• Numbness
• Abnormal sensations (paresthesia); "pins and needles"
• Painful sensations
• Muscle weakness
• Muscle cramps or muscle aches
• Heat intolerance, especially after exercise
• Impotence (in men)
• Difficulty urinating
  • Incontinence (leaking urine)
  • Feeling of incomplete bladder emptying
  • Difficulty beginning to urinate
• Constipation
• Diarrhea
• Nausea, vomiting

Additional symptoms that may be associated with this disease:

• Swallowing difficulty
• Speech impairment
• Loss of muscle function or feeling
• Muscle contractions or spasm
• Muscle atrophy
• Movement, dysfunctional
• Hoarseness or changing voice
• Eyelid drooping (ptosis)

Note: Changes in muscle strength and/or sensation usually occur on both sides of the body and are more common in the legs than in the arms. Symptoms may develop gradually and progressively become worse over time.

Neurological examination may be abnormal. Reflexes may be reduced and focal neurologic deficits (localized nerve abnormalities) may be present. Neurologic deficits are usually symmetrical. Signs of autonomic dysfunction may be present. Eye inspection may show decreased pupil response or other abnormality. Blood pressure may show orthostatic changes (a fall in blood pressure when the person rises to a standing position).

Lab tests may be performed as indicated by the history, signs, and symptoms to rule out other possible causes of neuropathy.

• Nutritional studies may show deficiencies of thiamine (Vitamin B1), pyridoxine (Vitamin B6), pantothenic acid and biotin, Vitamin B12, folic acid, niacin (Vitamin B3), Vitamin A, or other deficiencies. Alcoholism is a risk factor for nutritional deficiency.
• Serum chemistries may show abnormalities (see chem-20).
• Nerve conduction tests and EMG (a test of electrical activity in muscles) may be used to determine the extent of neurologic damage. Nerve biopsy may be used to rule out other possible causes of the signs and symptoms.
• An upper GI and small bowel series may show decreased motility, delayed emptying of the stomach, or other abnormalities. This study may be used to rule out physical obstruction as a cause of vomiting or other GI (gastrointestinal) symptoms.
• EGD (esophagogastroduodenoscopy) is used to rule out physical obstruction as a cause of gastrointestinal (GI) symptoms.
• Isotope studies may indicate gastroparesis (decreased gastric motility).
• VCUG (voiding cystourethrogram) may show decreased bladder emptying caused by damage to the nerves controlling the bladder.

Other tests may be performed to determine the presence and extent of other neurologic losses.