January 8, 2026

@michaelokun

Neuropathy in parkinsonism: 2025 update. Neuropathy refers to damage to peripheral nerves that can affect sensation, pain, strength and autonomic functions such as blood pressure and digestion. Cristina Moreno Lopez and colleagues describe in a new paper in Movement Disorders Clinical Practice how peripheral neuropathy is far more common in parkinsonism than many of us recognize, and why it may matter. Key Points: - Peripheral neuropathy frequently coexists w/ parkinsonism and is commonly overlooked or misattributed to non motor symptoms. - Multiple mechanisms can be involved including levodopa related metabolic changes, small fiber neuropathy and genetic contributions. - A practical diagnostic framework can help health care providers identify causes that are treatable or actionable My take: This review is an important reminder that parkinsonism is not just a brain condition. Peripheral nerves are frequently involved, and we miss opportunities to improve gait, balance, comfort and quality of life. If you are on dopamine replacement, you need to be on a multi-vitamin and have homocysteine levels checked. Five points that resonated w/ me: 1- Neuropathy can precede motor symptoms and may be an early clue. 2- Small fiber neuropathy is common and can drive pain, autonomic symptoms and fatigue. 3- Long term levodopa exposure can contribute to neuropathy through vitamin and metabolic pathways however it is not the only cause. 4- Genetic forms of parkinsonism and inherited neuropathies frequently overlap and should be considered, especially in younger onset cases. 5- Systematic screening for neuropathy can change management and help to avoid unnecessary disability. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.70503 #michaelokun #fixelinstitute #parkinson