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Related Experiment Videos

Small-fiber neuropathy.

David Lacomis1

  • 1Department of Neurology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, F878, Pittsburgh, Pennsylvania 15213, USA. lacomis@np.awing.upmc.edu

Muscle & Nerve
|September 5, 2002
PubMed
Summary
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Small-fiber neuropathy, often idiopathic, causes painful feet in older adults. Diagnosis relies on clinical signs and specialized tests, with treatment focusing on pain relief when no cause is found.

Area of Science:

  • Neurology
  • Clinical Medicine

Background:

  • Small-fiber neuropathy (SFN) is a prevalent neurological disorder.
  • It frequently presents as idiopathic painful feet, particularly in individuals over 60.
  • While autoimmune causes are suspected, they are seldom confirmed.

Purpose of the Study:

  • To outline the diagnostic approaches for small-fiber neuropathy.
  • To discuss the various etiologies and clinical presentations of SFN.
  • To highlight the role of specialized testing in SFN diagnosis and management.

Main Methods:

  • Diagnosis is based on clinical presentation, normal nerve conduction studies, and specialized small-fiber function tests.
  • Key diagnostic modalities include epidermal nerve fiber density assessment, sudomotor testing, quantitative sensory testing, and cardiovagal testing.

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  • The sensitivity of these specialized tests ranges from 59% to 88%.

    • Main Results:

    • Small-fiber neuropathy can be idiopathic or linked to conditions like diabetes mellitus, amyloidosis, toxins, and inherited neuropathies.
    • Autonomic dysfunction may accompany SFN, varying from subclinical to significant.
    • Specialized tests, while complementary, have varying sensitivities and specificities.

    Conclusions:

    • Accurate diagnosis of SFN requires a combination of clinical evaluation and specialized functional tests.
    • Identifying an underlying etiology is crucial for targeted treatment.
    • When no specific cause is identified, management focuses on alleviating neuropathic pain.