Neuropathy is not a diagnosis on its own β it's a signal that something is affecting your nerves. That's why the most important step is a neurologist-led evaluation to pinpoint the cause, because many forms of neuropathy can be slowed, managed, or even reversed when caught early. At Mir Neurology, our board-certified neurologists both perform and interpret nerve testing in-house and treat the underlying cause β for patients across Western Maryland, the Eastern Panhandle of West Virginia, and South-Central Pennsylvania.
Request an Appointment or call (301) 797-7600.
What Is Peripheral Neuropathy?
Peripheral neuropathy is damage to the peripheral nerves β the nerves that carry signals between your brain and spinal cord and the rest of your body. When these nerves are damaged, the signals get disrupted, leading to numbness, pain, tingling, and weakness, most often starting in the feet and hands.
Neuropathy is not a single disease β it is a sign that something is affecting your nerves. There are dozens of possible causes, and identifying which one is responsible is the foundation of effective treatment. A neurologist is the specialist trained to find that cause and treat it, not simply mask the pain.
Neuropathy Symptoms
Symptoms depend on which nerves are affected and usually develop gradually. Common signs include:
- Numbness or reduced ability to feel, often starting in the toes and feet
- Tingling or pins and needles
- Burning, stabbing, or shooting pain
- Extreme sensitivity to touch
- Weakness in the feet, legs, or hands
- Loss of balance and coordination
- A feeling of wearing invisible socks or gloves
- Symptoms that are often worse at night
Many people describe a stocking-glove pattern β symptoms beginning in the feet and later affecting the hands as the condition progresses.
Types of Neuropathy
Neuropathy is described by which and how many nerves are involved:
Peripheral Sensory Neuropathy
Affecting sensation, the most common form.
Small Fiber Neuropathy
Affecting small nerves that sense pain and temperature, often causing burning pain and tingling.
Autonomic Neuropathy
Affecting nerves that control automatic functions like blood pressure, digestion, and bladder.
Motor Neuropathy
Affecting nerves that control muscles, causing weakness.
Focal Neuropathy
Affecting a single nerve, such as in carpal tunnel syndrome.
Mixed Neuropathy
Many patients have more than one type of nerve involvement.
What Causes Peripheral Neuropathy?
There are dozens of possible causes. The most common include:
- Diabetes β the leading cause
- Vitamin deficiencies, especially B12 and others
- Alcohol use
- Autoimmune diseases such as lupus, rheumatoid arthritis, and Guillain-BarrΓ© syndrome
- Infections, including shingles and Lyme disease
- Certain medications, including some chemotherapy drugs
- Thyroid or kidney problems
- Inherited conditions
- Injury or nerve compression
In some cases, no cause is found (idiopathic neuropathy). A thorough evaluation still matters, because several common causes β like vitamin deficiency or thyroid problems β are very treatable when identified.
Diabetic vs. Non-Diabetic Neuropathy
Because diabetes is the most common cause, it helps to understand how diabetic neuropathy differs from neuropathy with other causes. This is one of the first things your neurologist works to sort out.
| Diabetic neuropathy | Non-diabetic neuropathy | |
|---|---|---|
| Underlying driver | Prolonged high blood sugar damaging nerves | B12 deficiency, thyroid disease, alcohol, autoimmune conditions, medications, or infection |
| Typical pattern | Symmetric, both feet first, gradual "stocking-glove" spread | Can be symmetric or focal/one-sided depending on the cause |
| First treatment step | Tight blood-sugar control plus symptom relief | Correct the specific underlying cause (e.g., replace B12, treat thyroid) |
| Outlook | Progression can be slowed; focus on preventing foot complications | Often improves β sometimes fully β when the cause is reversible |
If you have diabetes and notice numbness, tingling, or pain in your feet, an evaluation is important β early detection helps prevent complications such as foot ulcers.
When Nerve Symptoms Need Urgent Care
Most neuropathy develops slowly and is not an emergency. But certain patterns can signal a serious problem such as Guillain-BarrΓ© syndrome or spinal cord involvement, and need prompt medical attention.
