You may also need to look for other causes like nutritional or metabolic causes which may cause neuropathy. Following work up may be necessary as the next step, if everything comes out negative;
Investigations to ascertain the nutritional neuropathy;
Thiamine (vitamin B 1 ) deficiency: A serum thiamine (vitamin B 1 ) level
Pyridoxine (vitamin B 6 ) level
Folate deficiency: Serum folate levels .
Niacin (vitamin B 3 ) deficiency: Urinary excretion of N -methylnicotinamide
Cyanocobalamin (vitamin B 12 ) level
Pantothenic acid deficiency: Excretion is less than 1 mg/d.
Alpha-tocopherol (vitamin E) deficiency: The serum α -tocopherol (vitamin E) level
Hypophosphatemia: Serum phosphate level
Aminolevulinic acid synthase in urine (porphyria
Arylsulfatase A and B (leukodystrophies)
Urine oxalate levels
Serum lactate, ammonia, and pyruvate
Enzyme assays of muscle, blood, and fibroblast
Leukocyte glycogen levels to detect acid maltase deficiency
Leukocyte, DNA analyses (McArdle disease)
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