Chronic idiopathic polyneuropathy presenting in middle or old age: a clinical and electrophysiological study of 75 patients.

Abstract

The clinical and electrophysiological features were prospectively studied of 75 patients (46 men and 29 women) with chronic polyneuropathy presenting in middle or old age in whom a diagnosis could not be made even after extensive evaluation and a follow up of six months. The mean age at the onset of symptoms was 56'5 years. The clinical features of chronic idiopathic polyneuropathy are heterogeneous. On clinical grounds 44 patients had a sensorimotor, 29 patients a sensory, and two patients a motor polyneuropathy. The overall clinical course in chronic idiopathic polyneuropathy was slowly progressive. None of the patients became severely disabled. Electrophysiological and nerve biopsy studies were compatible with an axonal polyneuropathy. Antibodies against myelin associated glycoprotein, gangliosides, and sulphatides were assessed in 70 patients and found to be negative.

Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of laboratory and genetic testing (an evidence-based review)

“…Two Class III studies showed that routine CSF analysis had a low diagnostic yield except in demyelinating polyneuropathies, which usually showed an increased CSF protein level. 5,8 Vitamin B12 deficiency was relatively frequent in patients with polyneuropathy, and the yield was greater when the metabolites of cobalamin (methylmalonic acid and homocysteine) were tested (Class II and III). 4,[14][15][16][17] Serum methylmalonic acid and homocysteine were elevated in 5-10% of patients whose serum B12 levels were in the low normal range of 200 -500 pg/dL.…”

“…10 The majority of studies indicated that screening laboratory tests comprised of a complete blood count, erythrocyte sedimentation rate, comprehensive metabolic panel (blood glucose, renal function, liver function), thyroid function tests, serum B12, and serum protein immunofixation electrophoresis are indicated for most patients with polyneuropathy. [4][5][6][7][8][9][10][11][12][13] Five Class III studies indicated that the highest yield of abnormality was seen with screening for blood glucose, serum B12, and serum protein immunofixation electrophoresis. 4,6,10,13,14 The test with the highest yield was the blood glucose, consistent with the well-known fact that diabetes mellitus is the most common cause of DSP.…”

“…Such a comprehensive investigation yields an etiologic diagnosis in 74 to 82% of patients with polyneuropathy. [4][5][6][7][8][9][10][11][12][13] Laboratory test results must be interpreted in the context of other clinical information since the etiologic yield of laboratory testing alone is limited by the low specificity of many of the tests. For example, one study of idiopathic polyneuropathy found that laboratory tests alone had only a 37% diagnostic yield (Class III).…”

Sural nerve T-cell receptor Vβ gene utilization in chronic inflammatory demyelinating polyneuropathy and vasculitic neuropathy

“…CIAP has a slowly progressive course, and during a 5-year follow-up no cause was found. 22,23 Clinical data of patients are listed in table 1. Biopsy findings were not used to assign diagnoses except in cases of vasculitis, for which well-established morphological criteria exist.…”

Thermogram of idiopathic segmental anhidrosis

“…All patients with polyneuropathy and M-protein without other causes of the neuropathy were included after signed informed consent. 13 In all patients the initial workup included 1) medical history, 2) neurologic examination, 3) routine laboratory analysis, 4) electrophysiologic studies, including nerve conduction and concentric needle examination using standardized techniques, identifying a predominantly axonal or demyelinating neuropathy according to the criteria of the American Academy of Neurology (AAN), 14,15 5) a survey for M-protein by immunofixation of serum and 10 x concentrated urine, 6) antibody reactivity, 16,17 7) physical examination by a hematologist, 8) skeletal X-ray, 9) X-ray of the lungs, 10) sonography or CT scan of the abdomen (on indication), and 11) bone marrow investigation. Bone marrow as-pirates and biopsies were obtained from the crista iliaca posterior and viewed by a pathologist.…”