TY  - JOUR
T1  - Diagnosis of neuropathy: Comment on “tests and expenditures in the initial evaluation of peripheral neuropathy”
AU  - Smith A
Y1  - 2012/01/23
N1  - 10.1001/archinternmed.2011.1718
JO  - Archives of Internal Medicine
SP  - 132
EP  - 133
VL  - 172
IS  - 2
N2  - 
Peripheral neuropathy is one of the most common neurologic disorders, with a prevalence of approximately 15% in individuals older than 40 years.2 Neuropathy is the most common microvascular complication of diabetes mellitus, and one of the most disabling. In 2003, its direct health care costs were more than $13 billion.3 Diagnosis is based on a history and examination demonstrating “length-dependent” numbness and sensory loss (“stocking-glove distribution”). Nerve conduction studies (NCS) are the gold standard diagnostic test. Individuals with small-fiber neuropathy have painful dysesthesias, and results of NCS are frequently normal. In this situation, skin biopsy with assessment of intraepidermal nerve fiber is often ordered.4 There is growing literature to guide diagnostic evaluation. The American Academy of Neurology recently published a practice guideline supporting evaluation for diabetes mellitus, vitamin B12 deficiency, and monoclonal gammopathy in all patients.5 Several studies6 indicate that patients with idiopathic neuropathy have an elevated risk of impaired glucose tolerance. Thus, patients who have a normal laboratory evaluation should undergo oral glucose tolerance testing (OGTT). These recommendations are familiar to most neurologists, but do we follow them?

SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2011.1718
UR  - http://dx.doi.org/10.1001/archinternmed.2011.1718
ER  -