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Small fiber peripheral neuropathy is a type of peripheral neuropathy that occurs from damage to the small unmyelinated and myelinated peripheral nerve fibers. These fibers, categorized as C fibers and small Aδ fibers , are present in skin , peripheral nerves , and organs. [ 1 ]
The measurement requires no specific patient preparation or medical personnel training. The test lasts less than 3 minutes, and is innocuous and non-invasive. In general, decreased ESC values indicate a higher risk of sudomotor dysfunction, and thus a greater likelihood of small fiber neuropathy.
These tests include a sweat test and a tilt table test. Diagnosis of small fiber involvement in peripheral neuropathy may also involve a skin biopsy in which a 3 mm-thick section of skin is removed from the calf by a punch biopsy, and is used to measure the skin intraepidermal nerve fiber density (IENFD), the density of nerves in the outer ...
Neuropathic pain usually manifests in the setting of small fiber neuropathy. Small fiber neuropathy is common and may arise from a number of conditions such as diabetes, metabolic syndrome, infectious diseases, toxins, and autoimmune disorders. The gold standard for diagnosing small fiber neuropathy as the etiology of neuropathic pain is skin ...
The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) have recommended the clinical use of QST in the diagnosis and evaluation of patients with small and large fibre neuropathy as well as screening for deficits of the somatosensory system (which may include deficits in the brain for instance).
The gold standard for diagnosing small fiber neuropathy as the etiology of neuropathic pain is skin biopsy. Sudomotor assessment, through electrochemical skin conductance, an accurate objective technique, could be considered as a good screening tool to limit skin biopsy in patients in whom it is not suitable. [8] [9]
Treatment of dysautonomia can be difficult; since it is made up of many different symptoms, a combination of drug therapies is often required to manage individual symptomatic complaints. In the case of autoimmune neuropathy, treatment with immunomodulatory therapies is done. If diabetes mellitus is the cause, control of blood glucose is ...
Epidermal nerve fiber density testing (ENFD) is a more recently developed neuropathology test in which a punch skin biopsy is taken to identify small fiber neuropathies by analyzing the nerve fibers of the skin. This pathology test is becoming available in select labs as well as many universities; it replaces the traditional sural nerve biopsy ...