Advertisement

Human Physiology

, Volume 44, Issue 8, pp 838–843 | Cite as

Small Fiber Neuropathy

  • N. A. Suponeva
  • N. V. BelovaEmail author
  • N. I. Zaitseva
  • D. G. Yusupova
  • D. Yu. Lagoda
  • O. S. Korepina
  • M. A. Piradov
Article
  • 6 Downloads

Abstract

Small fiber neuropathy (SFN), despite a thirty-year history of study, remains one of the most mysterious diseases that are difficult to diagnose and treat. The prevalence of SFN is 52.95 per 100 000 population; diabetes mellitus is considered to be the most frequent cause of this disease. Chronic neuropathic pain syndrome, temperature sensation abnormalities, and autonomic disorders develop as a result of damage to fine myelinated Аδ- and unmyelinated C fibers. The disease mainly spreads in the upward direction: from feet to the proximal parts of the body and arms; primary axonal damage takes place. Although SFN is believed to be one of the most “benign” types of neuropathy as it does not involve the large sensory and motor fibers, patients’ quality of life is markedly reduced.

Keywords:

small fiber neuropathy (SFN) peripheral neuropathy channelopathy skin biopsy quantitative sensory testing (QST) quantitative sudomotor axon reflex test (QSART) 

REFERENCES

  1. 1.
    Vinik, A., Ullal, J., Parson, H.K., and Casellini, C.M., Diabetic neuropathies: clinical manifestations and current treatment options, Nat. Clin. Pract. Endocrinol. Metab., 2006, vol. 2, pp. 269–281. PMID 16932298. doi 10.1038/ncpendmet0142CrossRefGoogle Scholar
  2. 2.
    Loseth, S., Stalberg, E., Jorde, R., and Mellgren, S.I., Early diabetic neuropathy: thermal thresholds and intraepidermal nerve fiber density in patients with normal nerve conduction studies, J. Neurol., 2008, vol. 255, pp. 1197–202. PMID 18574618. doi 10.1007/ s00415-008-0872-0CrossRefGoogle Scholar
  3. 3.
    Malik, R.A., Veves, A., Tesfaye, S., et al., Small fiber neuropathy: role in the diagnosis of diabetic sensorimotor polyneuropathy, Diabetes Metab. Res. Rev., 2011, vol. 27, pp. 678–684. PMID 21695760. doi 10.1002/ dmrr.1222CrossRefGoogle Scholar
  4. 4.
    Serra, J., Collado, A., Sola, R., et al., Hyperexcitable C nociceptors in fibromyalgia, Ann. Neurol., 2014, vol. 75, pp. 196–208. PMID 24243538. doi 10.1002/ana.24065CrossRefGoogle Scholar
  5. 5.
    van Acker, N., Rage, M., Slyudts, E., et al., Automated PGP9.5 immunofluorescence staining: a valuable tool in the assessment of small fiber neuropathy? BMC Res Notes, 2016, vol. 9, p. 280. PMID 27215701. doi 10.1186/s13104-016-2085-4CrossRefGoogle Scholar
  6. 6.
    Dyck, P.J., Incidence and prevalence of small-fiber neuropathy: a survey in the Netherlands, Neurology, 2014, vol. 82, p. 1385. PMID 24733860. doi 10.1212/ 01.wnl.0000446502.87636.91CrossRefGoogle Scholar
  7. 7.
    Peters, M.J., Bakkers, M., Merkies, I.S., et al., Incidence and prevalence of small-fiber neuropathy: a survey in the Netherlands, Neurology, 2013, vol. 81, pp. 1356–1360. PMID 23997150. doi 10.1212/WNL. 0b013e3182a8236eCrossRefGoogle Scholar
  8. 8.
    Chan, A. and Wilder-Smith, E., Clinical reasoning: burning hands and feet, Neurology, 2015, vol. 84, pp. e146–e152. PMID 25964484. doi 10.1212/WNL. 0000000000001559CrossRefGoogle Scholar
