Accuracy Of Ncv Ul+ll And S+m Tests In Peripheral Neuropathy

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Iqbal Singh Says:
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I was under treatment with of thalidomide from November to March 2012, for obscure GI bleeding. This bleeding started after GI ENDOSCOPY of stomach.

The thalidomide administration was stopped as I developed tingling, numbness, wet floor feeling , sensation of electric current etc and was advised
Nervigen D initially for three months and then Gabapantinine 200 for two months.

Since there was no improvement , I consulted Neurologist at Apolo Indrsprastha Hospital New Delhi. I was advised following tests:

1. S. B12, S.Vi+D3
2. NCV, UL+VL, S+M

Conclusions are:

1. Vit B12 > 2000 pg/ ml
2. Vit D. 32.40. nmol / L

Evaluated for Sensory deafferentation ataxia. Conclusions:

1) Sensory NCVs revealed a background axonal peripheral neuropathy , moderately severe in the arm/ hands, and severe in the legs/ feet, mostly symmetric.

2) In contrast , motor NCVs in all limbs , and bilateral F- waves ( APN/AHB) were Normal.

3). The ability to elicit robust H- Reflexes suggests possible myelopathy (SACD).

Stopped all earlier medicines and now prescribed:

A. Maxgalin 50 O----O
B. Tayo 60K 1 tab/ wk for 2 month.

Am I going to be as normal as I was before administration of Thalidomide.

I am 64 plus. I stopped smoking in 1992. I stopped drinking in 2003 April.

Please advise.



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Iqbal S. Says:
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I underwent GJ AND TRUNCAL VEGOTOMY IN Jan 1978.

Of late I was frequently having complaints of low Hb levels, which used to restore back to about 12.5 g/dL with administration of multi vitamin tablets.

I was under examination for low Hb (6.5 to 7.5 g/ dL) level at Dept of Gestroentrology, Sitarama Bhartia Hospital, New Delhi, India.

Occult blood test was negative.

Endoscopy and Colonoscopy was done. No abnormality was observed in Colonoscopy. However, endoscopy revealed nodule at GI SITE. Biopsy was done. Results suspected malignancy and therefore biopsy was done once again. No abnormality was reported. However, I became unconscious within two to three hours of biopsy and was taken to emergency wing from OPD. The Hb level came down to 4.5 g/dL so blood was transfused. However, I was discharged from the hospital after four days of treatment . Hb level was restored to 9 g/ dL. However, my condition detoriated same night and therefore was admitted to Appllo Indraprastha Hospital, New Delhi next day.

Hb level was found out to be 4.5 g/dL.

All possible tests related to diagnosing reasons for low Hb levels were conducted. Like :

1. endoscopy of upper GI AND biopsy for Iron deficiency anemia. --------- no abnormality.
2. Folate (Chemiluminescence): > 20.00 ng/ml
3. Ultrasound whole abdomen: normal.
4. CT Angiography of abdomen: all normal.
5. Colonoscopy : exact cause of bleeding could not be identified.

Diagnosis: ------ possibility of a vascular lesion was suspected.

Advised:

Thalidomide 50 mg---- 100 mg, pentocid 40 1----0,
FeriumXT 0-------1,
Zavit. 1-----0

Besides, I was administered five units of blood at Hospital.

When Hb level stabilized at 8 g/dL was discharged after 15 days, Hb having stabilized.

I was under treatment with of thalidomide from November 2012 to March 2013, for obscure GI bleeding.

The thalidomide administration was stopped as I developed tingling, numbness, wet floor feeling , feeling of gloves and stockings, sensation of electric current etc.

I was advised: Nervigen D initially for three months and then Gabapantinine 200 for two months.

Since there was no improvement, I consulted Neurologist at Apolo Indrsprastha Hospital New Delhi. I was advised following tests:

1. S. B12, S.Vi+D3
2. NCV, UL+VL, S+M

Conclusions are:

1. Vit B12 > 2000 pg/ ml
2. Vit D. 32.40. nmol / L

Evaluated for Sensory deafferentation ataxia. Conclusions:

1) Sensory NCVs revealed a background axonal peripheral neuropathy , moderately severe in the arm/ hands, and severe in the legs/ feet, mostly symmetric.

2) In contrast , motor NCVs in all limbs , and bilateral F- waves ( APN/AHB) were Normal.

3). The ability to elicit robust H- Reflexes suggests possible myelopathy (SACD).

Stopped all earlier medicines and now prescribed:

A. Maxgalin 50 O----O
B. Tayo 60K 1 tab/ wk for 2 month.

I had no past experience of obscure GI BLEEDING prior to first biopsy.

I had no past experience of peripheral neuropathy symptoms before I was administered thalidomide.

My query: Can some specialist advise me if I am going to be normal as I was before administration of Thalidomide.

I am 64 plus. I stopped smoking in 1992. I stopped drinking in 2003 April.

Please advise.

Iqbal,
{edited for privacy}


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