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L5 monoradiculopathies are the most common monoradiculopathy of the lower extremity The pain of an L5 radiculopathy typically extends from buttock to posterolateral thigh to anterolateral leg Sensory symptoms are felt in the lateral leg, instep, and particularly the big toe In most people, weakness will be most commonly and readily detected in great toe extension Weakness of foot dorsi exion, eversion, and inversion commonly occur as well Weakness of knee exion and hip abduction are less frequent and/or more dif cult to detect The differ-

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EDX assessment of prognosis can be ascertained in many different ways21 In general, demyelinating lesions are likely to resolve quickly (weeks to months) and completely if their cause is eliminated There are certain disorders such as radiation injury and multifocal motor neuropathy (MMN) in which conduction block may become persistent The prognosis for axon loss lesions is more uncertain and depends on the degree and location of the injury The severity of the lesion is best judged by the amplitudes of the SNAP and CMAP responses Reinnervation is most successful when there are many residual axons to sprout and few muscle bers to reinnervate Prognosis is also determined in axon loss lesions by the distance between the injury and the target For example, in brachial plexus injuries, improvement in biceps and deltoid function is common whereas signi cant return of hand function is far more tenuous Rapid disease progression in ALS correlates with at least three recognized electrodiagnostic patterns These are patients with an abundance of brillation potentials

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and modest changes of chronic denervation and reinnervation, patients with prominent MUP variability, and patients with rapid declines in MUP estimates over time15 Prognosis in the GBS had been linked to a composite of CMAP amplitudes Although reduced CMAP amplitudes could represent demyelinating conduction block in terminal nerve twigs between the distal point of nerve stimulation and muscle, these are more likely to represent axon loss with the more pessimistic prognosis for rapid recovery that it portends22

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QST is used in both clinical and research settings, in an attempt to provide measurements of small myelinated and unmyelinated nerve function23 25 Peripheral neuropathies are usually pathologically indiscriminate and affect peripheral nerve bers of all sizes and functions The concept of small ber neuropathy (SFN) recognizes the existence of a select group of neuropathy patients in whom the signs and symptoms suggest preferential injury to small poorly myelinated (A-delta) or unmyelinated (C) peripheral nerve bers less than 7 microns in diameter26 28 As mentioned above, conventional EDX does not assess small ber viability and function and is therefore of limited utility in SFN unless larger myelinated bers are concomitantly affected Quantitative sensory techniques represent an attempt to ll this diagnostic gap as well as to provide a potential tool for epidemiologic studies and therapeutic trials and potentially to screen for subclinical neuropathy in industry where the potential for neurotoxic exposure exists23,24,29 Two other techniques that may also be used in SFN assessment, autonomic testing and the assessment of intraepidermal nerve ber density (INFD) through skin biopsy, will be discussed in the next section and next chapter, respectively The latter technique is reported to have a sensitivity of 88% and a speci city of 91% in the diagnosis of SFN30 This sensitivity may exceed that of QST and ANST although the test results may not be concordant, implying the potential bene t of using multiple testing modalities in SFN suspects30,31 Clinically, SFN is typically a symmetric LDPN, as discussed in detail in 20, representing perhaps 5% of the LDPN population in whom sensory symptoms predominate27,31,32 It has been hypothesized that the natural history of SFN is to evolve into a more typical LDPN phenotype with both small and large ber involvement30 Other patterns of SFN involvement are suspected, although there is no current diagnostic gold standard to de ne the limits of phenotypic expression Typically, patients complain of painful, often burning paresthesias with associated cutaneous hypersensitivity In its purest form, the only abnormalities on clinical examination in SFN, if any, are diminished perception of.

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