Peripheral Neuropathy Diagnosis
Peripheral Neuropathy is primarily a clinical diagnosis
That is, the diagnosis is made by symptoms and physical examination rather than what you may think of as traditional laboratory tests. Tingling, burning and numbness are the complaints physicians hear most often.The disease state can quickly progress to impact activities of normal daily life including sleep, balance, walking and sexual function. Loss of sensation is most common in the lower extremities, putting the patient at risk for serious complications because the protective mechanisms are therefore lost. It can lead to ulcerations and collapse of the joints of the foot, and is the primary cause of non-traumatic limb loss in the United States. Neuropathy is the single most reliable predictor of lower extremity amputation in the diabetic population.
Light touch is often lost from distalmost extremities, and is bilaterlaly symmetrical. That means it starts at the tips of your toes and affects both sides fairly equally. Here is something you can try: Use the bristle of a paint brush. With your eyes closed, ask a friend to touch different areas of your feet. Did you feel it?
Close your eyes when standing on both feet in a protected area. Do you sway or stumble? This can be a sign of loss of proprioception, an important sensory feedback loop..
Sural nerve neurometry is gaining acceptance as well. With a hand held device in the office setting, the nerve function can be evaluated in a 2 minute procedure. Neurometry can be repeated to follow the progress of therapy.Epidermal nerve fiber density testing (ENFDT) is the gold standard. This involves taking a punch biopsy of the sural nerve, and sending it to a specialized pathology lab, where the sample is compared to a control group. Results will show the number of nerve fibers present. This test can also be helpful in following the progress of treatment..