Neuromuscular Medicine & Peripheral Neuropathy

Neuromuscular diseases and peripheral neuropathies can arise from dysfunction anywhere along the peripheral nervous system, including peripheral nerves, nerve roots, plexuses, neuromuscular junctions, and skeletal muscle. Dr. Funk diagnoses a broad range of neuromuscular and peripheral nerve conditions, including peripheral neuropathy, polyneuropathy, small fiber neuropathy, mononeuropathies and nerve entrapment syndromes, radiculopathy, plexopathy, cranial neuropathies, autonomic neuropathy, inflammatory and autoimmune neuropathies, infectious and post-infectious neuropathies, metabolic and nutritional neuropathies, toxic and medication-associated neuropathies, hereditary neuropathies, neuromuscular junction disorders, myopathies, and other conditions producing numbness, tingling, burning pain, weakness, altered sensation, muscle dysfunction, or impaired motor control.

Dr. Funk goes beyond identifying that a patient has “neuropathy.” He performs a comprehensive neurological examination to characterize the pattern and distribution of sensory, motor, reflex, autonomic, and neuromuscular abnormalities and localize the dysfunction to the specific peripheral nerves, nerve roots, plexuses, neuromuscular junctions, muscles, or interacting central and peripheral neurological pathways involved. This localization helps distinguish among neurological diseases that can produce similar symptoms while identifying whether multiple neurological processes may be occurring simultaneously.

Determining why the neuropathy or neuromuscular disease developed is a major component of the diagnostic process. When clinically indicated, Dr. Funk performs extensive laboratory diagnostic testing to investigate metabolic, endocrine, nutritional, autoimmune and neuroimmune, inflammatory, infectious and post-infectious, hematological and paraproteinemic, toxic, genetic, and other potential causes of peripheral nerve and neuromuscular disease. He integrates laboratory findings with the neurological examination, medical history, medications, neuroimaging, electrodiagnostic findings, and other objective diagnostic data to establish and refine the neurological diagnosis.

When electrodiagnostic testing is indicated, Dr. Funk orders electromyography (EMG) and nerve conduction studies (NCS) and integrates the findings into the neurological diagnosis and localization. EMG and nerve conduction testing can provide important objective information regarding peripheral nerve, nerve root, neuromuscular, and muscle dysfunction and help further characterize the distribution, severity, and physiological features of the neurological disease.

A polysubspecialty approach is particularly important because peripheral neuropathy and neuromuscular disease frequently reflect pathology extending beyond the peripheral nervous system itself. Dr. Funk integrates Neuromuscular Medicine with Neuroimmunology, Neuro-Infectious Disease, Neuroendocrinology, Vascular Neurology, Dysautonomia, Neuroimaging, Neurodegenerative Neurology, and other relevant neurological subspecialties to determine how neurological and systemic mechanisms interact within the individual patient.

Treatment follows the diagnosis, etiology, and neurological localization. Dr. Funk identifies modifiable metabolic, nutritional, inflammatory, neuroimmune, infectious, endocrine, vascular, toxic, and physiological factors contributing to peripheral nerve or neuromuscular dysfunction. Treatment may incorporate individualized nutraceutical and over-the-counter medication strategies, with recommendations and co-management involving other healthcare providers when prescription medication or additional specialty treatment is appropriate.

Neurological rehabilitation is directed toward the specific nerves, pathways, and neurological systems identified during the evaluation. Targeted peripheral nerve stimulation is frequently incorporated to stimulate affected peripheral nerves and influence the neural pathways and networks with which they communicate. Dr. Funk also frequently incorporates pulsed electromagnetic field therapy (PEMF) as part of individualized peripheral nerve and neuromuscular rehabilitation. Depending on the neurological localization and clinical presentation, treatment may additionally incorporate sensory and motor rehabilitation, balance and coordination rehabilitation, vestibular and oculomotor stimulation, neuro-optometric rehabilitation, transcutaneous auricular vagus nerve stimulation (taVNS), transcranial photobiomodulation, and other targeted neurological rehabilitation and neuromodulation strategies.

The objective is not simply to treat numbness, tingling, weakness, or nerve pain. Dr. Funk diagnoses the neurological disease, determines its underlying etiology, localizes the affected peripheral nerves and neuromuscular structures, identifies modifiable mechanisms contributing to the disease, and develops an individualized treatment strategy directed at the specific neurological dysfunction identified.