How to Diagnose Peripheral Neuropathy

How to Diagnose Peripheral Neuropathy

“How to Diagnose Peripheral Neuropathy? No Simple Answers: Experts Offer Some Guiding Principles”, Neurology Today, March 15, 2012, volume 12(6); pp 30, 32-33 by Mark Moran.

Neurology Today is to be congratulated for featuring this article during a time when we fight hard for increased awareness and increased clinical training for medical professionals in the diagnosis and treatment of the neuropathies.

This is a significant article and represents a growing awareness among doctors and patients about the complexity of diagnosing Peripheral Neuropathy and establishes some important standards that should help doctors sort out the issues and hopefully help them reach a diagnosis other than “idiopathic”. It is a giant step for those who have been fighting for something in the clinic other than “you have neuropathy, there is nothing you can do, go home” or worse.

The call for more research to “define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy” in the January 2012 Achieves of Internal Medicine is more than encouraging.

David Simpson, M.D. noted what many have been saying for years, that “a thorough history and initial neurological exam is critical….Based on these steps, a clinician should be able to go a long way to narrowing the differential diagnosis…as one can ascertain the time course, symmetry, and clinical pattern as a first step.”

The one important question the article does not address is why the authors did not mention the diagnostic value of the spinal tap as an important step in the diagnosis of the autoimmune neuropathies while including the nerve/muscle biopsy which is very seldom needed. Both procedures are not full proof and sometimes do not necessarily provide the information needed. But given the unwanted and significant drawbacks for the patient in the nerve muscle biopsy versus the same issues with the spinal tap and the possible value in diagnosis, one is left wondering why the spinal tap was excluded in this otherwise great information for doctors.

In this regard, where you aware that recent University Studies have found in the medical records of President Roosevelt strong evidence that he may not have been paralyzed by polio as thought back in 1921? After looking at his symptoms common to the neuropathies and not polio, it is now thought that he actually had undiagnosed and untreated GBS or Guillain-Barre Syndrome! The scientists doing this study stated that the only way to confirm it was by doing, guess what, a spinal tap, but that of course is not possible now.
Following my experience of over three decades of failed diagnosis, my current neurologist’s ask in 2005, why did they not do a spinal tap and evaluate the fluid? This test is far less intrusive than the nerve/muscle biopsy and is very valuable in determining what is happening in the autoimmune neuropathies.

Meanwhile we are grateful to these men of knowledge for their work on behalf of many who suffer from this underdiagnosed and under treated disease of so many types and causes.

Read the entire article at: How to Diagnose Peripheral Neuropathy? No Simple Answers

About the Author

LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.

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2 Comments

  1. I have had blood tests, spinal tap, skeletal X-rays Mri of lower spine. nothing was conclusive to cause. Now Dr. Is asking for nerve biopsy. should I go ahead or are we wasting time and another point of numbness. I have not tried any drugs. I am 68 and. In otherwise good health and still quite active

    1. Dave: That is a good question. If you are in good health and active, I am not sure the spinal tap is worth the risk it involved… and has limited diagnostic value. I will get back to you on this issue…. by E mail directly… Would be interested to know if any doctor gave you a diagnosis as to TYPE that can point to a cause… beyond Idiopathic? Col Gene

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