Peripheral neuropathy

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Kdantin

Peripheral neuropathy

Post by Kdantin » Tue Aug 21, 2018 2:51 pm

Applicant has a diagnosis of peripheral neuropathy. Neurologist writes letter stating that his condition is not severe and that he feels it will not interfere with safe execution of his commercial driving duties. However, he is treating the applicant with fycompa off label for neuropathic pain.
I would like to hear opinions on this situation.



Robert Swotinsky MD
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Re: Peripheral neuropathy

Post by Robert Swotinsky MD » Wed Aug 22, 2018 9:10 pm

Per page 156 of the FMCSA Medical Examiner Handbook http://www.occ-doc.net/FMCSA_Medical_Ex ... 4MAR18.pdf:
Peripheral Neuropathies

This group of disorders consists of hereditary and acquired conditions where the nerves, including the
axon and myelin or the myelin selectively outside the spinal cord, are affected. These conditions may
affect the sensory or motor nerves individually, or both may be affected.
Peripheral neuropathy may be a complication of diabetes mellitus. You should evaluate the sensory
modalities of pain, light touch, position, and vibratory sensation in the toes, feet, fingers, and hands for
signs of peripheral neuropathy.

Waiting Period

Not applicable.

Decision

Recommend to certify if:

Not applicable.

Recommend not to certify if:

The driver has a diagnosis of a peripheral neuropathy.

I don't claim to know more about this than the authors of the Handbook. And, certainly, having neurologic impairment in the arms or legs does not improve one's driving skills. On the other hand, peripheral neuropathy is one of those things that is often based on self-report. And, the severity and clinical course is highly variable. Certainly, some people who have peripheral neuropathy are not at increased risk, others are, and we don't know about those in between.

As a Medical Examiner, I might be interested in what information supports the diagnosis. This off-label medicine use seems to support it, in an off-label manner. Is there an underlying condition that causes peripheral neuropathy? Are there clinical findings of peripheral neuropathy? These and other factors could help define the presence and severity of peripheral neuropathy. Given the FMCSA guideline, the default (and perhaps only) option is to declare it disqualifying.

Kdantin

Re: Peripheral neuropathy

Post by Kdantin » Thu Aug 23, 2018 10:36 am

Thanks for the reply.
I of course used the same guideline but also had the paragraph about considering certification in mild cases where a neurologist familiar with the duties of a commercial driver states that the condition will not interfere with commercial driving duties. I did not certify in this case. I was also very concerned about the contradiction of stating that the case is mild enough not to interfere while also stating that the neuropathic pain is severe enough to require fycompa. The warnings/precautions with this med are also of major concern.
Thanks again

Kdantin

Re: Peripheral neuropathy

Post by Kdantin » Thu Aug 23, 2018 12:38 pm

Also, i apologize about not answering the question about etiology of the neuropathy but it seemed to be non-specific. Applicant not diabetic.

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