Table 1.
Diagnostic Information
| Pt. # | Age | Sex | Diagnosis | Symptom duration | Diagnostic workup | EMG findings | Failed treatments |
|---|---|---|---|---|---|---|---|
| 1 | 24 | F | Idiopathic small-fiber neuropathy | 9 years | Serologic testing Urine heavy metals Abdominal fat pad biopsy MRI of brain & of cervical, thoracic & lumbar spine |
(1) NCS of left arm & leg Unremarkable (2) NCS/EMG of right leg Unremarkable |
Gabapentin: 2400 mg daily Methylprednisolone: 1 g 1–2-day course, 1–4 times per year, × 7 years Nortriptyline: 30 mg nightly Citalopram: 20 mg daily Hydrocodone/acetaminophen: 5–500 prn |
| 2 | 43 | M | Idiopathic small-fiber neuropathy | 20 years | Serologic testing |
(1) NCS of left arm & leg Normal, with mildly prolonged peak latency of sural nerve, attributed to cold temperature (2) NCS/EMG of left arm & leg Normal sural latency; no evidence of large-fiber neuropathy |
Gabapentin: 300 mg daily Tramadol: 50 mg every 6 hours prn Vitamin E: Daily |
| 3 | 45 | M | Idiopathic small-fiber neuropathy | 10 months | Serologic testing CSF testing MRI of brain, & of cervical, thoracic & lumbar spine |
(1) NCS/EMG of right arm & leg No evidence of large-fiber neuropathy |
Gabapentin: 2700 mg daily, Amitriptyline: 75 mg at bedtime |
| 4 | 52 | F | Length-dependent axonal sensorimotor neuropathy & limited autonomic neuropathy | 4 years | Serologic testing Autonomic testing |
(1) NCS/EMG of left arm & leg Mild, axonal, length-dependent sensorimotor peripheral neuropathy |
Alpha-lipoic acid: Twice daily Vitamin E: Daily |
| 5 | 56 | M | Idiopathic small-fiber neuropathy | 6.5 years | Serologic testing MRI of cervical spine |
(1) NCS/EMG of right arm Negative for neuropathy or radiculopathy |
Gabapentin: 1800 mg daily Hydrocodone/acetaminophen: 5/300 mg daily prn Duloxetine: 60 mg daily Amitriptyline: 25 mg at bedtime |
| 6 | 57 | F | Idiopathic small-fiber neuropathy | 2 years | Serologic testing |
(1) NCS/EMG of left arm & leg No evidence of large-fiber neuropathy |
Alpha-lipoic acid: Twice daily Vitamin E: Daily |
| 7 | 58 | M | Length-dependent axonal sensorimotor neuropathy & idiopathic small-fiber neuropathy | 1 year & 9 months | Serologic testing Skin biopsy Autonomic testing, QST MRI of cervical & lumbar spine |
(1) NCS/EMG of left arm & leg Length-dependent sensorimotor axonal neuropathy |
Gabapentin: 2700 mg daily Alpha-lipoic acid: Twice daily Vitamin E: Daily |
| 8 | 64 | M | Anti-MAG neuropathy | 6 years | Serologic testing CSF testing |
(1) NCS/EMG of right arm & leg Very severe sensory predominant sensorimotor polyneuropathy |
IVIG: (4-day course) for 3 months Plasmapheresis: × 3 over 3 months Rituximab: 3 courses Gabapentin: 3600 mg daily Pregabalin: 600 mg daily Duloxetine: 60 mg daily Tramadol: 50 mg q6h as needed |
| 9 | 67 | M | Idiopathic small-fiber neuropathy | 7 years | Serologic testing Skin biopsy |
(1) NCS/EMG of left arm & leg Mild bilateral carpal tunnel syndrome; no evidence of large-fiber neuropathy |
Gabapentin: 2700 mg daily Alpha-lipoic acid: Twice daily, Coenzyme Q10 and vitamin E: daily Gluten-free & lactose-free diet: Ongoing |
| 10 | 69 | M | Length-dependent axonal sensorimotor neuropathy | 3 years | Serologic testing Autonomic testing |
(1) EMG × 2 Length-dependent, sensorimotor, axonal peripheral neuropathy |
Gabapentin: 1800 mg daily Oxycodone: 5 prn as needed at bedtime |
Pt., patient; EMG, electromyography; F, female; M, male; MRI, magnetic resonance imaging; NCS, nerve conduction study; prn, pro re nata (as needed); CSF, cerebrospinal fluid, QST, quantitation sensory testing; MAG, myelin-associated glycoprotein; IVIG, intravenous immunoglobulin.