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CLINICAL NEUROPHYSIOLOGY SOCIETY OF SOUTH AFRICA

Discussion on Peripheral Neuropathy Protocol

  • 12 Jun 2020 10:21
    Message # 9032421
    Anonymous

    A lot of the patients who are referred for nerve conduction studies and EMG, comes with a question to assess for possible peripheral neuropathy.

    I would like to use this forum to discuss the different protocols available, and try to establish minimum standards for us to use.

    Please look at the recent publication in Clinical Neurophysiology Practice, and comment on the findings as well as your experience.

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  • 15 Jun 2020 21:55
    Reply # 9039051 on 9032421

    For DSP, this old article (p. 120) of 2005 is incredibly useful. In my own experience, the NCV of n fibularis is more sensitive than that of posterior tibialis. The differences with your article probably relates to technique. 

    However, it is important to understand if your referring doctor wants to confirm a very suggestive clinical picture of DSP, or needs assistance to distinguish between several different kinds of neuropathy, etc. If it is important to define the distribution of demyelination along the length of a nerve, the distribution of A-waves in poterior tibialis late responses is over-sensitive but very informative about distribution.

    Age-related disappearance of sural responses makes this relatively useless. Prof Stålberg mentioned another nerve on the foot which is similarly sensitive and retained much better beyond 60 years of age.

    At the end, each patient is unique, and brings along his or her own physical built and risks, which makes it less efficient to try to set a protocol down that will work for everybody.

    I hope this helps!

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