Acquired peripheral neuropathy.
The element of time is a crucial factor in the electrodiagnostic presentation of PN. The characteristic changes seen in various neuropathies evolve over time. If testing is performed very early in the course of the disease, abnormalities may not yet be present, in part, because the range of normal values for NCS parameters is broad. In addition, if the process is asymmetric, the affected nerves may not be sampled. Very late in the course of the disease, a multifocal process may appear diffuse and symmetric as the areas of focal involvement coalesce. A primarily, demyelinating process may begin to demonstrate secondary axonal involvement. In very severe neuropathies, it may become difficult to evoke any NCS responses to characterize the neuropathy. It is essential to place the electrodiagnostic findings within the context of the clinical progression to avoid drawing erroneous conclusions. Sometimes, the true nature of the neuropathy is clear only after sequential testing. The etiologic diagnoses of acquired polyneuropathy are vast. A well-crafted electrodiagnostic evaluation can categorize neuropathies into more specific diagnostic groups by identifying the descriptive diagnosis, significantly narrowing the list of possible etiologic diagnoses. Electrodiagnostic testing, which always starts with a pertinent history and physical examination, should always be viewed as a continuation and quantification of the physical examination. Only by knowing the extent and pattern of the clinical involvement is it possible to formulate a thorough electrodiagnostic evaluation. This knowledge is especially important in cases in which the presentation is multifocal, because the neuropathy can be missed entirely if the affected nerves are not evaluated. When evaluating a neuropathy, there are three important questions to answer: (1) Is the process diffuse or multifocal? (2) Is it demyelinating or axonal? (3) Does it predominantly involve the motor or sensory nerves? By assessing the neuropathy along these three axes, the large number of possible etiologic diagnoses becomes much more manageable.