Autoimmune Diseases CIDPUSA

Neuropathy Testing

Tests in neuropathy

Peripheral Neuropathy guidelinesmost of neuropathy is really CIDP.
Table 10. Tests to Consider for Patients with Suspected Peripheral Neuropathy
Test IndicationsInterpretation
Laboratory
CBC, erythrocyte sedimentation rate Conduct in most patients Commonly abnormal in systemic disease. Erythroblastic anemia suggests vitamin B12 or folate deficiency; erythrocyte stippling suggests lead toxicity.
Blood sugar, hemoglobin A1C Suspected diabetic PN
Undiagnosed PN
Symptoms of neuropathy may be the first presentation of diabetes mellitus
Blood chemistry battery (e.g., SMA 20) Conduct in most patients Detects renal insufficiency and other metabolic disorders
Vitamin B12 levels Conduct in most patients
Suspected nutritional PN
CNS and posterior-column manifestations may obscure PN; folate treatment normalizes CBC, but does not prevent progressive neurologic injury
Serum protein electrophoresis Conduct in most patients If a paraprotein is identified, request a bone survey and consider bone biopsy to rule out multiple myeloma or osteosclerotic myeloma.
Serum creatinine kinase (CK) Suspected motor-neuron disease (MND) Moderate CK elevation is often supportive of MND diagnosis [6]
Serologic testing for syphilis, HIV, Lyme disease; tuberculin skin test; antinuclear antibodies; urine tests for aminolevulinic acid, porphobilinogen; urine immunoelectrophoresis; 24-hr urine test for heavy metals (Pb, TI, As) In selected patients with suggestive clinical indications Yield is very low in the absence of specific clinical indications
Cerebral spinal fluid examination May be particularly helpful in patients with predominant sensory neuropathy, with or without corticospinal findings, and in paraneoplastic neuropathies [5] CSF protein will be elevated in >90% of patients with acute and chronic inflammatory demyelinating polyneuropathy; it is also frequently elevated in paraneoplastic sensory neuropathy [21]. Elevated total protein with <5 cells/mm3 suggest Gullain-Barre syndrome or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
Radiologic
MRI Suspected nerve compression (e.g., carpal tunnel syndrome) Used primarily to confirm peripheral-nerve entrapments/compressions or root disease
Invasive
Nerve biopsy Considered when there is a specific diagnosis in mind or when no etiology is evident from serologic and electrodiagnostic tests Diagnostic abnormalities present in [2]:
Vasculitis
Amyloidosis
Sarcoidosis
Leprosy
Hereditary neuropathy with liability to pressure palsies
Giant axonal neuropathy
Metachromatic leukodystrophy
Paraproteinemic neuropathy
Tumor infiltration
Based on Bosch [2], Logigian [5], Barohn [6].

Table 11. Electrodiagnostic Studies: Key Measurements
Study Key measurement Nerves measured Important parameters
Motor conduction Compound muscle action potential (CMAP) Ulnar
Median
Peroneal
Posterior tibial
Latency
Amplitude
Conduction velocity
F wave
H reflex
Sensory conduction Sensory-nerve action potential (SNAP) Ulnar
Median
Radial
Sural
Latency
Amplitude
Needle electromyography Configuration and size of individual motor unit potentials Not relevant Spontaneous activity
Firing pattern
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