Neuro Question-SPEP

[Doctor Grim]

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What is the significance of ordering SPEP as a routine blood work in outpatient neuro clinics esp. with patients who suffer from gait disorders? I appreciate your help. Thanks.

 

[neurologist]

What is the significance of ordering SPEP as a routine blood work in outpatient neuro clinics esp. with patients who suffer from gait disorders? I appreciate your help. Thanks.

This is not an easy question to answer, since there are many reasons for "gait disorder." Like any other test, SPEP should be ordered for a reason (i.e., clinical suspicion) -- if it is being ordered just in a "shotgun" approach for everyone with any kind of "gait disorder" then it is probably not too useful in the aggregate. For example if the gait disorder is due to Parkinson's disease or Friedrich's ataxia, an SPEP is not going to be useful. However, patients can also have gait problems from peripheral neuropathies, for some causes of which an SPEP can be diagnostically useful . . . so, depends on particular scenario, guided by the patient's history and exam and suspicion of particular underlying cause. Ideally, I'd think it should be obtained on a case-by-case basis rather than a general screening lab.

 

[Doctor Grim]

This is not an easy question to answer, since there are many reasons for "gait disorder." Like any other test, SPEP should be ordered for a reason (i.e., clinical suspicion) -- if it is being ordered just in a "shotgun" approach for everyone with any kind of "gait disorder" then it is probably not too useful in the aggregate. For example if the gait disorder is due to Parkinson's disease or Friedrich's ataxia, an SPEP is not going to be useful. However, patients can also have gait problems from peripheral neuropathies, for some causes of which an SPEP can be diagnostically useful . . . so, depends on particular scenario, guided by the patient's history and exam and suspicion of particular underlying cause. Ideally, I'd think it should be obtained on a case-by-case basis rather than a general screening lab.

Thanks a lot. So if the SPEP were positive, what differential dx are you thinking of in association with neuro etiology of gait disorders? Is there an association between peripheral neuropathy and a positive SPEP?

Thanks again.

 

[Fencer]

It depends upon the abnormality. Are you looking for a monoclonal gammopathy, multiple myeloma or other dysproteinemia? Several of these conditions can be associated with peripheral neuropathy. This is not my area of expertise (i.e.: Epilepsy) but that is typically the reasoning during the work up of a peripheral neuropathy.