction). The patients would present with symptoms of muscle weakness, double vision, speech or swallowing difficulties, drooping of eyelids etc. The symptoms can fluctuate. Specialised nerve studies (Repetitive nerve stimulation) and single fibre EMG studies are very useful in the diagnosis together with blood tests (Antibody tests). Various treatment options are available depending on the severity of the symptoms. Dr. Seneviratne under took most of his research studies while at the Mayo Clinic, USA, in the field of Myasthenia Gravis, which has been published in leading International Neurology journals. He continues to have a special interest in the management of patients with Myasthenia.

Motor neurone disease (MND) is also called amyotrophic lateral sclerosis (ALS), Anterior Horn Cell Disease and Lou Gehrig’s disease. MND is a rapidly progressive, neurological disease, which causes degeneration of Motor neurones (nerve cells that control the voluntary muscles of the trunk and limbs), and affect speech, swallowing and breathing. Damage to these nerves causes muscle weakness, fasciculations (twitching) and wasting. The clinical examination together with blood tests and complex EMG studies are essential to diagnose this disease, and also to differentiate from other medical problems that can be confused with MND. Patients with MND usually carry a poor prognosis, therefore, accurate diagnosis is essential to differentiate from other treatable conditions that can present with similar symptoms.

This is a group of disorders that cause muscle weakness, muscle pain and sometimes cramping/stiffness. Some of the myopathies have an autoimmune basis that can be treated with immunosuppresive medications. Other causes include myopathies induced by medications (Such as Cholesterol lowering medications etc.), hereditary causes, metabolic, infectious and endocrine disorders. The complex EMG studies form a vital part in the diagnosis. Usually a muscle biopsy is also recommended as part of the evaluation process, which is helpful in identifying the exact nature of the myopathy, and to determine treatment options and assess the prognosis of the condition.

This is a condition due to injury to the nerve trunks in the brachial plexus or lumbar plexus. The common causes include auto immune, diabetes, traumatic, infective, idiopathic and neoplastic aetiologies. Depending on the site of the lesion, patients present with weakness, numbness, pain and autonomic symptoms of arms or legs. Complex nerve studies and EMG studies are essential in the accurate diagnosis and in differentiating nerve root and peripheral nerve injuries from plexopathies.

This is due to injury to the median nerve at the wrist which supplies the outer aspect of the palm and first 3 ½ digits. The injury is usually around the wrist region and the nerve conduction studies would be quite useful in the diagnosis. These studies would indicate the severity of the injury and prognosis, which would dictate treatment options. Nerve studies are essential in the diagnosis, since the symptoms alone are not good indicators of the site and nature of the injury or the severity of the disease. The tests are also useful in assessing the progress/success following surgery sometimes. EMG studies are helpful in differentiating a more proximal median nerve lesion (proximal to the wrist) or a plexopathy.

With neuropathic pain, the nerve fibers may be damaged or dysfunctional. These damaged nerve fibers send incorrect signals to pain centers. This may cause symptoms at the site of injury and areas around the injury. The symptoms may vary from burning/cold sensations, numbness, tingling, sharp pain or dull aches. There are different causes of neuropathic pain, and neurological examination and nerve study tests would be helpful to diagnose the cause of the neuropathic pain or sometimes to exclude a neurological cause for the symptoms. Most neuropathic pain symptoms respond well to neuropathic medications and other treatment measures available.

The ulnar nerve supplies the inner border of the hand and 4th, 5th digits of the hand. This nerve can be damaged around the axilla, elbow, forearm or wrist. The nerve conduction studies/EMG studies are useful in localising the injury and assessing the severity and prognosis, as well as excluding other possibilities for symptoms such as plexus injuries. Depending on the outcome of the results, specific hand therapy measures or surgical options would be recommended.

This is a specific type of neuropathy that is diagnosed on the combined results of clinical presentation, investigations including electrophysiological studies and sometimes following a nerve biopsy. Patients with CIDP present with weakness, numbness, problems with gait and balance and sometimes autonomic symptoms. Depending on the results, specific medications are available which can be quite successful in treatment.

There are different causes for these symptoms which include nerve root damage/irritation due to prolapsed discs or other lesions, soft tissue injuries in the relevant areas, referred pain from shoulder/hip regions, plexopathies or non-neurological conditions. The nerve studies and EMG studies together with imaging studies of the relevant areas are quite useful in diagnosing different conditions. Depending on the outcome of the results, further referral to another specialist may be warranted.