Small-fiber neuropathy definition, diagnosis, and treatment

  • Natalia Y. Basantsova
  • Anna A. StarshinovaEmail author
  • Amir Dori
  • Yulia S. Zinchenko
  • Piotr K. Yablonskiy
  • Yehuda Shoenfeld
Review Article


In the last 30 years, improvement of diagnostic methods enabled routine evaluation of small A-delta and C nerve fibers impairment, which results with the clinical condition known as a small-fiber neuropathy (SFN). This syndrome develops as a result of metabolic, toxic, immune-mediated, or genetic factors. The main clinical features include neuropathic pain and autonomic disturbance, which are occasionally disclaimed due to outstanding fatigue, daily performance decline, anxiety, and depression. As clinical, neurological, nerve conduction, and electromyography studies are commonly normal, diagnosis often depends on the finding of decreased intra-epidermal density of nerve fibers, per skin biopsy. This review highlights the etiology, clinical, diagnostic aspects, and SFN treatment.


Small-fiber neuropathy Neuropathic pain Autoimmune diseases Sarcoidosis 


Source of funding

This work is supported by the grant of the Government of the Russian Federation for the state support of scientific research carried out under the supervision of leading scientists, agreement 14.W03.31.0009, on the basis of SPbU projects of 13.02. 2017.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Laboratory of the Mosaic of AutoimmunityFederal State Budget Educational Institution of Higher Education “St. Petersburg State University”Saint-PetersburgRussia
  2. 2.Department of Faculty TherapyFederal State Budget Educational Institution of Higher Education “St. Petersburg State University”Saint-PetersburgRussia
  3. 3.Ministry of Health of Russian FederationFederal State Budgetary Institution “St. Petersburg Research Institute of Phthisiopulmonology”St. PetersburgRussia
  4. 4.Department of Neurology, Talpiot Medical Leadership ProgramChaim Sheba Medical CenterTel Ha ShomerIsrael
  5. 5.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  6. 6.Zabludowicz Center for Autoimmune DiseasesChaim Sheba Medical CenterTel Ha ShomerIsrael

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