As promised, Neuro letter follow up:

Further to my letter of 5th August, I had a telephone and Zoom consultation with Mr [BEEP] –
he presents with symptoms which came on after a chest infection. This seemed to involve
the sural nerve territory but also the small fibres.
1. Detailed neurophysiological studies looking for abnormalities of large fibres but also
small fibre by Professor Martin Koltzenburg were normal.
2. Blood tests that were done which were normal or negative included LGI1 and
CASPR2 antibodies as he complained of fasciculations, although he has no cramp.
The calcium was normal, phosphate a little reduced at 0.86, magnesium normal,
thyroid function normal, vitamin D levels normal.
The symptoms he complains of are that of intermittent itchiness, tingling sensation, hot and
cold patches which are intermittent and can occur all over his body. He also has twitching
in the arms, forearms, eyelids and knees.
The working diagnosis here is that of a post-infectious neuropathic syndrome which seems
to affect small fibres and to a lesser extent large fibres. These are functional abnormalities as
structurally the nerves are normal, neurophysiologically.
My impression is this is a monophasic type illness and should resolve with time.
At the present time I see no indication for a skin biopsy.
We discussed treatment options and I certainly do not think he warrants treatment with
intravenous immunoglobulin or corticosteroids.
However, he is bothered by the symptoms and therefore I would recommend a trial of
Gabapentin, starting at 100mg in the evening for 3 days, then going up to 100mg BD for 3
days and then 100mg three times a day. The dose can be gradually titrated up to 600mg
three times a day. I have discussed the side effects of tiredness and perhaps weight gain.
On the whole, however, this drug is well tolerated.
If that fails, he could consider trying Pregabalin starting at 25mg at night, increasing after 3
days to 25mg BD, then 25mg in the morning 50mg in the evening for 3 days, then 50mg BD,
gradually titrating the dose up to 300mg BD.
I would therefore be grateful if you would give him a trial of these symptomatic treatments.
He will get in touch with me if he feels he requires a further appointment or any further
advice, I shall be happy to review him.
Kind regards and best wishe