Causes of peripheral neuropathy: Diabetes and beyond

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Abstract

Leg paresthesias can be challenging to evaluate because of the varied causes and clinical presentations. This diagnostic guide with at-a-glance tables can help.

PRACTICE RECOMMENDATIONS

> When evaluating a patient with lower extremity numbness and tingling, order fasting blood glucose, vitamin B12 level with methylmalonic acid, and either serum protein electrophoresis (SPEP) or im- munofixation electrophoresis (IFE) because these test have a high diagnostic yield. (C)

PRACTICE RECOMMENDATIONS

> Obtain SPEP or IFE when evaluating all patients over age 60 with lower extremity paresthesias. (C)

PRACTICE RECOMMENDATIONS

> Consider prescribing pregabalinfor treating painful paresthesias because strong evidence supports its use; the evidence for gabapentin, sodium valproate, amitriptyline, venlafaxine, and duloxetine is moderate. (A)

Strength of recommendation (SOR)

(A) Good-quality patient-oriented evidence

Strength of recommendation (SOR)

(B) Inconsistent or limited-quality patient-oriented evidence

Strength of recommendation (SOR)

(C) Consensus, usual practice, opinion, disease-oriented evidence, case series

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