Needed Change in Neuropathy Testing

Millions of Americans are affected by peripheral neuropathy, a debilitating condition that causes weakness, numbness, and pain in the hands and feet.  When peripheral neuropathy is suspected, magnetic resonance imaging (MRIs) and electrodiagnostic testing (EMG) are frequently ordered and drive most diagnostic costs.  However, they rarely change the diagnosis or management of the condition.

Instead, American Academy of Neurology (AAN) guidelines recommend using certain blood tests for better diagnosis and insight into the disease. Also, the American Diabetes Association recommends against routine EMG testing and Choosing Wisely recommends against MRIs in patients with peripheral neuropathy. 

Brian Callaghan, M.D., Ph.D., the Eva L. Feldman, MD, PhD, Professor of Neurology, led a research group that looked into whether diagnostic practices had, in fact, changed since these testing guidelines and recommendations were made.  The results published in JAMA Neurology found that the ANA guidelines were not heeded, with overuse of MRIs and EMGs and underuse of certain blood tests, which Dr. Callaghan said was a problem.

“Current practice leads to too many EMG and MRI studies that are costly and do not improve the lives of patients with peripheral neuropathy,” explains Dr. Callaghan. “While at the same time, not enough simple blood tests are ordered to determine the cause of this condition. Recommendations and time are not enough to improve our practice. Instead, interventions are needed to encourage optimal care.”

Other authors: Evan L. Reynolds, Ph.D., of Michigan State University, Lavanya Muthukumar, M.S., and Melissa Elafros, M.D., Ph.D, also from University of Michigan, Leslie E. Skolarus, M.D., M.S., from Northwestern University, and James F. Burke, M.D., and Kevin A. Kerber, M.D., from Ohio State University.

Paper cited: Callaghan BC, Reynolds EL, Muthukumar L, Elafros MA, Skolarus LE, Burke JF, Kerber KA. Diagnostic Testing for Patients With Peripheral Neuropathy. JAMA Neurol. 2025 Mar 3:e250001. doi: 10.1001/jamaneurol.2025.0001. Epub ahead of print. PMID: 40029634; PMCID: PMC11877403.