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Advances in diagnosis and management of distal sensory polyneuropathies
Journal article   Open access   Peer reviewed

Advances in diagnosis and management of distal sensory polyneuropathies

Matthew Silsby, Eva L Feldman, Richard D Dortch, Alison Roth, Simon Haroutounian, Yusuf A Rajabally, Steve Vucic, Michael E Shy, Anne Louise Oaklander and Neil G Simon
Journal of neurology, neurosurgery and psychiatry, Vol.94(12), pp.1025-1039
12/2023
DOI: 10.1136/jnnp-2021-328489
PMCID: PMC10544692
PMID: 36997315
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC10544692/pdf/nihms-1896829.pdfView
Open Access

Abstract

Distal sensory polyneuropathy (DSP) is characterised by length-dependent, sensory-predominant symptoms and signs, including potentially disabling symmetric chronic pain, tingling and poor balance. Some patients also have or develop dysautonomia or motor involvement depending on whether large myelinated or small fibres are predominantly affected. Although highly prevalent, diagnosis and management can be challenging. While classic diabetes and toxic causes are well-recognised, there are increasingly diverse associations, including with dysimmune, rheumatological and neurodegenerative conditions. Approximately half of cases are initially considered idiopathic despite thorough evaluation, but often, the causes emerge later as new symptoms develop or testing advances, for instance with genetic approaches. Improving and standardising DSP metrics, as already accomplished for motor neuropathies, would permit in-clinic longitudinal tracking of natural history and treatment responses. Standardising phenotyping could advance research and facilitate trials of potential therapies, which lag so far. This review updates on recent advances and summarises current evidence for specific treatments.
Neuroimmunology NEUROGENETICS Neuromuscular NEUROPATHY PERIPHERAL NEUROPATHOLOGY

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