![]() ![]() The most common cause is a peripheral neuropathy from such things as diabetes, alcoholism, and toxins. ![]() A second opinion regarding the patient's diagnosis and management also should be considered before initiating long-term opioid therapy.The knee jerk reflex is an example of a deep tendon reflex (DTR) in a neurological exam and is graded on the following scale:Ībsence of the knee jerk can signify an abnormality anywhere within the reflex arc, including the muscle spindle, the Ia afferent nerve fibers, or the motor neurons to the quadriceps muscle. In general the afferent loop is much more critical for reflex function than the efferent loop, so that unless the muscle is almost paralysed, loss of reflexes suggests a sensory nerve or root lesion rather than a motor nerve lesion. 2 Narcotics may have a role in the treatment of chronic neuropathic pain in selected patients 19 candidates initially should be evaluated for their risk of substance abuse and addiction, and several nonnarcotic regimens should be tried first. 18 Other supportive measures, such as foot care, weight reduction, and shoe selection, may also be helpful. 15 – 17 Topical patches and sprays containing lidocaine (Lidoderm) or capsaicin (Zostrix) also may relieve pain in some patients. 12 Several pharmacologic options exist to treat neuropathic pain, including some antiseizure medications (e.g., gabapentin, topiramate, carbamazepine, pregabalin ) 13, 14 and antidepressants (e.g., amitriptyline). It is important to help patients control troublesome symptoms of peripheral neuropathy, such as severe numbness and pain, as well as to alleviate disability resulting from weakness. Salivary flow rate, Schirmer test, rose bengal test, labial gland biopsyĪcute or chronic inflammatory demyelinating neuropathy Heavy metal toxicity, porphyrias, multiple myelomaĪntimyelin-associated glycoprotein and antiganglioside antibodies Urinalysis (including 24-hour urine collection) Lead and mercury mainly cause motor neuropathyĢ4-hour urine collection for heavy metal titers Heavy metals (e.g., arsenic, lead, mercury, gold) Neuropathy with liability to pressure palsies Peripheral neuropathy is intermixed with upper motor neuron signsĬBC vitamin B 12 and homocysteine levels methylmalonic acid test Rapid plasma reagin, VDRL, cerebrospinal fluid analysis Monoclonal gammopathy of undetermined significance Urine and serum protein electrophoresis with immunofixationĪxonal damage predominates after treatment Phenolic glycolipid-1 antibody, skin biopsy Usually acute or subacute, but can be chronic Serum creatinine and blood urea nitrogen levels Hepatic transaminase, bilirubin, albumin, and alkaline phosphatase levelsįasting blood glucose level, glucose tolerance test, A1C level Mainly demyelinating, especially in viral hepatitis Paraneoplastic panel (anti-Hu, anti-Yo, anti-Ri, anti-Tr, anti-Ma, and anti-CV2 antibodies) Treatment should address the underlying disease process, correct any nutritional deficiencies, and provide symptomatic treatment. Electrodiagnostic studies, including nerve conduction studies and electromyography, can help in the differentiation of axonal versus demyelinating or mixed neuropathy. Lumbar puncture and cerebrospinal fluid analysis may be helpful in the diagnosis of Guillain-Barré syndrome and chronic inflammatory demyelinating neuropathy. Initial blood tests should include a complete blood count, comprehensive metabolic profile, and measurement of erythrocyte sedimentation rate and fasting blood glucose, vitamin B 12, and thyroid-stimulating hormone levels specialized tests should be ordered if clinically indicated. A systematic approach begins with localization of the lesion to the peripheral nerves, identification of the underlying etiology, and exclusion of potentially treatable causes. The diagnosis requires careful clinical assessment, judicious laboratory testing, and electrodiagnostic studies or nerve biopsy if the diagnosis remains unclear. The most common treatable causes include diabetes mellitus, hypothyroidism, and nutritional deficiencies. Peripheral neuropathy has a variety of systemic, metabolic, and toxic causes. ![]()
0 Comments
Leave a Reply. |