Should You Be Tested For Neuropathy, Or Is Your Story Enough?

Today's post from foundationforpn.org (see link below) looks at the sort of testing you might expect when you first go to the doctor with neuropathic symptoms. Now two things should be made clear here: the doctor may reach a conclusion and diagnose neuropathy based on your story, history and symptoms alone and many doctors will look at the expense and decide not to carry out many of the tests outlined below - deeming them unnecessary and often inconclusive. As a patient, you may be pleased that you're being taken seriously enough not to go onto the testing roundabout but similarly, you may feel that you have the right to be tested properly, in order to remove any doubt. The problem with this is that neuropathy always throws up doubts and in many cases the testing is not conclusive; leading to a diagnosis of idiopathic neuropathy ('idiopathic' meaning they can't establish the cause or even the extent of the nerve damage via the testing procedures.) It's a bit of a minefield for both doctor and patient. Generally, neuropathic symptoms are so specific that there's little doubt as to what's going wrong in your body - so saving time and heading straight for medical relief via pain killers and treatment may be an attractive option but if you have any doubts, you should at least attempt to press for some sort of testing, if only to rule other things out. Worth a read and I'd be interested to know how much you were tested before a diagnosis was established.

Evaluation + Tests
foundationforpn.org 2017

Before diagnosing peripheral neuropathy, your physician will review your medical history and conduct a physical exam and neurological evaluation.

A neurological evaluation, which consists of a number of simple and painless tests, is usually performed to diagnose peripheral neuropathy. Depending on your symptoms and outcome of the neurological evaluation, you may encounter other tests that can determine what type of peripheral neuropathy you have.

What is a Neurological Exam?

A neurological exam helps doctors to diagnose peripheral neuropathy and may include the following:

The history: questions concerning your symptoms and condition

An evaluation of neurological function
Diagnostic tests
Electrodiagnostic tests
Blood tests
Other common tests
 
History

You should be prepared to discuss your symptoms in detail with your doctor. Your doctor will ask you to describe your symptoms, when you experience them, how long the episodes last and the amount of discomfort or pain you experience. The more specific you can be about the tingling, numbness, weakness or other symptoms you are experiencing, the easier it will be for your doctor to understand your condition.

Your doctor may also ask you general health questions that may seem unrelated to your symptoms, but are, in fact, important. These questions could be about whether or not you feel faint, nauseated or tired. The doctor may also ask if your bladder control and sexual function are normal. You will also be asked if you are suffering from any other illnesses and if you are taking medications.

The physician will then perform a physical exam to test for loss of vibratory sensation. He or she will test ankle jerks and other reflexes. Sensations in the feet and hands will be evaluated with a pin.

Since some neuropathies are hereditary, you doctor will ask if other members of your family have suffered from any type of neuropathy or neurological disorder. 

Evaluation

A neurological evaluation consists of a physical exam and a number of simple and painless tests. The purpose of these tests is to assess your neurological function, including your muscle strength, how your autonomic nerves are functioning, and your ability to feel different sensations. 

Diagnostic testing

The neurologist may recommend certain diagnostic tests, depending on the patient’s symptoms, medical history and physical examination.

Frequently the neurologist will recommend electrodiagnostic testing to measure the electrical activity of muscles and nerves. If necessary, the neurologist may also recommend a nerve biopsy, a spinal tap or magnetic resonance imaging (MRI). However, for some patients with longstanding neuropathy, the cause may not be found in spite of extensive tests and examinations.

Electrodiagnostic test

Electrodiagnostic tests measure the electrical activity of muscles and nerves. By measuring the electrical activity they are able to determine if there is nerve damage, the extent of the damage and potentially the cause of the damage. Frequently the neurologist will recommend common, noninvasive neurological evaluations such as electromyography (EMG) and nerve conduction velocity (NCV) testing. 

Blood tests

Blood tests are commonly employed to check for vitamin deficiencies, toxic elements and evidence of an abnormal immune response.

Depending on your individual situation, your doctor may request certain laboratory tests to identify potentially treatable causes for neuropathy. These include tests for:

Vitamin B12 and folate levels
Thyroid, liver and kidney functions
Vasculitis evaluation
Oral glucose tolerance test
Antibodies to nerve components (e.g., anti-MAG antibody)
Antibodies related to celiac disease
Lyme disease
HIV/AIDS
Hepatitis C and B
Other common tests

If your doctor suspects that you have a specific type of neuropathy, an advanced case of neuropathy, or an entirely different condition, it may be suggested that you undergo additional testing. Your doctor may recommend quantitative sensory testing (QST) and autonomic testing, or other tests to diagnose a specific disorder.

Evaluation + Tests

Autonomic Testing

Evaluation of how the systems in the body controlled by the autonomic nerves respond to stimulation.

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Nerve, Skin, Muscle, Tissue Biopsy

Samples of nerves, skin, muscle or other tissues are examined to identify and diagnose various disorders.

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Electrodiagnostic Testing

Measures the electrical activity of muscles and nerves to determine if there is nerve damage.

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Lumbar Puncture

Method of collecting a sample of a patient’s spinal fluid to identify the presence of an autoimmune disorder.

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Imaging

These tests create images of the body and its organs that may be used in the diagnosis or exclusion of disorders with similar symptoms.

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Quantitative Sensory Testing (QST)

Used to diagnose and assess the severity of nerve damage, especially in the small nerve endings.

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https://www.foundationforpn.org/what-is-peripheral-neuropathy/evaluation-and-tests/