From the Guidelines
For poly sensory neuropathy with demyelination in the tibial and fibular distribution bilaterally, I strongly recommend a multi-faceted approach including both medication and lifestyle modifications, prioritizing gabapentin or pregabalin as first-line medications, as they have shown efficacy in reducing symptoms and improving quality of life 1.
Key Considerations
- The management of poly sensory neuropathy with demyelination should focus on alleviating symptoms, preventing progression, and improving quality of life, as specific treatment to reverse the underlying nerve damage is currently not available 1.
- First-line medications include gabapentin (starting at 300mg daily and gradually increasing to 300-600mg three times daily) or pregabalin (starting at 75mg twice daily, increasing to 150-300mg twice daily as needed), which have been recommended for the treatment of painful diabetic peripheral neuropathy 1.
- Duloxetine (60mg daily) or amitriptyline (10-25mg at bedtime, gradually increasing if needed) can also be effective in managing symptoms, but should be considered based on patient co-morbidities and costs 1.
Lifestyle Modifications
- Physical therapy focusing on maintaining strength and range of motion is crucial, as is regular low-impact exercise like swimming or stationary cycling, to prevent further nerve damage and promote overall well-being.
- Proper foot care is essential, including daily inspection of feet, wearing comfortable shoes, and regular visits to a podiatrist, to prevent injuries and diabetic foot ulcers.
- Blood sugar control is vital if diabetes is present, as glycemic control can effectively prevent diabetic peripheral neuropathy and cardiac autonomic neuropathy in type 1 diabetes, and may modestly slow their progression in type 2 diabetes 1.
Monitoring and Follow-up
- Regular follow-up with a neurologist is important to monitor the condition and adjust treatment as needed, ensuring that the patient receives optimal care and management of their poly sensory neuropathy with demyelination.
From the Research
Poly Sensory Neuropathy with Demyelination
- Poly sensory neuropathy with demyelination in tibia fibular distribution equal bilaterally can be a complex condition to manage, as it involves damage to the myelinated nerve fibers, which can result in proprioceptive deficits and ataxia 2.
- The causes of poly sensory neuropathies are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions, making diagnosis and treatment challenging 2.
- Electrophysiologic testing, including nerve conduction studies, can help diagnose demyelinating polyneuropathies, and the distribution patterns of demyelination can reflect the underlying pathogenesis 3, 4.
Distribution of Demyelination
- The distribution of demyelination in chronic inflammatory demyelinating polyneuropathy (CIDP) subtypes can vary, with some studies showing that distal latencies are prolonged in typical CIDP and near normal in multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) 3.
- Other studies have found that conduction block (CB) is more likely to occur around the elbow in CIDP-CB than in multifocal motor neuropathy (MMN), but less likely to occur between the wrist and the elbow than in Lewis-Sumner syndrome (LSS) 4.
- Tibial nerve CB was most frequently observed in MMN, suggesting that the distribution of demyelination can vary between different conditions 4.
Treatment and Management
- The treatment of poly sensory neuropathies depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy 2.
- In some cases, management remains symptomatic and supportive, as there is no directed treatment available 2.
- Electrophysiologic studies are critically important as an investigatory tool in the evaluation of patients with suspected demyelinating neuropathies, and can help guide treatment decisions 5.