Diagnostic Evaluation

Screening laboratory studies in a distal, symmetric polyneuropathy may include a complete blood count, basic chemistries including serum electrolytes and tests of renal and hepatic function, fasting blood glucose, HbA1c, urinalysis, thyroid function tests, B12, folate, ESR, rheumatoid factor, antinuclear antibodies (ANA), serum protein electrophoresis (SPEP) and immunoelectrophoresis or immunofixation, and urine for Bence Jones protein. An oral glucose tolerance test is indicated in pts with painful sensory neuropathies even if other screens for diabetes are negative.

Tests to further characterize the neuropathy include nerve conduction studies (NCS), electromyography (EMG), sural nerve biopsy, muscle biopsy, skin biopsies, and quantitative sensory testing. Diagnostic tests are more likely to be informative in pts with asymmetric, motor-predominant, rapid-onset, or demyelinating neuropathies.

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