  9. 9.
    Oh, S.J., LaGanke, C., and Claussen, G.C., Sensory Guillain–Barre syndrome, Neurology, 2001, vol. 56, pp. 82–86. PMID 11148240CrossRefGoogle Scholar
  10. 10.
    Suponeva, N.A. and Pavlov, Y.V., Diagnosis and basic therapy of chronic polyneuropathies, Vrach, 2009, no. 9, pp. 43–44.Google Scholar
  11. 11.
    Smith, A.G. and Singleton, J.R., Impaired glucose tolerance and neuropathy, Neurologist, 2008, vol. 14, no. 1, pp. 23–29. PMID 18195653. doi 10.1097/NRL. 0b013e31815a3956CrossRefGoogle Scholar
  12. 12.
    Smith, A.G., Impaired glucose tolerance and metabolic syndrome in idiopathic neuropathy, J. Peripher. Nerv. Syst., 2012, vol. 17, suppl. 2, pp. 15–21. PMID 22548618. doi 10.1111/j.1529-8027.2012.00390.xCrossRefGoogle Scholar
  13. 13.
    Chao, C.C., Wu, V.C., Tan, C.H., et al., Skin denervation and its clinical significance in late-stage chronic kidney disease, Arch. Neurol., 2011, vol. 68, pp. 200–206. PMID 21320986. doi 10.1001/archneurol. 2010.372CrossRefGoogle Scholar
  14. 14.
    McManis, P.G., Windebank, A.J., and Kiziltan, M., Neuropathy associated with hyperlipidemia, Neurology, 1994, vol. 44, pp. 2185–2186. PMID 7969981CrossRefGoogle Scholar
  15. 15.
    Vas, P.R., Sharma, S., and Rayman, G., LDI flare small fiber function in normal glucose tolerant subjects with and without hypertriglyceridemia, Muscle Nerve, 2015, vol. 52, pp. 113–119. PMID 25363244. doi 10.1002/mus.24504CrossRefGoogle Scholar
  16. 16.
    Boger, M.S., Hulgan, T., Haas, D.W., et al., Measures of small-fiber neuropathy in HIV infection, Auton. Neurosci., 2012, vol. 169, pp. 56–61. PMID 22542355. doi 10.1016/j.autneu.2012.04.001.Google Scholar
  17. 17.
    Herrmann, D.N., McDermott, M.P., Sowden, J.E., et al., Is skin biopsy a predictor of transition to symptomatic HIV neuropathy? A longitudinal study, Neurology, 2006, vol. 66, pp. 857–861. PMID 16567702. doi 10.1212/01.wnl.0000203126.01416.77CrossRefGoogle Scholar
  18. 18.
    Mah, V., Vartavarian, L.M., Akers, M.A., and Vinters, H.V., Abnormalities of peripheral nerve in patients with human immunodeficiency virus infection, Ann. Neurol., 1988, vol. 24, no. 6, pp. 713–717. PMID 2849921. doi 10.1002/ana.410240604CrossRefGoogle Scholar
  19. 19.
    Oaklander, A.L., Herzorg, Z.D., Downs, H.M., and Klein, M.M., Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia, Pain, 2013, vol. 154, pp. 2310–2316. PMID 23748113. doi 10.1016/j.pain.2013.06.001CrossRefGoogle Scholar
  20. 20.
    Gemignani, F., Fibromyalgia syndrome and small-fiber neuropathy, Ann. Neurol., 2014, vol. 76, p. 916. PMID 25186210. doi 10.1002/ana.24269CrossRefGoogle Scholar
  21. 21.
    de Araújo, F., de Melo Neto, A.P., Oliveira, I.S., et al., Small (autonomic) and large fiber neuropathy in Parkinson disease and parkinsonism, Neurology, 2016, vol. 16, p. 139. PMID 27530902. doi 10.1186/s12883-016-0667-3Google Scholar
  22. 22.
    Khoshnoodi, M.A., et al., Longitudinal assessment of small fiber neuropathy: evidence of a non–length-dependent distal axonopathy, JAMA Neurol., 2016, vol. 73, no. 6, pp. 684–690.CrossRefGoogle Scholar
  23. 23.
