LABORATORY TESTING IN PERIPHERAL NERVE DISEASE - 11/09/11

Doi : 10.1016/S0733-8619(05)70246-2

John W. Griffin, MD ^{^{*
From the Department of neurology, the Johns Hopkins University School of medicine, Baltimore, Maryland}}, Sung-Tsang Hsieh, MD, PhD ^{^{*
From the Department of neurology, the Johns Hopkins University School of medicine, Baltimore, Maryland}}, Justin C. McArthur, MBBS, MPH ^{^{*
From the Department of neurology, the Johns Hopkins University School of medicine, Baltimore, Maryland}}, David R. Cornblath, MD ^{^{*
From the Department of neurology, the Johns Hopkins University School of medicine, Baltimore, Maryland}}

Resumen

The most successful peripheral nerve diagnosticians use a sequence of differential diagnosis that first classifies the patient's neuropathy clinically:^{19 Griffin J.W., Cornblath D.R. Diseases of the peripheral nervous system Comprehensive Neurology New York: Raven Press (1991).
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•

Time course

•	Acute
•	Subacute
•	Chronic
•	Lifelong

•

Functional modalities affected

•

Motor

•

Sensory

•	Large fiber
•	Small fiber
•	Global

•

Autonomic

•

Distribution

•	Distally predominant
•	Proximal involvement
•	Patchy

•	Age of onset
•	Family history
•	Other medical conditions

The next step is electrodiagnostic testing to evaluate the nature of the underlying pathophysiology, and the last, appropriate laboratory tests. The focus of this article is on the rational use of laboratory testing. The economic implications of unfocused laboratory testing deserve emphasis. It is possible to spend as much as $1000 on serologic testing for antiglycolipid antibodies alone, for example. For this reason, this article discusses both the rational and irrational use of laboratory tests.

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Esquema

ELECTRODIAGNOSTIC TESTING

QUANTITATIVE SENSORY TESTING

BLOOD TESTS

ANTIBODY ASSAYS

Antiglycolipid Antibodies

Anti-Hu Antibodies in Carcinomatous Sensory Neuronopathy

ANTICALCIUM CHANNEL ANTIBODIES IN THE LAMBERT-EATON SYNDROME

CUTANEOUS NERVE BIOPSIES

Vasculitis

Amyloidosis

SKIN BIOPSIES TO EXAMINE INTRACUTANEOUS INNERVATION

SUMMARY

Address reprint requests to John W. Griffin, MD, Department of Neurology, The Johns Hopkins Hospital, Meyer 6-109, 600 North Wolfe Street, Baltimore, MD 21287
This work was supported in part by NIH NS 26643, RR00722, and a grant from Genentech, Inc.