From the Research
The workup of non-diabetic neuropathy should begin with a thorough clinical history and physical examination, followed by targeted laboratory and diagnostic testing, as outlined in the most recent study 1. This approach is crucial in identifying the underlying cause of neuropathy, which can significantly impact morbidity, mortality, and quality of life. The initial evaluation should include a complete medical history, including medication use, alcohol consumption, family history, and exposure to toxins. Laboratory tests should be selected based on the suspected type of neuropathy, and may include:
- Complete blood count
- Comprehensive metabolic panel
- Vitamin B12 level
- Folate
- Thyroid function tests
- Erythrocyte sedimentation rate
- C-reactive protein
- Serum protein electrophoresis with immunofixation Additional testing may include glucose tolerance test, HbA1c, HIV, hepatitis panel, and autoimmune markers such as ANA, ANCA, and rheumatoid factor, as recommended by 2 and 3. Nerve conduction studies and electromyography are essential to characterize the type and distribution of neuropathy, as stated in 4. In selected cases, cerebrospinal fluid analysis may be necessary to evaluate for inflammatory or infectious causes, and genetic testing should be considered for patients with a family history of neuropathy. Imaging studies such as MRI of the spine may be needed if radiculopathy is suspected. This systematic approach helps identify potentially treatable causes of neuropathy, allowing for targeted treatment rather than just symptomatic management, which is in line with the recommendations of 5 and 1.