New Guidelines on Testing for Neuropathy

New evidence-based guidelines have been issued by the American Academy of Neurology to test for distal symmetric polyneuropathy (DSP). Published in the December 3, 2008 issue of Neurology, the guidelines were developed upon review of 106 articles and abstracts by researchers from the AAN, American Association of Neuromuscular & Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

The review found that “a combination of laboratory and genetic blood tests and other specialized assessments like autonomic testing and nerve and skin biopsy appear to be the most helpful tests for finding the cause of DSP.”

“There are many people with a neuropathy who have been walking around for years without having been diagnosed and treated,” said lead author John D. England, MD, FAAN, in a press release. “Both neurologists and people with neuropathy need to know that the appropriate choice of tests is critical to accurate diagnosis.”

All patients experiencing numb and painful feet are recommended to undergo screening tests, particularly for vitamin B12, serum protein, and blood glucose levels, as those tests are often identify the most common causes of neuropathy.

Findings from the report:

• Autonomic testing should be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B).

• Nerve biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a nerve biopsy may be useful in the evaluation of DSP (Level U).

• Skin biopsy is a validated technique for determining intraepidermal nerve fiber density and may be considered for the diagnosis of DSP, particularly SFSN (Level C).

• There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.

Full guidelines and research can be found here.