Office approach to small fiber neuropathy
1Medical Director, Neuromuscular Division, Associate Professor, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. jinny.tavee@nm.org; htavee@hotmail.com.
Cleveland Clinic Journal of Medicine
|October 6, 2018
Summary
Small fiber neuropathy causes painful feet despite normal nerve tests. Diagnosis uses skin biopsy and autonomic studies, with treatment focusing on the cause, pain management, and lifestyle changes.
Area of Science:
- Neurology
- Dermatology
Background:
- Small fiber neuropathy (SFN) presents as neuropathic pain, typically in the feet.
- Standard neurological exams and nerve conduction studies are often normal in SFN patients.
Purpose of the Study:
- To outline a diagnostic and management approach for small fiber neuropathy.
- To emphasize the importance of specialized testing for SFN diagnosis.
Main Methods:
- Diagnosis involves specialized tests such as autonomic function studies.
- Skin biopsy to assess intraepidermal nerve fiber density is crucial.
- A stepwise approach to identify underlying causes is recommended.
Main Results:
- SFN is frequently idiopathic, but various underlying causes exist.
- Reduced intraepidermal nerve fiber density confirms the diagnosis.
- Effective management involves addressing the cause, pain control, and lifestyle adjustments.
Conclusions:
- A systematic diagnostic strategy is essential for small fiber neuropathy.
- Timely identification of causes and appropriate management improve patient outcomes.
- Specialized testing is key to diagnosing SFN when initial evaluations are inconclusive.
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