Can we call it cryptogenic sensory polyneuropathy??

A 49 year old male presented to OPD after having visited several doctors for his only one complaint that bothers him a lot is tingling sensation in different areas of the body, sometimes legs, hands etc He even adds he feels his legs muscles are moving, pushing at night He also adds that he has pain in his right elbow and right knee, which I attribute to raised uric acid History He has been given Vit B12 supplements a lot in the past and his Vit B12 is raised and is 1760, VIT D3 is Normal Only his S. URIC ACID IS RAISED - 8.12 Though he lives alone, but eats well, sleeps good and have a positive outlook towards life. No addictions in life Management I have given him a trial of Duloxetine 30mg to start with in morning for first week, then escalate to 60mg if not relieved and tolerated too I have added furic 40 for raised uric acid levels Please guide me for this paresthesia thing, ur experiences with duloxetine to treat leg pain, neuropathic pain etc

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Nice to learn the terminology of cruptogenic sensory polyneuropathy yes appears to be correct as a pt of solitary living is anyway for depression and thence neurological complaints Agree duolexitene +methycoblamine Doses as per response Yes gabapentin 300mg+nortryptiline 10mg can be added Stepup the doses of fabuoxate to 80mg Also add some NSAIDs like cap indomethacin or eterocoxib for artheralgia

Thanx dr Pushkar ji Bhomia
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? NEUROPATHY .. PEREPHERAL.. NEUROPATHY .. NEED'S.. NEUROLOGICAL EVALUATION .. NEUROTROPHIC VITAMINS.. GABAPENTIN.. SYMPTOMATIC T/T WITH CLINICAL CORRELATION ..

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There is a condition named cryptogenuc sensory neuropathy, usually occurring in old people after the age of 65 yrs. Distal numbness in the lower limbs from soles .This pt has tingling sensations in different areas of the body,some times in the hands ,some times legs and hence and hence one cannot diagnose this as sensory neuropathy. What about the physical exam. No mentioned about the motor system/ reflexes/ sensory exam.Is he ethanolic ? .Needs more history and physical exam findings

Peripheral neuropathy Uricosis Restless leg syndrome Hb1ac r/0 DM Methylcobalamin inj1500 mg od

Gabapantin300 mg hs
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Peripheral Neuropathy  Rx started Bruhatvatchintamani 2gm+chopchini churna 25gm +guduci churna 25gm +nagarmotha churna 25gm make 30doses & adviced to take 1 BD with amrutarishta....khreebala tail(101) for nasya...Mahanarayan tail for snehan..Dashamularishta 30ml BD...Majjbasti for 11 days..

This is a secondary symptom to involve somatic complains induced by organic cause may be have uric acid raised due to metabolic changes as Sugar levels,poor GFR functions,liver. And rule out gout, arthritis, Diabetes. Physician reference to require for uric acid raised. Then other consultants

Gabapentine 300 mg bd Pregabaline 75 mg bd Rest continue as he is a case of M D P

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Peripheral Neuropathy: Inj. optineurone im on A/D deep in gluteal region×7 such, A course of vit.D. Physiotherapy

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Medically Unexplained Symptoms (Somatoform disorder- Not Otherwise Specified) Tingling due to unexplained non organic pathology can be seen in cases of Nor epinephrine deficits at the synaptic levels. Duloxetine is a Serotonin Nor-epinephrine Re-uptake inhibitor that increases the levels of nor-epinephrine at the synapses. You have made the right choice by starting the gentleman on Duloxetine. Duloxetine can be tried up to 80 mg in this case.

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I AGREED DR.MANORAMA mam ,DR.SHIVRAJ sir , but i think may be PSYCHOLOGIST consultation needed

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