[evandtwins]

I'll try to make a long story short. I began to experience PN symptoms in Jan. 1994 and had an extensive workup at that time, including at Mayo in MN. Findings were elevated CSF protein (92), elevated IgG 13.2, elevated albumin 73.5. CSF synthesis rate elevated at 12.07. Serum immunoelectrophoresis notable for a modest polyclonal increase in immunoglobulins. QSART reduced over the foot and spotty hypohydrosis.

Following were negative or normal: lyme, HIV, Vitamins E and B12, Hep A and B, TSH, rheumatoid, anti-SSA and SSV (and a bunch of others).

My neuropathy was stable and just a small nuisance for 18 years, then flared up horribly July 2012. It is very painful now to be on my feet, the fasciculations and burning are far more intense, and I get this strange, warm sensation only in my right lower leg intermittently. Also, lower back pain has flared up very bad over roughly the same period.

Recently, a skin biopsy confirmed reduce small fiber density.

20 years later, and still no diagnosis other than "idiopathic sensory neuropathy".

I would much appreciate any feedback on:

(i) any tests that I might discuss with my neurologist. 1994 was a long time ago and a lot has changed in the interim
(ii) ideas on what might have suddenly flared up this neuropathy so badly (other than the aforementioned bad back and the fact that I took a new job and can't stand one of my superiors.)

My thanks in advance for any assistance you could render

[glenntaj]

--to repeat those abnormal tests from some years ago; they point to an autoimmune possibility for the symptoms, which may have been dormant until recently.

In particular, you should get an immunofixation electrophoresis of serum and urine to check for rogue polycolonal and monoclonal proteins and cryoglobulins, which are associated with neuropathy through antibody cross reaction to nerve antigens. Moreover, there are now assays for antibodies specific to components of peripheral nerve that were not available 19 years ago. And an overall physical exam would probably be a good idea to eliminate something new.

Take a look at:

www.lizajane.org (particularly the immune section)

http://www.questdiagnostics.com/test...ripheralNeurop

[Koi13]

Originally Posted by glenntaj

--to repeat those abnormal tests from some years ago; they point to an autoimmune possibility for the symptoms, which may have been dormant until recently.

In particular, you should get an immunofixation electrophoresis of serum and urine to check for rogue polycolonal and monoclonal proteins and cryoglobulins, which are associated with neuropathy through antibody cross reaction to nerve antigens. Moreover, there are now assays for antibodies specific to components of peripheral nerve that were not available 19 years ago. And an overall physical exam would probably be a good idea to eliminate something new.

Take a look at:

www.lizajane.org (particularly the immune section)

http://www.questdiagnostics.com/test...ripheralNeurop

Are most of those tests through that Quest Lab a blood test or a spinal tap fluid test? Particularly the autoantibodies to peripheral nerve antigens.

[glenntaj]

--listed on that lab listing is serum (blood) test.

Most of those antibodies could also be looked for in a spinal tap, but most of the time a spinal tap would be done to look for other proteins more characteristic of problems with breakdown of myelin in the central nervous system, rather than the peripheral. (Brain and spinal cord myelin has a different lipid structure than that of peripheral nerve myelin.)