| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a history of carpal tunnel syndrome, neck (cervical) or lower back (lumbosacral) problems, restless leg syndrome, diabetic neuropathy, vitamin B12 deficiency (pernicious anemia), or alcoholism?
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Does individual have a history of cancer, human immunodeficiency virus (HIV), hypocalcemia, malabsorption, multiple sclerosis, or Guillain-Barré syndrome?
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Does individual have a history of workplace or avocational exposure to toxins that may cause paresthesias (heavy metal, solvents, etc.)?
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Are there sensations of a limb falling asleep, tingling, pins and needles, prickling, electric, burning, vibrating, buzzing, or crawling?
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Does individual report pain, numbness, weakness, stiffness, or clumsiness?
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Where are these sensations located and how long have they been present?
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Does the paresthesia worsen or improve with position change or with a specific activity?
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Was electromyography (EMG) done to rule out nerve dysfunction?
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Were vitamin B12 and calcium levels obtained? Any abnormalities?
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If restless leg syndrome was suspected, was polysomnography done?
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If suspicion of multiple sclerosis, was MRI taken?
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Did a spinal tap (lumbar puncture) rule out Guillain-Barré syndrome and multiple sclerosis?
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Was blood tested to determine if liver function levels were elevated? Is there alcohol abuse?
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Was the underlying cause for the paresthesia diagnosed?
Regarding treatment:
- Has the underlying cause been identified and confirmed?
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If carpal tunnel syndrome is the cause, have wrist splints, anti-inflammatory medications, or surgical decompression been used? Did this relieve the paresthesia?
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If vitamin B12 or calcium deficiency is the cause, has individual received vitamin B12 and calcium supplementation?
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If individual has Guillain-Barré syndrome, has plasmapheresis been done?
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Has multiple sclerosis been treated with corticosteroid medications, interferon beta-1a and beta-1b, and glatiramer acetate?
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If individual has diabetes, is blood sugar adequately controlled?
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Would individual benefit from an alcohol cessation program, as appropriate?
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Have appropriate industrial hygiene measures been undertaken to control toxic exposures?
Regarding prognosis:
- What is the underlying condition causing the paresthesia? Is underlying condition under control? If not, what other treatments are available? Is individual compliant with all medication and treatment regimens for the underlying condition?
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Could there be another condition or reason for the paresthesia?
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Given enough time to heal, is it likely the paresthesia will resolve?
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Have any complications occurred as a result of the underlying disorder? If so, what are they and what is expected outcome with treatment?
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Source: Medical Disability Advisor