Periperhal neuropathy plagues many diabetic patients and non-diabetic patients alike.
The typical patient that comes into my office with a diagnosis of neuropathy, has seen a neurologist or a primary care doctor that has given them this diagnosis, typically by assessment of the nerves in the legs and feet, during the course of a typical physical examination, with some concentration of the nerve patterns (dermatomes and myotomes) in the lower extremities, as well as a patient history.
Although this IS enough information to warrant a prescription of LYRICA, GABA, and the like, I would suggest that for some of these patients, it is not enough to tell if there condition may be reversible, at least in some part, through the usage of anything other than anti-seizure medications, as listed above.
I have seen many patients misdiagnosed with neuropathies that actually are suffering from radiculopathies or neuropathies!! The differences can be critcial when it comes to treatment!!
And, by the way, I hope you read that right, those drugs are anti-seizure drugs that are commonly prescribed for the treatment of peripheral neuropathies.
So, what are the 12 things that you should be tested for when creating a diagnosis of peripheral neuropathy?
The Toronto Clinical scoring system examination provides a very elaborate examination that quantifies the degree of defecit and neuropathy present in the patient. It quantifies the patients’ ability to detect sensations in the cutaneous (skin) nerves at the leg, knee and foot, and each limb is tested individually.
1. Patient History (usually taken in any physical examination)
2. A general examination consisting of vitals, organ systems, etc.. (usually done by any doctor)
3. Myotome (muscle grading) testing (usually performed in a neurological exam)
4. Dermatomes (skin sensation nerves) testing (usually, but not always, performed in a neurological exam)
5. Responses to “cool” sensations of the knee, leg, and foot
6. Responses to “Intense C0ld” sensations of the knee, leg, and foot
7. Responses to “Intense Heat” sensation of each knee, leg, and foot
8. Responses to “Sharpness” sensation of each knee, leg, and foot
9. Responses to “Vibration” sensation of each knee, leg, and foot
10. Responses to “Light touch” sensation of each knee, leg, and foot
11. Reflex testing of the patella and the achilles reflexes (generally in a regular physical exam)
Numbers 5-10 are exclusive to the toronto examination, a test not typically utilized by American Doctors.
In our clinic, when we suspect periperhal neuropathies, each patient is subjected to the Toronto Clinical Scoring System, and given a score for each of their legs and feet.
We use these scores to determine the proper treatments and protocols to help the patients. We also re-test the patients during and after their treatments, to monitor their progress and evaluate their improvement levels.
Yours in Health,