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Small fiber neuropathy: Getting bigger!

Amanda C Y Chan1, Einar P Wilder-Smith1,2

  • 1Division of Neurology, National University Hospital, Level 10 Tower Block, University Medicine Cluster, 1E Kent Ridge Road, 119228, Singapore.

Muscle & Nerve
|February 14, 2016
PubMed
Summary
This summary is machine-generated.

Small fiber neuropathy (SFN) presents diverse symptoms affecting pain and temperature. Diagnosis relies on nerve fiber density and specialized tests, with common causes including diabetes and idiopathic factors.

Keywords:
autonomic testintraepidermal nerve fiber densityskin biopsysmall fiber neuropathysodium channelopathy

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Area of Science:

  • Neurology
  • Clinical Medicine

Background:

  • Small fiber neuropathy (SFN) exhibits significant etiological and clinical heterogeneity, complicating a unified diagnostic and management approach.
  • SFN involves dysfunction in nociception, temperature, and autonomic pathways, necessitating focused reviews on specific symptom clusters.

Purpose of the Study:

  • To review the epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management of small fiber neuropathy (SFN).
  • To focus on SFN impacting nociception and temperature modalities.

Main Methods:

  • Literature review examining SFN epidemiology, etiology, clinical features, diagnostic methods, pathophysiology, and treatment strategies.
  • Analysis of prevalence data, common etiologies (diabetes, idiopathic), and diagnostic criteria including intraepidermal nerve fiber density and quantitative sensory/autonomic testing.

Main Results:

  • SFN prevalence is 52.95 per 100,000 population, with diabetes and idiopathic causes being most frequent.
  • Common symptoms include dysesthesia, allodynia, pain, burning, and cold sensations, often in a length-dependent pattern, alongside frequent but poorly objectified autonomic features.
  • Diagnosis combines intraepidermal nerve fiber density, quantitative sensory/autonomic tests, and normal nerve conduction studies.

Conclusions:

  • Understanding SFN pathophysiology is advancing, particularly regarding sodium channel dysfunction and genetic factors.
  • Current treatment targets underlying causes and symptoms using antidepressants and anticonvulsants.
  • Further systematic cohort studies are required to elucidate long-term outcomes in SFN.