Severe(Uncomplicated Peripheral neuropathy)

Management escalation pathway

• Withhold ICPI and admit patient
• Initiate (methyl) prednisolone 2mg/kg i.v.
• Involve neurologist in care
• Respiratory function should be checked 6 x pd
• Daily or more frequent neurological review according to severity

Multidisciplinary team involvement:

• Physiotherapy, occupational therapy and speech therapy as appropriate, opthalmology review for ocular/cranial nerve issues
• Orthopedic devices (e.g. for foot drop) should be considered

Assessment and Investigations

• Neurologic consult within 24-48h
• 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