G60.9/G62.9/G62.0-1/E10.6/E11.6
DESCRIPTION
Initially sensory symptoms consisting of tingling, prickling, burning in the balls of the feet or tips of the toes or in a general distribution over the soles. The symptoms are symmetrical and with progression spread proximally.
Later sensory loss over both feet and weakness of dorsiflexion of the toes may be present. Patients may experience difficulty in walking on their heels and foot drop becomes apparent.
Common causes include HIV, Diabetes Mellitus, isoniazid, antiretrovirals (stavudine and didanosine), vitamin B12 deficiency and alcohol.
GENERAL MEASURES
- HIV testing.
- Screen for diabetes mellitus, syphilis and vitamin B12 deficiency
- Avoid alcohol.
- A balanced diet to prevent nutritional deficiency.
MEDICINE TREATMENT
- Stop the offending medicine or give suitable substitute e.g. substitute stavudine or didanosine with tenofovir or lamivudine.
- Patients on isoniazid (TB treatment or prophylaxis): increase pyridoxine to 25–50 mg 8 hourly for 3 weeks, followed by 25–50 mg daily.
- Amitriptyline, oral, 25 mg at night (Doctor prescribed).
- Titrate at two weekly intervals to a maximum of 75 mg at night.
REFERRAL
- All children.
- Difficulty in walking or foot drop
- Any limb weakness present.
- Unsteady/ataxic gait.
- Severe sensory loss.