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How to diagnose neuropathy

How to diagnose neuropathy

Neurology Today is to be congratulated for featuring this article during a time when we fight hard for increased awareness and increased clinical training for medical professionals in the diagnosis and treatment of the neuropathies.

This is a significant article and represents a growing awareness among doctors and patients about the complexity of diagnosing Peripheral Neuropathy and establishes some important standards that should help doctors sort out the issues and hopefully help them reach a diagnosis other than “idiopathic”. It is a giant step for those who have been fighting for something in the clinic other than “you have neuropathy, there is nothing you can do, go home” or worse.

The call for more research to “define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy” in the January 2012 Achieves of Internal Medicine is more than encouraging.

David Simpson, M.D. noted what many have been saying for years, that “a thorough history and initial neurological exam is critical….Based on these steps, a clinician should be able to go a long way to narrowing the differential diagnosis…as one can ascertain the time course, symmetry, and clinical pattern as a first step.”

The one important question the article does not address is why the authors did not mention the diagnostic value of the spinal tap as an important step in the diagnosis of the autoimmune neuropathies while including the nerve/muscle biopsy which is very seldom needed. Both procedures are not full proof and sometimes do not necessarily provide the information needed. But given the unwanted and significant drawbacks for the patient in the nerve muscle biopsy versus the same issues with the spinal tap and the possible value in diagnosis, one is left wondering why the spinal tap was excluded in this otherwise great information for doctors.

In this regard, where you aware that recent University Studies have found in the medical records of President Roosevelt strong evidence that he may not have been paralyzed by polio as thought back in 1921? After looking at his symptoms common to the neuropathies and not polio, it is now thought that he actually had undiagnosed and untreated GBS or Guillain-Barre Syndrome! The scientists doing this study stated that the only way to confirm it was by doing, guess what, a spinal tap, but that of course is not possible now.
Following my experience of over three decades of failed diagnosis, my current neurologist’s ask in 2005, why did they not do a spinal tap and evaluate the fluid? This test is far less intrusive than the nerve/muscle biopsy and is very valuable in determining what is happening in the autoimmune neuropathies.

Meanwhile we are grateful to these men of knowledge for their work on behalf of many who suffer from this underdiagnosed and under treated disease of so many types and causes.

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About the Author

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.

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2 Comments

I have had blood tests, spinal tap, skeletal X-rays Mri of lower spine. nothing was conclusive to cause. Now Dr. Is asking for nerve biopsy. should I go ahead or are we wasting time and another point of numbness. I have not tried any drugs. I am 68 and. In otherwise good health and still quite active

Dave: That is a good question. If you are in good health and active, I am not sure the spinal tap is worth the risk it involved… and has limited diagnostic value. I will get back to you on this issue…. by E mail directly… Would be interested to know if any doctor gave you a diagnosis as to TYPE that can point to a cause… beyond Idiopathic? Col Gene

Autonomic neuropathy is a condition that arises when the nerves controlling the normal functioning of involuntary body functions are injured. Some of these involuntary functions include blood pressure, sexual function, digestion, temperature control, and bladder function and so on. When the nerves have damaged the flow of message transferred from the brain to different organs are interrupted. This ultimately leads to various health problems.

How To Diagnose Autonomic Neuropathy?

Autonomic neuropathy is a side effect or complication caused as a result of various diseases. The tests prescribed for diagnosing this problem majorly depends on the symptoms and the associated risk factors.

Diagnosis With Risk Factors

Patients who suffering from diabetes or any other health problem can create favorable conditions for significantly increasing the possibility for developing autonomic neuropathy risk factors. Then in this condition, doctors perform a physical examination of the patient and also inquire about the symptoms faced for diagnosing autonomic neuropathy. If the patient is undergoing or has undergone treatment for cancer, where the drug used is known for causing nerve damage, the doctors look for the possible symptoms of the same to confirm the health problem.

Diagnosis Without Risk Factors

Patients experiencing the symptoms of nerve damage but have no risk factors, then the process of diagnosis becomes more intense. Doctors study the medical background of the patient, ask them about the symptoms they are experiencing and also perform the physical examination. Doctors may also prescribe some tests to evaluate and confirm the presence of autonomic neuropathy. The lists of tests include: Breathing Test: This test helps to measure the heart rate and the blood pressure while performing severe heavy exercises in which forceful exhaling is involved. Gastrointestinal Test: This is one of the most common and effective tests for identifying the digestive abnormalities, which include such as delay in the digestion process and in cleaning the stomach. This test is not performed by any physical practitioner, instead; only gastroenterologist i.e. doctors holding specialization in digestive disorders perform this test. Thermoregulatory Sweat Test: In this test, the body of patients is covered with a thick coat of a specific powder, which changes color when patient sweat. Then they are asked to stay for some time in a chamber in which the temperature is closely increased, this initiate sweating. The sweat pattern actually helps in diagnosing the presence of autonomic neuropathy. In addition, it also helps to identify the varying causes for the decrease or increase of sweating. Tilt-Table Test: This test helps in identifying how the body responds to fluctuating blood pressure and heart rate with changing positions and postures, like when the patient is standing or lying down. While performing the test, the patient is asked to lie down on a table, which is then moved up and down to create variation in the body posture. Normally, when the blood pressure is dropped, then the body has a tendency to narrow blood vessels and increase the heart rate to compensate for the condition. This process gets slow down or becomes restrictive if the patient is suffering from autonomic neuropathy. Another test that helps in identifying is to ask the patient to stand straight for a minute and then perform squats for a minute. In between monitoring the fluctuation in the blood pressure and the heart rate for any abnormality. Ultrasound: If the patient suffers from an abnormality related to bladder functioning, then the doctor may prescribe undergoing an ultrasound. In this test, a sound wave of high-frequency is used for creating different images of the bladder and other parts closed organs of the urinary tract.