    Gibbons, C.H., Small fiber neuropathies, Continuum, 2014, vol. 20, no. 5, pp. 1398–1412. PMID 25299289. doi 10.1212/01.CON.0000455874.68556.02Google Scholar
  24. 24.
    McArthur, J.C., Painfull small fiber neuropathies, Continuum Lifelong Learn. Neurol., 2012, vol. 18, no. 1, pp. 106–125. PMID 22810072. doi 10.1212/01.CON. 0000411570.79827.25CrossRefGoogle Scholar
  25. 25.
    Sumner, C.J., Sheth, S., Griffin, J.W., et al., The spectrum of neuropathy in diabetes and impaired glucose tolerance, Neurology, 2003, vol. 60, pp. 108–111. PMID 12525727CrossRefGoogle Scholar
  26. 26.
    European Handbook of Neurological Management, Gilhus, N.E., Barnes, M.P., and Brainin, M., Eds., Oxford: Blackwell, 2011, 2nd ed.Google Scholar
  27. 27.
    Quattrini, C, Tavakili, M., Jeziorska, M., et al., Surrogate markers of small fiber damage in human diabetic neuropathy, Diabetes, 2007, vol. 56, pp. 2148–2154. PMID 17513704. doi 10.2337/db07-0285CrossRefGoogle Scholar
  28. 28.
    Tavee, J. and Zhou, L., Small fiber neuropathy: a burning problem, Cleveland Clin. J. Med., 2009, vol. 76, no. 5, pp. 297–305. PMID 19414545. doi 10.3949/ ccjm.76a.08070CrossRefGoogle Scholar
  29. 29.
    Umapathi, T., Tan, W.L., Loke, S.C., et al., Intraepidermal nerve fiber density as a marker of early diabetic neuropathy, Muscle Nerve, 2007, vol. 35, pp. 591–598. PMID 17221881. doi 10.1002/mus.20732CrossRefGoogle Scholar
  30. 30.
    Devigili, G., Tugnoli, V., Penza, P., et al., The diagnostic criteria for small fiber neuropathy: from symptoms to neuropathology, Brain, 2008, vol. 131, pp. 1912–1925. PMID 18524793. doi 10.1093/brain/awn093CrossRefGoogle Scholar
  31. 31.
    McArthur, J.C., Stocks, E.A., Hauer, P., et al., Epidermal nerve fiber density: normative reference range and diagnostic efficiency, Arch. Neurol., 1998, vol. 55, pp. 1513–1520. PMID 9865794CrossRefGoogle Scholar
  32. 32.
    Hoeijmakers, J.G., Faber, C.G., Miedema, C.J., et al., Small fiber neuropathy in children: two case reports illustrating the importance of recognition, Pediatrics, 2016, vol. 138, no. 4, p. e20161215. PMID 27660061. doi 10.1542/peds.2016-1215CrossRefGoogle Scholar
  33. 33.
    Latronico, N., Filosto, M., Fagoni, N., et al., Small nerve fiber pathology in critical illness, PLoS One, 2013, vol. 8, no. 9, p. e75696. PMID 24098716. doi 10.1371/journal.pone.0075696CrossRefGoogle Scholar
  34. 34.
    Oaklander, A.L. and Klein, M.M., Evidence of small-fiber polyneuropathy in unexplained, juvenile-onset, widespread pain syndromes, Pediatrics, 2013, vol. 131, pp. 1091–1100. PMID 23478869. doi 10.1542/peds.2012-2597CrossRefGoogle Scholar
  35. 35.
    Dyck, P.J., Kincaid, J.C., Chaudhry, V., et al., Assessing mNIS+7Ionis and international neurologists’ proficiency in a familial amyloidotic polyneuropathy trial, Muscle Nerve, 2017, vol. 56, no. 5, pp. 901–911. PMID 28063170. doi 10.1002/mus.25563CrossRefGoogle Scholar
  36. 36.
    Mantyh, G., Dyck, P.J., Dyck, P.J., et al., Epidermal nerve fiber quantification in patients with erythromelalgia, JAMA Dermatol., 2016, vol. 153, no. 2, pp. 162–167. doi 10.1001/jamadermatol.2016.4404CrossRefGoogle Scholar
  37. 37.
