Diagnostic criteria for small fibre neuropathy in clinical practice and research

Devigili, Grazia; Rinaldo, Sara; Lombardi, Raffaella; Cazzato, Daniele; Marchi, Margherita; Salvi, Erika; Eleopra, Roberto; Lauria, Giuseppe

doi:10.1093/brain/awz333

Cited by 139 publications

(173 citation statements)

References 63 publications

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“…Cold and warm threshold of upper and lower limbs were also obtained for each patient using thermal QST. The presence of peripheral neuropathy according to conventional NCS and thermal QST was determined for each patient 18‐20 …”

Section: Methodsmentioning

confidence: 99%

Immune‐mediated axonal dysfunction in seropositive and seronegative primary Sjögren’s syndrome

Tani

Liao

Hsu

et al. 2020

Ann Clin Transl Neurol

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Objective: The present study investigates the peripheral neuropathy in Primary Sj€ ogren's syndrome (pSS) using the nerve excitability test to further elucidate how peripheral nerves are affected by the autoantibodies. Methods: Each patient received clinical evaluation, examination for anti-SSA/Ro and anti-SSB/ La antibodies titer, paired motor and sensory nerve excitability test, thermal quantitative sensory test (QST), and nerve conduction study (NCS). Results: A total of 40 pSS patients wasenrolled. Motor axonal study of the pSS with positive anti-SSA/Ro or anti-SSB/La antibodies (n = 28) was found to have increased stimulus for 50% compound muscle action potential (CMAP) (P < 0.05), increased rheobase (P < 0.01), increased minimum I/V slope (P < 0.01) and hyperpolarizing I/V slope (P < 0.05), increased relative refractory period (RRP, P < 0.001), decreased accommodation of threshold electrotonus toward depolarizing current (P < 0.05), and increased accommodation toward hyperpolarizing current (P < 0.05). Seronegative pSS (n = 10) showed much less prominent motor axonal changes, showing only increased minimum I/V slope (P < 0.05). Sensory axonal study in seropositive pSS patients is found to have increased stimulus for 50% sensory nerve action potential (SNAP) (P < 0.01), decreased latency (P < 0.01), increased RRP (P < 0.01), and increased subexcitability (P < 0.05). Seronegative pSS patients have shown no significant sensory axonal changes. Thermal QST showed more prominent abnormalities in seronegative pSS compared to seropositive pSS. Interpretation: Anti-SSA/Ro and anti-SSB/La autoantibodies might cause dysfunction in nodal and internodal region of the axon and small nerve fibers; meanwhile, autoreactive antibodies in seronegative pSS mainly affect small nerve fibers. Thus, the underlying pathophysiology for the two types of pSS is different.

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Section: Methodsmentioning

confidence: 99%

Immune‐mediated axonal dysfunction in seropositive and seronegative primary Sjögren’s syndrome

Tani

Liao

Hsu

et al. 2020

Ann Clin Transl Neurol

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“…The diagnostic criteria for small fiber neuropathy are not established, influencing the approach to patients in clinical practice [1].…”

Section: Small Fibre Neuropathymentioning

confidence: 99%

“…QST could be a useful screening test for small and large fiber neuropathies [3]. The combination of clinical signs and abnormal QST and/or IENFD findings is a more reliably diagnostic method for SFN than the combination of abnormal QST and IENFD findings in the absence of clinical signs [1]. Sensory symptoms alone should not be considered a reliable screening feature [1].…”

Section: Small Fibre Neuropathymentioning

confidence: 99%

“…The combination of clinical signs and abnormal QST and/or IENFD findings is a more reliably diagnostic method for SFN than the combination of abnormal QST and IENFD findings in the absence of clinical signs [1]. Sensory symptoms alone should not be considered a reliable screening feature [1]. Physical examination often does not reveal any abnormalities because muscle strength, vibration sense and tendon reflexes are often preserved.…”

Section: Small Fibre Neuropathymentioning

confidence: 99%

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

2020

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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.

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“…The assessment of thermal detection thresholds allows quantifying negative (hypoesthesia) and positive sensory signs (hyperesthesia) in patients with suspected somatosensory impairment (Mucke et al., 2016). They are increasingly used in the diagnostic workup of small‐fibre neuropathies (neuropathies affecting autonomic and thermonociceptive primary afferents; Devigili et al., 2019; Terkelsen et al., 2017; Tesfaye et al., 2010) and, compared to structural or electrophysiological testing, they can be easily implemented in routine clinical practice because the procedure is non‐invasive, inexpensive and easy to conduct.…”

Section: Introductionmentioning

confidence: 99%

Assessing thermal sensitivity using transient heat and cold stimuli combined with a Bayesian adaptive method in a clinical setting: A proof of concept study

Courtin

Slootjes

Caty

et al. 2020

European Journal of Pain

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Background Quantitative sensory testing of thermal detection abilities is used as a clinical tool to assess the function of pain pathways. The most common procedure to assess thermal sensitivity, the ‘method of limits’, provides a quick but rough estimate of detection thresholds. Here, we investigate the potential of evaluating not only the threshold but also the slope of the psychometric functions for cold and warm detection. Method A convenience sample of 15 patients with diabetes mellitus (DM) and 15 age‐matched healthy controls (HC) was tested. Thirty brief (100 ms) stimuli of each modality were applied to the volar wrist and foot dorsum. Cold and warm stimuli were delivered with a Peltier thermode and a temperature‐controlled CO2 laser, respectively. Stimulus intensities were dynamically selected using an adaptive Bayesian algorithm (psi method) maximizing information gain for threshold and slope estimation. ROC analyses were used to assess the ability of slopes, thresholds and the combination of both to discriminate between groups. Results Assessment of the slope and threshold of the psychometric function for thermal detection took about 10 min. The ability to detect warmth was not reduced in DM patients as compared to HC. Cold detection performance assessed using slope or threshold parameters separated DM from HC with good discriminative power. Discrimination was further increased when both parameters were used together (93% sensitivity and 87% specificity), indicating that they provide complementary information on patient status. Conclusion The psi method may be an interesting alternative to the classical method of limits for thermal QST. Significance Current QST protocols provide an incomplete and potentially biased estimate of sensory detection performance. We propose a method that estimates the slope and the threshold of the psychometric function, defining heat and cold sensory detection performance, in only a few minutes. Furthermore, we provide preliminary evidence that combining slope and threshold parameters of cold detection performance leads to a better discriminative ability than relying solely on the threshold.

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Diagnostic criteria for small fibre neuropathy in clinical practice and research

Cited by 139 publications

References 63 publications

Immune‐mediated axonal dysfunction in seropositive and seronegative primary Sjögren’s syndrome

Immune‐mediated axonal dysfunction in seropositive and seronegative primary Sjögren’s syndrome

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

Assessing thermal sensitivity using transient heat and cold stimuli combined with a Bayesian adaptive method in a clinical setting: A proof of concept study

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