From the Guidelines
Diagnosing polyneuropathy in your father requires a comprehensive medical evaluation by a healthcare provider, starting with a detailed medical history and physical examination, and annual assessments for diabetic peripheral neuropathy using simple clinical tests, as recommended by the most recent guidelines 1. The diagnostic process typically begins with a detailed medical history and physical examination, focusing on symptoms like numbness, tingling, weakness, or pain in the extremities.
- The doctor will assess for distal symmetric polyneuropathy, including a careful history and assessment of either temperature or pinprick sensation (small-fiber function) and vibration sensation using a 128-Hz tuning fork (for large-fiber function) 1.
- Annual 10-g monofilament testing is also recommended to identify feet at risk for ulceration and amputation 1.
- Symptoms and signs of autonomic neuropathy should be assessed in patients with microvascular complications, including orthostatic dizziness, syncope, or dry cracked skin in the extremities 2. The following clinical tests may be used to assess small- and large-fiber function and protective sensation:
- Small-fiber function: pinprick and temperature sensation
- Large-fiber function: vibration perception and 10-g monofilament
- Protective sensation: 10-g monofilament These tests not only screen for the presence of dysfunction but also predict future risk of complications 1. Electrophysiological testing or referral to a neurologist is rarely needed, except in situations where the clinical features are atypical or the diagnosis is unclear 1. In all patients with diabetes and DPN, causes of neuropathy other than diabetes should be considered, including toxins (alcohol), neurotoxic medications (chemotherapy), vitamin B12 deficiency, hypothyroidism, renal disease, malignancies (multiple myeloma, bronchogenic carcinoma), infections (HIV), chronic inflammatory demyelinating neuropathy, inherited neuropathies, and vasculitis 3. It's essential to bring a complete list of your father's medications to the appointment, as some drugs can cause neuropathy as a side effect, and the doctor will also want to know about your father's alcohol consumption history, as chronic alcohol use is a common cause of polyneuropathy 2. Early diagnosis is crucial because treating the underlying cause can sometimes prevent further nerve damage, though established nerve damage may be permanent.
From the Research
Diagnostic Approach
To diagnose polyneuropathy, a thorough diagnostic workup is essential 4. This includes:
- Medical history
- Clinical examination
- Laboratory diagnostics
- Electrophysiological examination
- Cerebrospinal fluid diagnostics
Clinical Examination
Clinical signs and distribution patterns of symptoms can often provide clues to the underlying aetiology 4. A clinical examination is sufficient to diagnose polyneuropathy, but additional diagnostic procedures are necessary to reveal the etiology 5.
Diagnostic Procedures
The diagnostic procedures may include:
- Nerve conduction studies (NCS) to assess the severity of the polyneuropathy 6
- Serum biochemical studies to check for vitamin deficiencies or other underlying causes 6
- Anti-parietal cell antibody test to check for autoimmune causes 6
Importance of Early Diagnosis
Early diagnosis and therapy can enable the progression of the polyneuropathy to be stopped and polyneuropathic symptoms to be ameliorated in most cases 5. A timely diagnosis of the cause of polyneuropathy is a prerequisite for the initiation of appropriate specific treatment 7.
Referral to a Specialized Center
Patients with severe neuropathy of unidentified cause should be referred to a specialized center for a thorough diagnostic evaluation 7.
Treatment Options
Treatment options depend on the cause of the polyneuropathy, and may include: