Neuromuscular Electrical Stimulation (NMES) and α-Lipoic Acid
Any unilateral spontaneous foot drop as a sign of peripheral peroneal nerve palsy which is not associated with other symptoms (e.g. pain) and not explained by a preceding injury can be the first manifestation of underlying diabetes mellitus. Consequently, the patient’s family history should be taken and fasting glucose levels as well as Hb1Ac should be measured. During my clinical training and the many years working in my own practice, neuromuscular electrical stimulation on weekdays and a dose of 600 mg α-lipoic acid (unfortunately no longer available on statutory health care prescription) taken in the morning have proven effective and the prognosis is good. At worst, spontaneous (potentially bilateral) foot drop can be the first sign of amyotrophic lateral sclerosis (ALS), but this is rarely the case. If ALS is suspected, the patient should be carefully examined for abnormal reflexes, abnormal muscle tone, fasciculations, and the presence of pyramidal signs. The patient should only be informed that a diagnosis of ALS is suspected, if additional signs and symptoms have clearly been identified.
Dr. med. Franz-Ulrich Beutner
|1.||Carolus AE, Becker M, Cuny J, Smektala R, Schmieder K, Brenke C: The interdisciplinary management of foot drop. Dtsch Arztebl Int 2019; 116: 347–54 VOLLTEXT|