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Electromyography and nerve conduction study (EMG/NCS) approximately one year into his symptoms showed findings consistent with a severe axonal length-dependent sensorimotor neuropathy, including absent bilateral fibular motor responses at the extensor digitorum brevis, absent bilateral tibial motor responses, reduced amplitude of the bilateral fibular compound muscle action potentials at the tibialis anterior, absent bilateral sural sensory responses, fibrillation potentials and positive sharp waves in the left tibialis anterior and gastrocnemius, and increased incidence of high amplitude motor unit action potentials and reduced motor unit action potential recruitment in the left tibialis anterior and gastrocnemius

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Some patients and practitioners opt for a combination approach: compounded tirzepatide with glycine and B12 in the injection, plus oral niacinamide supplementation separately

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