    Shy, M.E., Frohman, E.M., So, Y.T., et al., Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, Neurology, 2003, vol. 60, pp. 898–904. PMID 12654951CrossRefGoogle Scholar
  38. 38.
    Thaisetthawatkul, P., Fernandes Filho, J.A., and Hermann, D.N., Contribution of QSART to the diagnosis of small fiber neuropathy, Muscle Nerve, 2013, vol. 48, pp. 883–888. PMID 23649502. doi 10.1002/ mus.23891CrossRefGoogle Scholar
  39. 39.
    Vinik, A.I., Casellini, C., and Nevoret, M.L., Alternative quantitative tools in the assessment of diabetic peripheral and autonomic neuropathy, Int. Rev. Neurobiol., 2016, vol. 127, pp. 235–285. PMID 27133153. doi 10.1016/bs.irn.2016.03.010CrossRefGoogle Scholar
  40. 40.
    Ebadi, H., Siddiqui, H., Ebadi, S., et al., Peripheral nerve ultrasound in small fiber polyneuropathy, Ultrasound Med. Biol., 2015, vol. 41, no. 11, pp. 2820–2826. PMID 26318562. doi 10.1016/j.ultrasmedbio. 2015.06.011CrossRefGoogle Scholar
  41. 41.
    Brouwer, B.A., Bakkers, M., Hoeijmakers, J.G., et al., Improving assessment in small fiber neuropathy, J. Peripher. Nerv. Syst., 2015, vol. 20, pp. 333–340. PMID 26114213. doi 10.1111/jns.12128CrossRefGoogle Scholar
  42. 42.
    Singleton, J.R., Bixby, B., Russell, J.W., et al., The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy, J. Peripher. Nerv. Syst., 2008, vol. 13, pp. 218–227. PMID 18844788. doi 10.1111/j.1529-8027.2008.00180.xCrossRefGoogle Scholar
  43. 43.
    Bakkers, M., Faber, C.G., Hoeijmakers, J.G., et al., Small fibers, large impact: quality of life in small-fiber neuropathy, Muscle Nerve, 2014, vol. 49, pp. 329–336. PMID 23716362. doi 10.1002/mus.23910CrossRefGoogle Scholar
  44. 44.
    Lauria, G., Merkies, I.S., and Faber, C.G., Small fiber neuropathy, Curr. Opin. Neurol., 2012, vol. 25, pp. 542–549. PMID 22941266. doi 10.1097/ WCO.0b013e32835804c5CrossRefGoogle Scholar
  45. 45.
    González-Duarte, A., Lem, M., Diaz-Diaz, E., et al., Efficacy of Pregabalin in the treatment of prediabetic neuropathic pain, Clin. J. Pain Publish Ahead Print, 2016, vol. 32, no. 11, pp. 927–932. PMID 26670614. doi 10.1097/AJP.0000000000000339CrossRefGoogle Scholar
  46. 46.
    Acevedo, J.C., Amaya, A., Casasola Ole, L., et al., Guidelines for the diagnosis and management of neuropathic pain: consensus of a group of Latin American experts, J. Pain Palliative Care Pharmacother., 2009, vol. 23, pp. 261–281. PMID 19670022. doi 10.1080/ 15360280903098572CrossRefGoogle Scholar
  47. 47.
    Bohlega, S., Alsaadi, T., Amir, A., et al., Guidelines for the pharmacological treatment of peripheral neuropathic pain: expert panel recommendations for the Middle East region, J. Int. Med. Res., 2010, vol. 38, pp. 295–317. PMID 20515552CrossRefGoogle Scholar
  48. 48.
    Bril, V., England, J., Franklin, G.M., et al., Evidence-based guideline: treatment of painful diabetic neuropathy. Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation, Neurology, 2011, vol. 3, p. 345. PMID 21482920. doi 10.1212/WNL.0b013e3182166ebeGoogle Scholar
  49. 49.
    Dworkin, R.H., O’Connor, A.B., Audette, J., et al., Recommendations for the pharmacological management of neuropathic pain: an overview and literature update, Mayo Clin. Proc., 2010, vol. 85, p. 14. PMID 20194146. doi 10.4065/mcp.2009.0649CrossRefGoogle Scholar
