,LABORATORY DATA: , 10/07/08:  Vitamin B1 210 (87-280), vitamin B6 6, ESR 6, AST 25, ALT 17, vitamin B12 905, CPK 226 (0-200), T4 0.85, TSH 3.94, magnesium 1.7, RPR nonreactive, CRP 4, Lyme antibody negative, SPEP abnormal (serum protein electrophoresis), but no paraprotein by manifestation, hemoglobin A1c 6.0, aldolase 3.9 and homocystine 9.0.,ASSESSMENT: , The patient is a 63-year-old gentleman with multiple neurologic and nonneurologic symptoms including numbness, gait instability, decreased dexterity of his arms and general fatigue. 
,LABORATORY DATA : , 10/07/08 : Vitamin B1 210 ( 87 - 280 ) , vitamin B6 6 , ESR 6 , AST 25 , ALT 17 , vitamin B12 905 , CPK 226 ( 0 - 200 ) , T4 0.85 , TSH 3.94 , magnesium 1.7 , RPR nonreactive , CRP 4 , Lyme antibody negative , SPEP abnormal ( serum protein electrophoresis ) , but no paraprotein by manifestation , hemoglobin A1c 6.0 , aldolase 3.9 and homocystine 9.0.,ASSESSMENT : , The patient is a 63 - year - old gentleman with multiple neurologic and nonneurologic symptoms including numbness , gait instability , decreased dexterity of his arms and general fatigue .