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JAMA Insights
July 7, 2020

Distal Symmetric Polyneuropathy in 2020

Author Affiliations
  • 1Department of Neurology, University of Michigan, Ann Arbor
  • 2Veterans Affairs Healthcare System, Ann Arbor, Michigan
  • 3Department of Neurology, University of Pennsylvania, Philadelphia
JAMA. 2020;324(1):90-91. doi:10.1001/jama.2020.0700

In the US, the prevalence of distal symmetric polyneuropathy (DSP) in 2015 was approximately 15% in individuals older than 40 years and approximately 30% among patients with diabetes, which is the most common cause of DSP.1 Individuals with DSP present with numbness, tingling, pain, and/or weakness starting in the toes and progressing proximally in a stocking-glove distribution. The diagnostic evaluation of DSP relies on clinical history; neurologic examination; and some laboratory tests, including a comprehensive metabolic panel, complete blood cell count, and measures of hyperglycemia, B12, and serum protein electrophoresis with immunofixation.1 The etiology of DSP can be determined in almost two-thirds of patients prior to laboratory testing. With the inclusion of the laboratory tests, an etiology is identified in an additional 10% of patients.2 Electrodiagnostic tests, magnetic resonance imaging, and more extensive laboratory tests are usually not needed unless atypical features are present, such as asymmetry, nonlength dependence, acute/subacute onset, and motor predominance.