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Updated: Sep 19, 2025
11:29
Corneal Confocal Microscopy: A Novel Non-invasive Technique to Quantify Small Fibre Pathology in Peripheral Neuropathies
Published on: January 3, 2011
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Small Fiber Neuropathy in Long COVID: A Cohort Study with Multimodal Assessment and Follow-Up
Natalia Drobinska1, Mayssam Nehme2, Fréderic Assal1
1Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
European Neurology
|June 3, 2025
Summary
Small fiber neuropathy (SFN) frequently occurs after coronavirus disease 2019 (COVID-19), causing persistent neuropathic pain and dysautonomia. Noninvasive tests aid in diagnosing SFN, complementing skin biopsy for long COVID patients.
Area of Science:
- Neurology
- Infectious Diseases
- Pain Medicine
Background:
- Post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, can manifest with persistent neuropathic pain and dysautonomic symptoms.
- Small fiber neuropathy (SFN) is increasingly recognized as a potential cause of these debilitating symptoms following SARS-CoV-2 infection.
Purpose of the Study:
- To estimate the occurrence of SFN in patients with long COVID experiencing neuropathic pain.
- To evaluate the diagnostic utility of multimodal SFN assessment tools.
Main Methods:
- A cohort of 18 patients with long COVID-19 and neuropathic pain (DN4 score ≥4) lasting ≥90 days, with normal nerve conduction studies, was evaluated.
- Multimodal assessment included skin biopsy, quantitative sensory testing (QST), laser evoked potentials (LEP), and electrochemical skin conductance (ESC).
Main Results:
- Out of 17 analyzed patients, 82% showed abnormal skin biopsy results, and 70% had autonomic complaints.
- Quantitative sensory testing (QST) demonstrated high sensitivity (79%) and specificity (67%) for SFN diagnosis.
- Electrochemical skin conductance (ESC) exhibited poor reliability (7% sensitivity, 50% specificity).
Conclusions:
- SFN is a likely complication of SARS-CoV-2 infection, contributing to persistent sensory and autonomic dysfunction.
- Noninvasive diagnostic methods, particularly QST and LEP, are valuable adjuncts to skin biopsy for diagnosing SFN in long COVID patients.
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