  50. 50.
    Moulin, D., Boulanger, A., Clark, A.J., et al., Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society, Pain Res. Manage., 2014, vol. 19, pp. 328–335. PMID 25479151CrossRefGoogle Scholar
  51. 51.
    Desai, B., Freeman, E. Huang, E., et al., Clinical value of tapentadol extended-release in painful diabetic peripheral neuropathy, Exp. Rev. Clin. Pharmacol., 2014, vol. 7, no. 2, pp. 203–209. PMID 24524594. doi 10.1586/17512433.2014.889562CrossRefGoogle Scholar
  52. 52.
    Games, G. and Hutchison, A., Tapentadol-ER for the treatment of diabetic peripheral neuropathy, Consult. Pharm., 2013, vol. 28, pp. 672–675. PMID 24129223. doi 10.4140/TCP.n.2013.672CrossRefGoogle Scholar
  53. 53.
    Dabby, R., Gliad, R., Sadeh, M., et al., Acute steroid responsive small-fiber sensory neuropathy: a new entity? J. Peripheral Nervous Syst., 2006, vol. 11, pp. 47–52. PMID 16519781. doi 10.1111/j.1085-9489.2006.00062.xCrossRefGoogle Scholar
  54. 54.
    Orstavik, K., Norheim, I., and Jorum, E., Pain and small-fiber neuropathy in patients with hypothyroidism, Neurology, 2006, vol. 67, pp. 786–791. PMID 16966538. doi 10.1212/01.wnl.0000234035.13779.4aCrossRefGoogle Scholar
  55. 55.
    Parambil, J.G., Tavee, J.O., Zhou, L., et al., Efficacy of intravenous immunoglobulin for small fiber neuropathy associated with sarcoidosis, Respir. Med., 2011, vol. 105, no. 1, pp. 101–105. PMID 20926271. doi 10.1016/j.rmed.2010.09.015CrossRefGoogle Scholar
  56. 56.
    Souayah, N., Chin, R.L., Brannagan, T.H., et al., Effect of intravenous immunoglobulin on cerebellar ataxia and neuropathic pain associated with celiac disease, Eur. J. Neurol., 2008, vol. 15, no. 12, pp. 1300–1303. PMID 19049545. doi 10.1111/j.1468-1331. 2008.02305.xCrossRefGoogle Scholar
  57. 57.
    Wakasugi, D., Kato, T., Gono, T., et al., Extreme efficacy of intravenous immunoglobulin therapy for severe burning pain in a patient with small fiber neuropathy associated with primary Sjogren’s syndrome, Mod. Rheumatol., 2009, vol. 19, no. 4, pp. 437–440. PMID 19458906. doi 10.1007/s10165-009-0180-2CrossRefGoogle Scholar
  58. 58.
    Chan, A. and Wilder-Smith, E.P., Small fiber neuropathy: getting bigger! Muscle Nerve, 2016, vol. 53, pp. 671–682. PMID 26872938. doi 10.1002/ mus.25082CrossRefGoogle Scholar
  59. 59.
    Goebel, A., Immunoglobulin responsive chronic pain, J. Clin. Immunol., 2010, vol. 30, suppl. 1, pp. S103–S108. PMID 20424897. doi 10.1007/s10875-010-9403-8CrossRefGoogle Scholar
  60. 60.
    de Greef, B.T., Geerts, M., Hoeijmakers, J.G., et al., Intravenous immunoglobulin therapy for small fiber neuropathy: study protocol for a randomized con- trolled trial, Trials, 2016, vol. 17, p. 330. doi 10.1186/ s13063-016-1450-xCrossRefGoogle Scholar

Copyright information

© Pleiades Publishing, Inc. 2018

Authors and Affiliations

  • N. A. Suponeva
    • 1
  • N. V. Belova
    • 1
    Email author
  • N. I. Zaitseva
    • 2
  • D. G. Yusupova
    • 1
  • D. Yu. Lagoda
    • 1
  • O. S. Korepina
    • 1
  • M. A. Piradov
    • 1
  1. 1.Research Center of NeurologyMoscowRussia
  2. 2.Moscow State UniversityMoscowRussia

Personalised recommendations