Peripheral Neuropathy

Question 1

What work up would you do for a suspected neuropathy?

Answer 1

CBC
Metabolic panel
B12
SPEP
Fasting glucose
Glucose tolerance test
Not great evidence for EMG/NCS, MRI

Question 2

What are common causes of peripheral neuropathy?

Answer 2

T2DM
B12 deficiency
Alcohol use
Lumbar spinal stenosis
Chemotherapy
Critical illness
Thyroid disease
HIV
Connective tissue disease

Question 3

What are treatment options for peripheral neuropathy?

Answer 3

1. Voltage gated calcium channel ligands = gabapentin, pregabalin
2. SNRI = duloxetine
3. TCA = amitriptyline, nortriptyline
4. DM management

Question 4

What are features on history and physical that indicate lumbar spinal stenosis?

Answer 4

1. Absence of pain while sitting
2. Poor balance with back pain
3. Thigh pain on lumbar extension
4. Wide based gait and Romberg
5. Back pain and weakness of ankle/great toe flexion/extension and loss of ankle reflexes

Question 5

What symptoms are with lumbar spinal stenosis?

Answer 5

Unilateral/bilateral buttock/thigh/calf symptoms
Walking better when leaning forwards
Onset with standing or walking
Better with sitting, flexion, lying down

Question 6

What are non pharm treatment options for lumbar spinal stenosis causing neurogenic claudication?

Answer 6

1. Education and advice
2. Lifestyle changes
3. Behavioural change techniques
4. Home exercise
5. Manual therapy
6. Rehab
7. Acupuncture

Question 7

What are pharm treatment options for LSS?

Answer 7

1. SNRIs
2. TCAs
   Do not suggest other drugs or epidural steroidal injections

Question 8

What are the surgical interventions for LSS?

Answer 8

Decompressive laminectomy
Benefits may not be sustained
Reoperation rate high
More adverse effects