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Answers from the Lab

Advancing Neuropathy Diagnosis With Laboratory Testing and Algorithms: Div Dubey, M.B.B.S

·16 min·1 clip
Dr. Div Dube reveals that up to 10% of people over 70 have peripheral neuropathy, a puzzling condition affecting millions.
The episode begins with host Dr. Bobbi Pritt introducing Dr. Div Dube, a neurologist and co-director of the Clinical Neuroimmunology Laboratory at Mayo Clinic. Dr. Dube defines peripheral neuropathy as conditions affecting peripheral nerves that control motor, sensory, and autonomic functions. He notes its prevalence is up to 3% in the general population and 10% in those over 70. Diagnosis is complex due to varied presentations and thousands of potential causes, with electrodiagnostic studies like EMG sometimes missing small fiber neuropathies. Early diagnosis is crucial for treatable forms, such as autoimmune neuropathies like CIDP or Guillain-Barre syndrome, where symptoms like rapid progression, asymmetric weakness, or severe pain are key indicators. Laboratory tests complement clinical tools by targeting causes based on presentation, including checks for diabetes, B12 deficiency, or monoclonal gammopathy. Mayo Clinic employs diagnostic algorithms to optimize testing, focusing on phenotypes to avoid false positives and reduce costs. For example, genetic testing might start with PMP22 for LHNPP, while autoimmune testing uses antibody panels. Dr. Dube describes the lab's pipeline for discovering and validating new antibodies, using assays like ELISA to translate research into clinical tests with high specificity. The episode concludes with a discussion on multidisciplinary care for neuropathy, involving physical medicine and rehabilitation, and the ongoing reduction of idiopathic cases through improved diagnostics.

As heard by us

A focused look at how symptom patterns guide neuropathy testing and clinical decision-making.

Peripheral neuropathy can be hard to pin down because the same broad complaint may point to very different causes. This Answers from the Lab episode keeps its focus on the testing logic, with Dr.

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Want to know why the shape of peripheral neuropathy changes the lab workup?

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