What Is The Best Medicine For Autonomic Neuropathy?

Diabetes is considered one of the major causes of autonomic neuropathy. In addition, the infection can also lead to autonomic neuropathy. There are some strong medications that can also nerve damage. As the cause of this problem varies from one patient to another, so the medication and the treatment approach also varies depending on the type of nerve damaged.

Best Test to Diagnose Neuropathy is the EMG/NCV Nerve Test

Exams and Tests for Neuropathy Symptoms

How to diagnose neuropathy

How Your Doctor Properly Diagnose Neuropathy

To diagnose Neuropathy correctly and develop a list of possible causes, an EMG/NCV (Electromyography/Nerve Conduction Velocity Study) is the most accurate and correct test and is required for a Confirmation Diagnosis.

The EMG Test measures:

1) Your nerves speed
2) Amount of electricity moving through the nerve
3) Reaction time of the nerve to stimulus
4) Overall pattern of peripheral nervous system function
5) Level of Severity! Is it progressively Worse?

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How to diagnose neuropathy

What Causes Neuropathy?

Diabetes is the most common cause of peripheral neuropathy in the US.

Neuropathy can also be caused by other health conditions and certain medications. In some cases, no cause can be identified and this is termed idiopathic neuropathy. Diabetes Peripheral neuropathy caused by either type 1 diabetes (Juvenile Onset) or type 2 diabetes (Adult Onset) is called diabetic polyneuropathy. It’s probably caused by high levels of glucose in your blood damaging the tiny blood vessels that supply your nerves.

Peripheral neuropathy becomes more likely the longer you’ve had diabetes. Up to one in every four people with the condition experience some pain caused by nerve damage.

If you have diabetes, your risk of polyneuropathy is higher if your blood sugar is poorly controlled or you smoke, regularly consume large amounts of alcohol and/or are over 40 years old

If you have diabetes, you should examine your own feet regularly to check for ulcers (open wounds or sores.

Other Causes

As well as diabetes, there are many other possible causes of peripheral neuropathy.

Some of the health conditions that can cause peripheral neuropathy include:

  • Excessive alcohol drinking for years
  • Low levels of vitamin B12 or other vitamins
  • Physical damage to the nerves; such as from an injury or during surgery
  • An underactive thyroid gland(hypothyroidism)
  • Specific infections – such as shingles, Lyme disease, diphtheria, botulism and HIV
  • Inflammation of the blood vessels (vasculitis)
  • Chronic liver disease or chronic kidney disease
  • Monoclonal gammopathy of undetermined significance (MGUS) – the presence of an abnormal protein in the blood
  • Certain types of cancer, such as lymphoma (a cancer of the lymphatic system) and multiple myeloma (a type of bone marrow cancer)
  • Charcot-Marie-Tooth (CMT) disease and other types of hereditary motor sensory neuropathy – genetic conditions that cause nerve damage, particularly in the feet
  • High levels of toxins in your body, such as arsenic, lead or mercury
  • Guillain-Barré syndrome – a rare condition that causes rapid onset of paralysis within days
  • Amyloidosis – a group of rare but serious conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body
  • Conditions caused by overactivity of the immune system – such as rheumatoid arthritis, lupus or Sjogren’s syndrome

Medication

A few medications may sometimes cause peripheral neuropathy as a side effect in some people. These include:
• Several types of chemotherapy for cancer – especially for bowel cancer, lymphoma or myeloma
• Several antibiotics, if taken for months – such as metronidazole or nitrofurantoin
• Phenytoin – used to treat epilepsy – if taken for a long time
• Amiodarone and thalidomide

How to diagnose neuropathy

Confirming if you have a neuropathy

A neurological testing specialist will conduct nerve tests including:

  • Nerve Conduction Velocity test (NCV) – where small metal wires called electrodes are placed on your skin which release tiny electric shocks that stimulate your nerves; the speed and strength of the nerve signal is measured
  • Electromyography (EMG) – where a small needle is inserted through your skin into your muscle and used to measure the electrical activity of your muscles NCS and EMG are usually carried out at the same time.

Identifying the cause of a neuropathy

Your Family Doctor usually has a good understanding of what is the underlying cause of a peripheral neuropathy. If diabetes is suspected, they can usually make an initial diagnosis based on your symptoms, a physical examination and checking the levels of glucose in your blood and urine. The confirmatory testing is then the EMG/NCV Test.

If you’re taking a medication known to cause peripheral neuropathy, your Family Docotr may temporarily stop or reduce your dose to see whether your symptoms improve. Occasionally, a nerve biopsy may be carried out as part of your diagnosis. This is a minor surgical procedure where a small sample of a peripheral nerve is removed from near your ankle so it can be examined under a microscope. It’s then checked for changes that could be a sign of certain types of peripheral neuropathy. However, nerve biopsies are rarely needed.