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2015 ; 314
(20
): 2172-81
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Distal Symmetric Polyneuropathy: A Review
#MMPMID26599185
Callaghan BC
; Price RS
; Feldman EL
JAMA
2015[Nov]; 314
(20
): 2172-81
PMID26599185
show ga
IMPORTANCE: Peripheral neuropathy is a highly prevalent and morbid condition
affecting 2% to 7% of the population. Patients frequently experience pain and are
at risk of falls, ulcerations, and amputations. We aimed to review recent
diagnostic and therapeutic advances in distal symmetric polyneuropathy, the most
common subtype of peripheral neuropathy. OBSERVATIONS: Current evidence supports
limited routine laboratory testing in patients with distal symmetric
polyneuropathy. Patients without a known cause should undergo a complete blood
cell count, comprehensive metabolic panel, vitamin B12 measurement, serum protein
electrophoresis with immunofixation, fasting glucose measurement, and glucose
tolerance test. The presence of atypical features such as asymmetry, non-length
dependence, motor predominance, acute or subacute onset, and prominent autonomic
involvement should prompt a consultation with a neurologist or neuromuscular
specialist. Electrodiagnostic tests and magnetic resonance imaging of the
neuroaxis contribute substantial cost to the diagnostic evaluation, but evidence
supporting their use is lacking. Strong evidence supports the use of tricyclic
antidepressants, serotonin norepinephrine reuptake inhibitors, and voltage-gated
calcium channel ligands in the treatment of neuropathic pain. More intensive
glucose control substantially reduces the incidence of distal symmetric
polyneuropathy in patients with type 1 diabetes but not in those with type 2
diabetes. CONCLUSIONS AND RELEVANCE: The opportunity exists to improve
guideline-concordant testing in patients with distal symmetric polyneuropathy.
Moreover, the role of electrodiagnostic tests needs to be further defined, and
interventions to reduce magnetic resonance imaging use in this population are
needed. Even though several efficacious medications exist for neuropathic pain
treatment, pain is still underrecognized and undertreated. New disease-modifying
medications are needed to prevent and treat peripheral neuropathy, particularly
in type 2 diabetes.
|Antidepressive Agents/therapeutic use
[MESH]
|Calcium Channel Blockers/therapeutic use
[MESH]
|Diabetes Mellitus, Type 1/complications/drug therapy
[MESH]
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