Seek urgent or emergency care if you have:
- Weakness or numbness that spreads rapidly over hours to days, especially climbing up from the feet
- Sudden weakness, particularly following a recent infection
- Loss of bladder or bowel control
- Severe, sudden imbalance or difficulty walking
- Weakness affecting breathing or swallowing
When in doubt, call your doctor or go to the nearest emergency department.
Can Neuropathy Be Reversed?
This is one of the most common β and important β questions. The answer depends on the cause.
Treatable Causes
When neuropathy is caused by something reversible β such as vitamin B12 deficiency, thyroid problems, or medication effects β addressing the cause can improve or even resolve symptoms.
Established Nerve Damage
When nerve damage is more established or the cause is progressive, the goal shifts to slowing progression, managing symptoms, and preventing further damage.
Either way, early diagnosis gives you the best chance of a good outcome β which is why you should not wait to get evaluated.
How Peripheral Neuropathy Is Diagnosed
Finding the cause requires a careful, neurologist-led evaluation. Ours may include:
- A detailed history and neurological exam β testing sensation, strength, reflexes, and coordination
- EMG and nerve conduction studies β the key tests that measure how well your nerves and muscles are working and how severely they are affected
- Blood tests to check for diabetes, vitamin deficiencies, thyroid problems, and autoimmune causes
- Additional testing when needed, such as a small-fiber assessment or, occasionally, a nerve biopsy
Because our neurologists perform and interpret EMG/nerve conduction studies in our own offices β rather than referring you out β we can move efficiently from symptoms to a clear diagnosis and start treatment sooner.
What Happens During Your EMG / Nerve Conduction Study
EMG (electromyography) and NCS (nerve conduction study) are usually done together in one visit to measure nerve and muscle function. Here's what to expect:
- Before your test
Take your usual medications unless told otherwise, and skip lotions or oils on your skin that day so the sensors make good contact. Wear loose clothing. Let us know in advance if you take blood thinners or have a pacemaker or defibrillator.
- Nerve conduction study (NCS)
Small sensors are placed on the skin, and brief, mild electrical pulses gently stimulate a nerve. You'll feel quick taps or tingles. This measures how fast and how strongly your nerve signals travel.
- Needle EMG
A very thin needle electrode is placed into a few muscles. You'll relax and then gently tense the muscle while it records the electrical activity. Any discomfort is mild and brief β there is no sedation needed.
- Real-time interpretation
Your neurologist performs the study personally and reads the results as they go, correlating the findings with your exam β an advantage over settings that send the test out to be read later.
- Your results and plan
Findings are often discussed the same day: which nerves are affected, how severely, and what it points to as the cause. The whole study usually takes 30β60 minutes with no downtime β you can drive yourself home.
Neuropathy Treatment
Effective treatment has two goals: address the underlying cause and relieve symptoms. Your plan is built around what's driving your neuropathy.
| Approach | What it does | Best for |
|---|---|---|
| Treat the root cause | Stops ongoing nerve damage (control blood sugar, replace B12, treat thyroid, adjust a medication) | Reversible or underlying causes |
| Nerve-pain medications | Calms burning, shooting, and stabbing pain | Painful neuropathy |
| Physical therapy | Improves strength, balance, and walking | Weakness and fall risk |
| Foot care & protection | Prevents ulcers and injuries when sensation is reduced | Diabetic and sensory neuropathy |
| Lifestyle measures | Supports nerve health (balanced nutrition, limiting alcohol, staying active) | All patients |
| Ongoing monitoring | Tracks progression and adjusts the plan over time | Chronic or progressive cases |
The earlier treatment begins, the better the chances of protecting your nerves and easing symptoms.
Why Choose Mir Neurology?
Diagnosed by a Neurologist
Care from board-certified neurologists with 20+ years of experience β specialists in nerve disease, not just symptom management.
In-House EMG / NCS
Accurate nerve testing performed and interpreted by your neurologist, close to home, without unnecessary travel.
Root-Cause Focus
We work to find and treat the underlying cause β not simply mask the pain.
Local Access
Personalized long-term care with two convenient locations and most major insurance plans accepted.
