The Diagnostic Yield of a Standardized Approach to Idiopathic Sensory-Predominant Neuropathy

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Abstract
Peripheral neuropathy is one of the most common neurologic disorders encountered in general medical practice. Population-based estimates suggest that at least 2% to 7% of individuals may have neuropathy.1,2 Although peripheral neuropathy is common, its evaluation frequently provokes feelings of diagnostic nihilism. Patients often undergo an extensive and expensive evaluation that frequently fails to reveal a definitive cause, and up to 50% of patients are left with a diagnosis of idiopathic neuropathy.3,4 Several investigators have demonstrated an improved diagnostic yield with thorough evaluation of peripheral neuropathy and several rational diagnostic algorithms have been suggested.5 These algorithms are largely based on identification of atypical features such as prominent weakness, asymmetry, proximal involvement, or autonomic failure, and accurate diagnosis often requires experience and expertise in peripheral nerve disease. Development of an algorithm that can be easily used in the primary care setting is desirable to minimize unnecessary laboratory testing and increase diagnostic yield prior to referral to a specialty peripheral neuropathy clinic. Most patients with peripheral neuropathy have a distal sensory-predominant axonal neuropathy that is symmetric, often painful, and associated with minimal weakness, if any. We hypothesize that patients with this common neuropathy pattern only require a limited diagnostic evaluation. In this study, we evaluated a simple and minimal diagnostic approach to this common problem.