peripheral neuropathy/sensory symptoms study

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Vol. 164 No. 9, May 10, 2004 Arch Intern Med. 2004;164:1021-1025.

Original Investigation

The Diagnostic Yield of a Standardized Approach to

Idiopathic Sensory-Predominant Neuropathy

A. Gordon , MD; J. Singleton, MD

Background: Peripheral neuropathy is a common problem that often

prompts a lengthy

and expensive diagnostic evaluation. A rational, evidence-based

diagnostic approach

to peripheral neuropathy is desirable. Prior studies have focused on all

patients

presenting to a tertiary referral center with a diagnosis of

unclassified neuropathy.

However, most patients with peripheral neuropathy have primarily sensory

symptoms.

This study focuses on patients with sensory-predominant neuropathy. The

goal was to

develop a focused diagnostic algorithm that can be easily applied in a

general medical

setting.

Methods: Patients referred with predominantly sensory symptoms and no

previously defined cause were included and evaluated using a standard

diagnostic approach.

Results: Among 138 patients, 25% had at least 1 first-degree relative

with symptoms suggestive of neuropathy. Among laboratory studies, a

2-hour oral glucose tolerance test had the highest diagnostic yield

(61%) and was more sensitive than other measures of glucose metabolism.

Vitamin B12 deficiency was identified in 2 patients. Results of serum

protein electrophoresis, immunofixation, and antinuclear antibody

testing were abnormal in less than 5% of patients, and these rates are

similar to those found in the general population. Using this approach,

only 31% of patients completing the recommended evaluation were found to

have an idiopathic neuropathy.

Conclusions: Patients with sensory-predominant neuropathy should be

tested for glucose tolerance and vitamin B12 concentration. The

significance of abnormalities of serum protein electrophoresis and

antinuclear antibodies is uncertain. Other tests should be performed

only when the clinical scenario is suggestive. Patients with atypical

features may benefit from referral to a peripheral neuropathy center.

From the Departments of Neurology (Drs and Singleton) and

Pathology (Dr ), University of Utah School of Medicine, Salt Lake

City. The authors have no relevant financial interest in this article.