The Periphery at the Center

Steven L. Lewis, MD, FAAN Peripheral Nerve and Motor Neuron Disorders p. 1239-1240 October 2017, Vol.23, No.5 doi: 10.1212/01.CON.0000526043.90553.24
Editor’s Preface


Dr Levin and his expert contributors have created a central resource to guide us in the diagnosis and management of our patients with disorders of the peripheral nerves and motor and sensory neurons.

This issue of Continuum is devoted to the diagnosis and management of disorders of the peripheral nervous system, from the anterior horn cells and dorsal root ganglia to the most distal peripheral nerve fibers (a reminder to readers that disorders of the neuromuscular junction are bundled with our core topic muscle disease issues). I am indebted to this issue’s guest editor, Dr Kerry H. Levin, for his remarkable work and devotion in the creation of this issue and for inviting such renowned peripheral nerve experts to bring these important topics to the front and center.

The issue begins with an overview of the general approach to peripheral nerve disorders by Dr James A. Russell in an article that serves as a detailed and instructive road map for our care of patients with peripheral nerve disorders and for our reading of the articles that follow. Dr John C. Kincaid then reviews the use and interpretation of neurophysiologic studies in the evaluation of polyneuropathy, an article that has insights of relevance to all neurologists, from the novice to the most experienced clinical neurophysiologist among our readers. Continuing to another diagnostic method in our armamentarium, Dr Francis O. Walker provides an overview of ultrasonography of peripheral nerves, a relatively new and increasingly utilized modality that provides a noninvasive view (literally) of peripheral nerve structure with significant implications regarding the diagnosis of various focal and generalized peripheral nerve disorders.

Moving on to specific types of peripheral nerve disorders, Dr Peter D. Donofrio reviews the clinical features, pathophysiology, diagnosis, and management of the various presentations of Guillain-Barré syndrome. This is followed by the article by Dr Jeffrey A. Allen, in which he reviews the diagnosis and management of the heterogeneous causes of the chronic demyelinating polyneuropathies.

Dr Stephen A. Goutman next provides his extensive review of the diagnosis and management of amyotrophic lateral sclerosis and other disorders of the motor neuron, which share the overall title of this issue. Dr Sindhu Ramchandren then reviews and helps us understand the categorization of the various forms of Charcot-Marie-Tooth disease and other genetic polyneuropathies.

The next four articles review various general presentations of peripheral neuropathies. Dr Yuebing Li reviews the clinical presentation and the many causes of the axonal sensorimotor polyneuropathies (the most common clinical presentation most of us encounter). Dr Jinny O. Tavee next provides a discussion of the causes of immune axonal polyneuropathies and their management. Dr Kelly Graham Gwathmey then discusses the diagnosis and management of the sensory polyneuropathies and sensory neuronopathies. In the final review article of the issue, Drs Komal Sawlani and Bashar Katirji review the peripheral nerve hyperexcitability syndromes, important disorders (with regard to their implications in some cases for an underlying neoplasm as well as for potential treatment) that I suspect are underemphasized in many peripheral nerve reviews and likely underrecognized in practice.

In this issue’s Ethical and Medicolegal Issues section, Dr Zachary Simmons presents the hypothetical case of a patient with recently diagnosed amyotrophic lateral sclerosis as a springboard for discussion about the rights of patients to try investigational therapies for incurable disorders.

In the Practice Issues article, Dr Raghav Govindarajan uses an instructive case of a patient with an initially misdiagnosed peripheral nerve disease to discuss the implications and potential causes of diagnostic errors and provides strategies to attempt to avoid them.

As with every issue of Continuum, several opportunities exist for CME. After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs Douglas J. Gelb and Adam Kelly, you may earn up to 12 AMA PRA Category 1 Credits™ toward self-assessment and CME. The Patient Management Problem, written by Dr Nimish J. Thakore, describes the case of a 50-year-old woman presenting with an 18-month history of progressive right upper extremity weakness. By following her case and answering 11 multiple-choice questions corresponding to diagnostic, management, and prognostic decision points along the course of her disorder, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits. Canadian participants can now claim a maximum of 14 hours toward the Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the Office of Continuing Medical Education and Professional Development, University of Calgary, for completing the Postreading Self-Assessment and CME Test and the Patient Management Problem.

I would like to extend my deepest thanks to Dr Levin for his essential role in the creation of this issue and his remarkable devotion and care to all aspects of its development. He and his expert contributors have created a central resource to guide us in the diagnosis and management of our patients with disorders of the peripheral nerves and motor and sensory neurons.

—Steven L. Lewis, MD, FAAN


Copyright © 2017 by the American Academy of Neurology.