Intra-epidermal nerve fibre density in patients with small fibre polyneuropathy with and without simultaneous large fibre involvement
| 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 fiber neuropathy; skin biopsy; intraepidermal nerve fibers |
| Description | Background and aim: The diagnosis of small fibre neuropathy (SFN) is currently based on the clinical picture, quantitative sensory testing (QST), and autonomic function assessment. A decreased density of intraepidermal innervation seem to be morphological correlates of small-fibre dysfunction. The aim of this study was to compare intraepidermal nerve fibre (IENF) density in skin punch biopsy samples from a group of SFN patients and from healthy volunteers, then to assess the influence of simultaneous large nerve-fibre involvement on IENF counts. Methods: PGP 9.5-immunoreactive intraepidermal nerve fibre (IENF) density was measured in 67 patients with painful sensory neuropathy and in 25 healthy controls. All the patients suffered from burning feet, and showed abnormal thermal thresholds on QST. Of the patients, 29 also revealed abnormities in nerve conduction studies and EMG examination, signs of large fibre involvement. Results: The mean IENF count per mm of epidermis was 5.8+-4.3 in the patients with large nerve fibre involvement, and 6.4+-3.3 in the patients without it (p=0.56). In the healthy volunteers, the mean IENF count was significantly higher (11.5+-2.9, p<0.001). Using a lower limit for normal, at a level of 6.69 fibres per mm derived from this group, an abnormal IENF count was present in 65% of patients with pure SFN and in 69% of patients with involvement of both small and large nerve fibres. Conclusions: IENF counts seem to particularly reflect small nerve fibre status. Our findings therefore corroborate the usefulness of IENF examination in SFN patients. |
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