EpistemisDysesthesia
Specialty: Neurology.
Why it occurs
- Multiple sclerosis (demyelinating sensory plaques in the spinal cord or brain that produce sensations of burning, painful cold or constriction)
- Diabetic or small fiber amyloid peripheral neuropathy
- Trigeminal neuralgia in chronic phase
- Post-stroke thalamic pain syndrome (Dejerine-Roussy syndrome)
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
Initial workup
Comparative sensory neurological examination; electromyography and nerve conduction studies (which may be normal if only small fiber involvement is present); skin biopsy to measure intraepidermal fiber density; MRI of the complete neuroaxis (brain and spinal cord) with gadolinium.
red flags
Appearance of acute bilateral generalized dysesthesias that ascend from the feet to the thorax associated with motor weakness and incontinence, indicative of transverse myelitis or acute spinal cord compression.
Standard management
- Duloxetine — 30-90 mg/day
- Pregabalin — 150-600 mg/day
- Amitriptyline — 10-50 mg at night, central modulator of neuropathic pain
- Gabapentin — 900-2400 mg/day
- Carbamazepine in cases of paroxysmal lancinating dysesthesias.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 5