[Caroline]

#27584

Dear Dr. Corenman,

I would greatly appreciate your insights into my chronic pain issues. I have bilateral neuropathy in my feet (numbness and intense burning). It started in my right foot in 2007, then slowly spread to my left over 2 years. I have lower back pain which is mostly confined to the lumbar region; it rarely radiates to the buttocks or down the legs. I also have had refractory epilepsy since 1990 for which I currently receive anti-epileptic drug (AED) polytherapy.

The AEDs caused osteoporosis which in turn resulted in an L4 compression fracture in 2011. The MRI showed: “a diffuse disk bulge and mild degenerative changes of the facets bilaterally. No significant central canal or neural foraminal narrowing. There is moderate stenosis of the lateral recesses bilaterally which could impinge the traversing L5 nerve roots on either side.”

In 2013, Mayo confirmed the neuropathy diagnosis and tested me for everything “treatable.” They concluded that it might be caused by a genetic mutation or less likely by radiculopathy. They declined to do genetic testing, and assured me that the neuropathy was not a side effect of the AEDs.

In 2016, a UCH neuromuscular neurologist conducted genetic testing for Charcot-Marie-Tooth syndrome (the only genetic disease that was likely given the late onset). All genes were normal. She concluded that the cause of the neuropathy was probably the AED polytherapy — toxic neuropathy, a conclusion completely contrary to that of the Mayo.

I’ve reduced the AEDs somewhat thanks to neurofeedback, but cannot see a way to get off them. My question is: to what extent, if any, could the stenosis of the lateral recesses at L4-L5 contribute to my neuropathy given that there is little or no pain radiating down my legs? Is another MRI in order?

Thank you for taking the time to consider my case.

Margaret

[Donald Corenman, MD, DC]

#27585

Peripheral neuropathy has some known associations (chemotherapy, diabetes) but many cases are idiopathic (we doctors are idiots and pathetic because we don’t know the cause). There are some studies possibly linking these medications to peripheral neuropathy but at this point, it might be speculation and not hard science. Treatment of peripheral neuropathy continues with anti epileptic drugs such as Lyrica and Neurontin. If there is a connection, it is still in the early stages of investigation as far as I can tell.

Foraminal stenosis will cause a specific type of symptom complex and is generally not bilateral. The symptoms would be relegated to one nerve root on one side which does not sound like your symptoms. Symptoms would also be worse with standing and walking and somewhat relieved by rest and generally associated with pain that radiates from the buttocks down the leg.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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