Correlation between abnormal thermal threshold and intra-epidermal nerve fibre density in small fibre neuropathy
| Authors | |
|---|---|
| Year of publication | 2005 |
| Type | Article in Periodical |
| Magazine / Source | European Journal of Neurology |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | small fibre neuropathy; intraepidermal nerve fibre density; skin biopsy; PGP 9.5 |
| Description | Clinical diagnosis of small fibre neuropathy (SFN) is based on positive sensory symptoms (burning feet). Thermal threshold testing (TTT) and Intra-epidermal nerve fibre densities (IENFD) using skin biopsy are methods used for verification of somatic small fibre involvement. Aim of the study was to evaluate the correlation between electrophysiological tests and skin biopsy findings in patients with small fiber involvement. PGP 9.5-immunoreactive intra-epidermal nerve fibre density was evaluated in skin biopsy samples from the distal calf in a two subgroups of patients with clinical signs of SFN and abnormal TTT findings: pure SFN group without clinical and EMG signs of thick fibre involvement (38 cases) and mixed neuropathy group (29 cases). TTT comprised both reaction time inclusive ane exclusive methods from both upper and lower extremities. Autonomic tests (Sympathetic skin response and cardiovascular tests based of heart rate variability) were also performed in all cases. Abnormal IENFD was found in 24 out of 38 pure SFN group and in 19 out of 29 mixed neuropathy group patients. The presence of IENFD abnormality showed highly significant correlation with the degree of abnormality of TTT (expressed as the mean z-score of thermal threshold values), but not with the presence of abnormalities of autonomic tests. Conclusion: TTT is a more sensitive method and it could detect slighter small fibre involvement before development of significant decrease of IENFD. Intra-epidermal PGP 9.5-immunoreactive nerve fibers quantified in skin biopsy are mostly somatic ones. |
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