Small Fiber Neuropathy Associated with Hyperlipidemia: Utility of Cutaneous Silent Periods and Autonomic Tests

Abstract

Background. Established electrophysiological methods have limited clinical utility in the diagnosis of small fiber neuropathy. The cutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions. Hyperlipidemia is a very rare cause of small fiber neuropathy. In this study, hyperlipidemia and small fiber neuropathy in symptomatic patients with normal nerve conduction studies were evaluated with autonomic tests and cutaneous silent periods. Methods. Twenty-five patients with clinically suspected small fiber neuropathy and 23 healthy volunteers were included. CSP latency and duration, as well as CSP latency difference of the upper and lower extremities, were examined. Two tests were used to assess the autonomic nervous system, namely, the R-R interval variation test in basal and profound breath conditions and the sympathetic skin response. Results. Twenty-five patients with clinically suspected small fiber neuropathy and normal nerve conduction studies were compared with 23 controls. In the upper extremities, patients had prolonged CSP latencies (P = 0.034) and shortened CSP durations (P = 0.039), whereas in the lower extremities, patients had shortened CSP durations (P = 0.001). The expiration-to-inspiration ratios were also reduced in patients groups. There was no significant difference between sympathetic skin response latencies and amplitude of the case and control groups. Conclusion. Our findings indicate that CSP may become a useful technique for the assessment of small fiber neuropathy in hyperlipidemic patients.

Peripheral neuropathy: A neglected cause of disability in COPD – A narrative review

“…Glucose variation is a well-known factor for PNP but not the only one [75]. Hyperlipidemia can cause neuropathy similar to diabetic neuropathy regarding symptoms progression [76,77]. Plasma lipid levels are associated with many peripheral neuropathies, including axonal distal polyneuropathy, vision and hearing loss, motor nervous system lesions, and sympathetic nervous system dysfunction.…”

The mediating role of HbA1c in the association between elevated low-density lipoprotein cholesterol levels and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus

“…Besides central nervous system damage, diabetic patients exhibiting severe lipid metabolic disorders are at a higher risk of DPN than those without lipid disorders [ 6 ]. In addition, a study with cutaneous silent periods and autonomic tests demonstrated that mixed hyperlipidemia is associated with neuropathy in small fiber [ 7 ]. It is similar with another clinical research which indicated that individuals with normal weight had a significant lower prevalence of DPN (46.99%) than those (66.62%) with obesity [ 8 ].…”

Tracking Epidermal Nerve Fiber Changes in Asian Macaques

“…, 2012, McArthur, 2012, Gibbons, 2014). The etiologies associated with SFN are numerous and include common metabolic disorders such as diabetes mellitus (Russell and Zilliox, 2014) and hyperlipidemia (Morkavuk and Leventoglu, 2013), infectious diseases such as HIV (Kaku and Simpson, 2014) and herpesviral infections (Steiner, 2012), as well as rare hereditary (Brouwer et al , 2014) and autoimmune conditions (Oomatia et al. , 2014).…”

“…The clinical manifestations of SFN typically involve a spectrum of positive and negative sensory abnormalities that may include neuropathic pain, paresthesias (spontaneous tingling or burning sensations), hyperalgesia, and numbness (Hoeijmakers et al 2012; McArthur 2012; Gibbons 2014). The etiologies associated with SFN are numerous and include common metabolic disorders such as diabetes mellitus (Russell and Zilliox 2014) and hyperlipidemia (Morkavuk and Leventoglu 2013), infectious diseases such as HIV (Kaku and Simpson 2014) and herpesviral infections (Steiner 2012), as well as rare hereditary (Brouwer et al 2014) and autoimmune conditions (Oomatia et al 2014). Relevant to neurotoxicology, several pharmaceutical compounds, including chemotherapeutic agents (Cavaletti et al 2010) and antiretroviral drugs (Cherry et al 2003; Ellis et al 2008; Dorsey et al 2015), have frequently been associated with peripheral neurotoxicity leading to SFN.…”