Moderate (Uncomplicated Peripheral Neuropathy)

Overview

Moderate

Some interference with activities of daily living, symptoms concering to patient

Management escalation pathway

Withhold ICPI
Initial observation reasonable or initiate prednisolone 0.5 to 1mg/kg (if progressing, e.g. from mild) and/or duloxetine for pain
Only consider resuming ICPI after multidisciplinary discussion
If no clinical improvement after 48h, manage as severe

Advice on steroid wean

Conversion from i.v. to oral steroids at clinician discretion once improvement is noted
Suggested oral prednisolone taper for 4-8 weeks
Consider PJP prophylaxis, vitamin D if > 4-weeks duration

Assessment and Investigations

Neurologic consult
Patient history : diabetes, alcohol, medication
EMG
Blood analysis : diabetic screen, Vitamine B12/folate, immunoelectrophoresis/ immunofixation, renal function, hematology, autoimmune serology, serology for lyme and HIV
Lumbar puncture
MR spine/brain to exclude other causes

Choose mild Choose severe

Abbrevations

CMV: Cytomegalovirus

CIDP: Chronic Inflammatory Demyelinating Polyneuropathy

GBS: Guillain-Barré Syndrome

PJP: Pneumocystis Jirovei Pneumopathy