A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation

Abstract

This systematic review describes the several methods to diagnose and measure the severity of small fiber neuropathies and aims to guide the physician to define all the diagnostic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Two reviewers independently reviewed and came to consensus on which articles met inclusion/exclusion criteria. The authors excluded all the duplicates, animals’ studies, and included the English articles in which the diagnostic measures were finalized to assess the effectiveness of rehabilitation and pharmacologic treatment of patients with small fiber neuropathies. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-one publications met the inclusion criteria and were included in the systematic review. Despite the range of diagnostic tools for the assessment of small fiber neuropathy, other robust trials are needed. In addition, always different diagnostic approaches are used, a unique protocol could be important for the clinicians. More research is needed to build evidence for the best diagnostic methodologies and to delineate a definitive diagnostic protocol.

Peripheral Neuropathy under Oncologic Therapies: A Literature Review on Pathogenetic Mechanisms

“…Neither drugs in therapy or prevention have succeeded in ameliorating sharply neuropathic symptoms and pain, nor quantitative assessment of neuropathy has been authorized or approved so far. Nevertheless, since taxanes and platinum salts are known to hit first small autonomic C-fibers, some efforts have been made to quantify neuropathic damagein the early steps of the anticancer treatment [ 133 , 198 , 199 , 200 ]. Recently, a sudomotor function testing has been suggested to screen early peripheral neuropathy, on the basis that sweat glands are innervated by small C-fibers,.…”

“…Recently, a sudomotor function testing has been suggested to screen early peripheral neuropathy, on the basis that sweat glands are innervated by small C-fibers,. Other assessment tools have already been reported in literature [ 198 , 199 , 200 ]: skin biopsy to determine the intradermal nerve fiber density and innervated skin structure; corneal confocal microscopy to quantify small nerve fibers in the cornea; sympathetic skin response, measured the unmyelinated nerve sudormotor function after a transient change in electrical skin potential; axon flare reflex tests, evidencing the hyperemic response of the axons; pain-related evoked potentials to assess the nociceptive system. …”

Intraepidermal Nerve Fiber Density as Measured by Skin Punch Biopsy as a Marker for Small Fiber Neuropathy: Application in Patients with Fibromyalgia

“…Skin biopsy is a minimally invasive technique used to diagnose SFN, with a sensitivity up to 94% and a specificity up to 97% [ 6 , 7 , 13 , 14 , 15 , 16 , 17 ]. Though nerve conduction studies and electromyography is beyond the resolution of small fiber neuropathy, it may be beneficial in ruling out large nerve fiber damage which can be present in SFN.…”

Contribution of Skin Biopsy in Peripheral Neuropathies

“…It is recommended for screening and monitoring purposes but less suitable as a stand-alone test [ 27 ]. Quantitative sensory testing, as well as additional tests, such as laser-evoked potentials [ 28 ], contact heat evoked potentials [ 29 ], Nociceptive Flexion Reflex [ 30 ], Cutaneous Silent Period [ 31 ], ultrasonography [ 32 ], and ultrasound assisted microneurography [ 33 ] can are useful tools to study SFN [ 34 ], but, according to current guidelines, the loss of IENFs represents the morphological hallmark and the only objective test that allows to confirm a suspect of SFN.…”