Treatment of peripheral neuropathy
general - Answers depends on underlying cause,
Optimizing glycemic control can lessen the severity of diabetic peripheral neuropathy
drugs
treatment of peripheral neuropathy
drugs - Answers tricyclic antidepressants- off-label
gabapentin and pregabalin- fda approved for post herpetic neuralgia; preagablin also approved
for diabetic neuropathy
duloxetine- fda approved
tapentadol- fda approved
tramadol and opiods- off label
topical agents
rediculopathy - Answers compression of spinal root as it exits spinal cord
rediculopathy
in older adults may result from - Answers herniated disc
osteophyte
radiculopathy
pain characteristics - Answers pain may radiate down neck, back, arm or leg
has proximal arm weakness
radiculopathy
neurologic examination may revel - Answers motor and sensory defects
diminution of reflexes in the distribution of spinal roots
radiculopathy
what may help with diagnosis - Answers mri with contrast and lumbar puncture with cytology
may help
,radiculopathy
Acute Inflammatory Demyelinating Polyradiculoneuropathy - Answers aka guillain barre
syndrome
treat acutely with plasma exchange or IV immunoglobulin
radiculopathy
chronic inflammatory demyelinating polyradiculoneuropathy - Answers is a from of AIDP and
requres long term immunotherapy
radiculopathy
patient with diabetes - Answers may present with diabetic amyotrophy, a lumbosacral
polyradiculitis, and plexopathy
starts with subacute onset of severe neuropathic pain in the thighs, often asymmetric, followed
by proximal muscle weakness in the legs and eventual atrophy
Myopathy in peripheral neuropathies - Answers characterized by proximal muscle weakness,
wasting, and diminished or absent reflexes
can be accompanied by an increase in muscle enzymes, the myopathic pattern on
electromyogram, and an abnormal muscle biopsy
polymyositis - Answers disorder of skeletal muscle
muscle biopsy sows signs of lymphocytic inflitration and usually also myocyte degeneration
and regeneration
Prednisone is the treatment of choice, but should be used with caution in older adults
Myopathy
thyroid related - Answers weakness and wasting are greatest in the pelvic girdle muscles, and to
some extent, the muscles of the shoulder region
reflexes cam be normal, and dignosis is based on the distribution of muscle weakness
Improves with successful treatment of the underlying endocrine disorder, such as
hypothyroidism
myopathy
, drug induced - Answers example with corticosteroids, lipid-lowering agents, colchicine,
procainamide
high-dose statin drugs, rare but dose-related
amyotrophic lateral sclerosis - Answers progressive fatal neurodegenerative condition involving
both upper and lower motor neuron cell bodies
progressive weakness and wasting of skeletal muscles, often in combination with bulbar palsy
and respiratory failure
als common symptoms - Answers gait disturbance
falls
footdrop
weakness in grip
dysphagia
dysarthria
Electromyography demonstrates what is in ALS - Answers Findings consistent with diffuse
denervation and poor recruitment of motor units
als symptoms and age - Answers The incidence of motor neuron disease increases with age but
reaches a plateau around age 70,
Age remains the most clearly identifying risk factors for als
Incidence and prevalence compared to other neurodegenerative diseases are low
also presenting on exam - Answers combo upper motor neuron signs; hyperreflexia, clonus
extensor motor responses
lower neuron signs- weakness and atrophy of muscles
Weakness of the face and tongue is also very common
als differential diagnosis - Answers lesions at the level of the foramen magnum
combination of cervical myelopathy associated with cervical and lumbar polyradiculopathies
motor predominant peripheral polyneuropathy
als survival - Answers 2-3 years, presence of bulbar weakness carries a poorer prognosis