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What is the best treatment for the Neuropathy that has

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settled in my feet and...
What is the best treatment for the Neuropathy that has settled in my feet and anke area. This is in the second year now. I am taking physical therapy by a therapist who comes to my home and B12 6000 mcg twice daily. I can only walk with a walker and not very far as I have balance issues. Diabetes was ruled out via bloodwork. I am a female, 67 years young and had an active life prior to this challenge.
Thank you for your response.
Submitted: 8 years ago.Category: Neurology
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Answered in 3 minutes by:
6/13/2010
Neurologist: Dr. Sophie :: Neurology, Neurologist (MD) replied 8 years ago
Dr. Sophie :: Neurology
Dr. Sophie :: Neurology, Neurologist (MD)
Category: Neurology
Satisfied Customers: 2,951
Experience: Neurology, Clinical Neurophysiology :: U of California
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Hello,

What kind of testing have you had thus far other than blood tests?

Do you have pain or numbness or both?

Any weakness?
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Customer reply replied 8 years ago
I have not had any other testing to date. An MRI was suggested, but I cannot tolerate the liquid they would have to inject into my spine, i.e., iodine or something similar. I almost died 20 plus years ago from an iodine injection for a bladder test! I also suffer from severe anxiety due to my predicament.
Neurologist: Dr. Sophie :: Neurology, Neurologist (MD) replied 8 years ago
It looks like you forgot to answer my 2 other questions:

Do you have pain or numbness or both?

Any weakness?
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Customer reply replied 8 years ago

Sorry. In the beginning I had numbness, but not so much now. Yes, I have pain and tingling. Also, in the beginning I had weakness in one leg. Since I have been doing physical therapy, I don't really have that weak feeling any more. I feel fairly strong actually.

Neurologist: Dr. Sophie :: Neurology, Neurologist (MD) replied 8 years ago
Thank you. It sounds like you have a condition called sensory ataxia which causes balance problems. It is a fairly common condition.

In sensory ataxia the nerves that send the information to your brain about position of your limbs become unhealthy and this leads to balance problems because your brain does not get the exact feedback about where you placed your legs and feet.

This can occur as a part of constellation of symptoms due to vit B12 deficiency or due to other causes of neuropathy. Since you don't have diabetes, toxic exposure, amyloid neuropathy and idiopathic / hereditary neuropathy, etc. should be considered as well.

If you had a longstanding vit B12 deficiency, this can lead to semi- or permanent damage in the spinal cord which is a really important thing to exclude. You need a thoracolumbar spine MRI to do that. This will also rule out pinched nerves as one of the culprits.

The iodine contrast dye you are describing is used with CT, not with MRI.
And, you do not need contrast with MRI to have a proper test.

You also need to be evalauted by a neurologist to have a nerve and muscle test called EMG. I don't think you need a nerve biopsy at this point, but this is sometimes done to rule out amyloid.

It is scary to lose your balance and it poses serious risks of falling and injury, so I completely understand your anxiety and empathize with you.

Gait and balance training and assist walking devices are important for fall prevention.

However, it is important that you have a thorough evaluation because treatable conditions need to be identified.
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Customer reply replied 8 years ago
I knew about the EMG, but was told that they would put electrical impulses in my legs and that it was extremely painful. Not sure I could tolerate it because of the fear many years ago from the medical mistake I mentioned earlier.
Neurologist: Dr. Sophie :: Neurology, Neurologist (MD) replied 8 years ago
EMG is not a pleasant test but it's not painful. I have done many, many EMGs and I only had maybe 2 patients who were no able to complete it but it was because they had painful neuropathy.

It's a very important part of your evaluation.
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Customer reply replied 8 years ago
Understand. Thank you for your help.
Neurologist: Dr. Sophie :: Neurology, Neurologist (MD) replied 8 years ago
You are welcome.

Please click Accept if I have answered your question.
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