Moderate (Uncomplicated Peripheral Neuropathy)


Some interference with activities of daily living, symptoms concering to patient

Management escalation pathway

  • Withhold ICPI
  • Initial observation reasonable or initiate prednisolone 0.5 to 1mg/kg (if progressing, e.g. from mild) and/or duloxetine for pain
  • Only consider resuming ICPI after multidisciplinary discussion
  • If no clinical improvement after 48h, manage as severe
Advice on steroid wean
  • Conversion from i.v. to oral steroids at clinician discretion once improvement is noted
  • Suggested oral prednisolone taper for 4-8 weeks
  • Consider PJP prophylaxis, vitamin D if > 4-weeks duration

Assessment and Investigations

  • Neurologic consult
  • Patient history : diabetes, alcohol, medication
  • EMG
  • Blood analysis : diabetic screen, Vitamine B12/folate, immunoelectrophoresis/ immunofixation, renal function, hematology, autoimmune serology, serology for lyme and HIV
  • Lumbar puncture
  • MR spine/brain to exclude other causes


CMV: Cytomegalovirus
CIDP: Chronic Inflammatory Demyelinating Polyneuropathy
GBS: Guillain-Barré Syndrome
PJP: Pneumocystis Jirovei Pneumopathy