Apparently, the quantitative immunoglobulin test came back with increased IgG levels, and the specific analysis of these (that's what the SPEP is for) has noticed a broad but diffuse polyclonal response. That's consistent with the overall gamma globulin levels being high--and points to some sort of immunological reaction. It may be autoimmune, and it may be a reaction to an actual bacterial/viral invader (the IgG immunological response to pathogens tends to be longer-term than the IgM or IgA responses, so it's qutie possible if it is an invader, it's not currently acutely active).

The good thing here is that there were no monoclonal antibodies detected. Those, as I wrote about before, can often be associated with blood cancers. And they are well known to be associated with neuropathy. And--the negative anti-Hu test means his situation is unlikely to be linked to antibodies the body might be producing against tumors (particularly those of the lungs).

The part that polyclonal antibodies play in the development of neuropathy is less well-known, though it can be associated with cryoglobulins that come from infectious processes or from vascultic conditions:

http://www.neuro.wustl.edu/neuromusc...m#cryoglobulin

I would wonder, given this, if Dr. G would now titer him up for cryoglobulins and for some of the other vasculitic antibodies. If I remember correctly, he's already had a lot of those tests, and they were negative, but I dont know if all of them were included. She might also want to test his immune complement to look for signs of polyarteritis nodosa, another autoimmune vasculitic condition that can result in neuropathy:

http://www.neuro.wustl.edu/neuromusc...nimax.html#pan

(This is consistent, by the way, with the finding that he once has an anti-nuclear antibody titer. But I don't remember you mentioning that he had other symptoms that are often associated with this--fever, skin discolorations, kidney problems. But feel free to mention the cryoglobulin/polyarteritis possibility--and you can tell her it came from me, if you'd like.)

One other thing--was that 3-hour glucose value REALLY 38? That would be a major reactive hypoglycemic reaction, and that may signal an overproduction of insulin and some degree of insulin resistance.