What Our Patients Say
Mir Neurology is one of the most reviewed neurology practices in the region, rated 4.6β across 200+ Google reviews.
"I went to Mir for an EMG/NCS, and it was performed by Dr. Khan. He was extremely pleasant and professional, as well as the front desk staff."
"Extremely impressed with Dr. Mir and his staff. He is so thorough, considerate and knowledgeable. I am beyond thankful for the time he spent with me to determine and treat the cause of my pain. There aren't many Doctors like him out there any longer. A+++"
Serving Western Maryland & the Tri-State Area
We treat neuropathy for patients across the region β without long drives to Baltimore, Pittsburgh, or D.C.
Maryland
Cumberland, Hagerstown, LaVale, Frostburg, Cresaptown, Hancock, Williamsport, Smithsburg, Boonsboro
West Virginia
Martinsburg, Keyser, Romney, Berkeley Springs, Paw Paw
Pennsylvania
Waynesboro, Greencastle, Chambersburg, Mercersburg
Cumberland office: 924 Seton Dr Suite C, Cumberland, MD 21502 β MonβSat, 7:30 AM β 4:30 PM
Hagerstown office: 11110 Medical Campus Rd Unit 151, Hagerstown, MD 21742 β MonβFri, 7:30 AM β 5:00 PM
Frequently Asked Questions
What is peripheral neuropathy?
It is damage to the peripheral nerves that causes numbness, tingling, burning pain, and weakness β most often starting in the feet and hands. It is a sign of an underlying problem affecting the nerves.
What are the first signs of neuropathy?
Often numbness, tingling, or a pins-and-needles feeling in the toes and feet, sometimes with burning pain that is worse at night.
Can neuropathy be reversed?
Sometimes. When the cause is treatable β like a vitamin deficiency, thyroid problem, or medication β symptoms can improve or resolve. In other cases, treatment focuses on slowing progression and managing symptoms.
What is the most common cause of neuropathy?
Diabetes is the leading cause. Other common causes include vitamin deficiencies, alcohol use, autoimmune diseases, infections, and certain medications.
What kind of doctor treats neuropathy?
A neurologist diagnoses and treats neuropathy, using EMG and nerve conduction studies to confirm the diagnosis and identify the cause, then targeting both the cause and the symptoms.
Does an EMG or nerve conduction study hurt?
Most people tolerate it well. The nerve conduction portion feels like quick taps or tingles from mild electrical pulses, and the EMG uses a very thin needle that causes only brief, mild discomfort. No sedation is needed and there's no downtime.
How is the cause of neuropathy found?
Through a neurological exam, EMG/nerve conduction studies, and blood tests for diabetes, vitamin levels, thyroid, and autoimmune conditions β occasionally with additional specialized testing.
Is all neuropathy diabetic neuropathy?
No. Diabetes is the most common cause, but neuropathy also results from vitamin deficiencies, thyroid disease, alcohol, autoimmune conditions, infections, medications, and inherited disorders β which is why finding the specific cause matters.
Why are my symptoms worse at night?
Nerve pain often feels more intense at night, when there are fewer distractions and, for some people, changes in temperature and circulation. Telling your neurologist about this pattern helps guide treatment.
Can neuropathy be prevented?
Often, yes β by managing risk factors such as blood sugar, maintaining good nutrition (including B12), limiting alcohol, and treating underlying conditions early.
When are nerve symptoms an emergency?
Seek urgent care for weakness or numbness that spreads rapidly (especially after an infection), sudden severe weakness, loss of bladder or bowel control, or trouble breathing or swallowing β these can signal a serious condition.
What can I expect at my first visit?
A review of your symptoms and history, a neurological exam, and β when appropriate β in-house nerve testing and blood work, so you leave with a clear plan to find and address the cause.
Numbness, Tingling, or Burning in Your Feet or Hands?
Find the cause and get relief. Mir Neurology diagnoses and treats peripheral neuropathy with in-house, neurologist-performed nerve testing in Cumberland and Hagerstown.
Request an appointment | (301) 797-7600
This page is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with questions about a medical condition. If you think you or someone else may be having a medical emergency, call 911.