Longitudinal follow‐up of biopsy‐proven small fiber neuropathy

MacDonald, Steven J.; Sharma, Tara L.; Li, Jianbo; Polston, David; Li, Yuebing

doi:10.1002/mus.26648

Cited by 21 publications

(18 citation statements)

References 20 publications

(53 reference statements)

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“…Moreover, Ziegler et al found that over a 2.5‐y follow‐up period about half the patients with polyneuropathy experience increasing sensory symptoms and pain 19 . In addition, in a longitudinal follow‐up study of patients with small fiber neuropathy, with an average follow‐up duration after diagnosis of 6.2 y, 86.1% noted pain at the initial visit, and 84.2% at the final visit 20 . It has previously been shown that some patients with small fiber neuropathy may develop large fiber neuropathy over time 21 …”

Section: Discussionmentioning

confidence: 99%

The complex association between pain and neuropathy

2021

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Background Several studies of patients with polyneuropathy failed to show differences between patients with and without pain. In the current study, we aimed to explore the association between neuropathic symptoms, mainly pain, and polyneuropathy characteristics. Methods A prospective cross‐sectional study recruiting 151 patients with non‐diabetic polyneuropathy was performed between November 2016 and May 2017. A total of 38 patients with chronic inflammatory demyelinating neuropathy were excluded. Patients underwent clinical, electrophysiological and functional assessments of their polyneuropathy. Polyneuropathy characteristics were compared depending on the presence and severity of neuropathic symptoms. Results The presence and the severity of weakness were associated with a more severe neuropathy as measured by clinical, electrophysiological and functional assessments, while the presence of pain was associated with higher sural amplitudes, and the severity of pain showed a curvilinear association with neuropathy severity. Conclusions Our study shows a novel finding of a curvilinear association between pain and polyneuropathy severity.

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Section: Discussionmentioning

confidence: 99%

The complex association between pain and neuropathy

2021

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“…In a previous study, MacDonald S et al [24] reported a retrospective analysis of 101 patients with biopsy-confirmed SFN, and the average follow-up was 6.2 years. They found that small fibre neuropathy tended to be stable and rarely affected ambulation and employment status.…”

Section: Follow-up and Outcome Of Pure Sfn And Mixed Dpn Subjectsmentioning

confidence: 99%

Better Islet Function and Cardiovascular Autonomic Function in Type 2 Diabetic Patients With Pure Small Fibre Neuropathy Than With Mixed Neuropathy

Wang

et al. 2021

Preprint

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BackgroundThe clinical characteristics and outcomes of small fibre neuropathy (SFN) in Chinese patients with type 2 diabetes have not been thoroughly described, and we investigated metabolic and neurological indexes and the prognosis of type 2 diabetic patients based on skin biopsy. MethodsThirty-four healthy Chinese volunteers were recruited for skin biopsy to establish the reference range of intraepidermal nerve fibre density (IENFD). Eighty-nine patients with type 2 diabetes from the Department of Endocrinology at Nanjing Drum Tower Hospital between December 2015 and April 2020 were included in the final study. Metabolic and neurological indexes were evaluated at baseline. Diabetic cardiovascular autonomic function was tested through cardiovascular autonomic reflex tests (CARTs). Seventeen pure SFN subjects and 9 mixed diabetic polyneuropathy (DPN) subjects were reassessed after the follow-up. ResultsLevels of HbA1c and postprandial blood glucose were lower (P=0.005 and P=0.041, respectively), while postprandial C-peptide and insulin were higher (P=0.001 and P=0.019, respectively) in the pure SFN group than in the mixed DPN group. Regarding the CARTs, the mixed DPN group obtained the highest score, indicating the worst cardiovascular autonomic neuropathy (CAN). Among the four CART items, postural BP change was lower while deep breathing max-min was higher in the pure SFN group than in the mixed DPN group (P=0.023 and P=0.040, respectively). A partial correlation showed that there was a negative correlation between IENFD of the distal leg and CART scores (r=-0.513, P=0.001) after adjusting for age and duration of diabetes. Only vitamin B12 (p=0.028) and motor nerve conduction velocity (MCV) of the common peroneal nerve (p=0.045) were increased in the 17 patients with pure SFN after the follow-up. However, MCVs of the common peroneal nerve (p=0.025) and tibial nerve (p=0.047) were decreased at the final visit in the mixed DPN group. ConclusionsBetter islet function and cardiovascular autonomic function were observed in patients with pure SFN compared with mixed DPN. CART scores were negatively correlated with IENFD in the distal leg even after adjusting for age and duration of diabetes. The metabolic and neurological indexes remained relatively stable in the follow-up of pure SFN subjects.

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“…Many different treatments were experienced. Opioid analgesics [8,21,24] or nonopioid analgesic [22,26], corticosteroids [8,10,33,34,37,44], intravenous immunoglobulin (IVIG) alone [8,12,15,23,27,31,37,39,46,47] or in combination with other specific drugs, such as azathioprine [29], anti-epileptic drugs [4,11,13,16,18,28,32], immunotherapy [14,19,37], hormone therapy [7,43]. Less used are the following therapeutic strategies, in used for specific disorders, such as ARA290, an erythropoietin derivate for sarcoidosis SFN [45], recombinant human nerve growth factor for diabetic SFN [5], propranolol for SFN related to aquagenic pruritus [9], plasma exchange therapy for complex regional pain syndrome [6], enzyme replacement therapy for Fabry related SFN [17,35], botulinum toxin type A for keloid [38].…”

Section: Pharmacologic and Rehabilitation Therapymentioning

confidence: 99%

“…The management of neuropathic pain has been a challenging task for physicians [24]. There is limited evidence on the effectiveness of specific medications for the treatment of pain associated with SFN, and the most commonly used medications include antidepressants, anticonvulsants, mexiletine, topical agents, opiates and neuromodulation [54,55].…”

Section: The Pharmacological Approachesmentioning

confidence: 99%

A Systematic Review of Pharmacologic and Rehabilitative Treatment of Small Fiber Neuropathies

et al. 2020

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The aim of this systematic review is to guide the physician in defining the pharmacologic and rehabilitative therapeutic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science to identify the treatment of small fiber neuropathies. Two reviewers independently reviewed and came to a consensus on which articles met inclusion/exclusion criteria. The authors excluded the duplicates, animal studies and included the English articles in which the treatment of patients with small fiber neuropathies was described. 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-two publications met the inclusion criteria and were included in the systematic review to describe the rehabilitative and pharmacologic treatment of small fiber neuropathies. Despite the range of different protocols of treatment for small fiber neuropathy, other robust trials are needed. In addition, always different therapeutic approaches are used; a unique protocol could be important for the clinicians. More research is needed to build evidence for the best strategy and to delineate a definitive therapeutic protocol.

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Longitudinal follow‐up of biopsy‐proven small fiber neuropathy

Cited by 21 publications

References 20 publications

The complex association between pain and neuropathy

The complex association between pain and neuropathy

Better Islet Function and Cardiovascular Autonomic Function in Type 2 Diabetic Patients With Pure Small Fibre Neuropathy Than With Mixed Neuropathy

A Systematic Review of Pharmacologic and Rehabilitative Treatment of Small Fiber Neuropathies

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