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Small-Fiber Neuropathy

Small fiber peripheral neuropathy


Presentation

  • Here, we report the first confirmed cases of small-fiber neuropathy (SFN) in LOPD and present the results of a first attempt at screening for SFN in this patient population.[ncbi.nlm.nih.gov]
  • Vasculitis-associated neuropathy usually presents as multiple mononeuropathies or sensorimotor polyneuropathies that affect large nerve fibers; painful small fiber sensory neuropathy has not previously been described in association with vasculitis.[ncbi.nlm.nih.gov]
  • We present the case of a 22-year-old postoperative case of right frontoparietal oligodendroglioma who received multiple drugs for his severe neuropathic pain without significant relief.[ncbi.nlm.nih.gov]
  • A lack of uniform diagnostic criteria for small fiber neuropathy and Sjogren’s syndrome presents several challenges for treatment.[practicalneurology.com]
  • This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management.[ncbi.nlm.nih.gov]
Burning Pain
  • The main features were burning, painful paresthesias and dysesthesias in the feet, lancinating pains, moderate to severe distal small fiber sensory loss, absent ankle reflexes, and minimal or no distal foot weakness.[ncbi.nlm.nih.gov]
  • Small-fiber neuropathy manifests in a variety of different diseases and often results in symptoms of burning pain, shooting pain, allodynia, and hyperesthesia.[ncbi.nlm.nih.gov]
  • pain, allodynia, hyperalgesia), which often dominate the clinical picture.[ncbi.nlm.nih.gov]
  • Idiopathic small-fiber neuropathy (I-SFN), clinically characterized by burning pain in distal extremities and autonomic dysfunction, is a disorder of small-caliber nerve fibers of unknown etiology with limited treatment options.[ncbi.nlm.nih.gov]
  • The most common reported symptoms include: Gradual onset of pain in the feet Cold-like pain Tingling sensations Burning pain Electric shock-like pain Worsening symptoms during resting periods and nighttime Allodynia (pain from normal touch; normally non-painful[usneuropathycenters.com]
Pneumonia
  • We report a rare sensory variant of GBS presenting with isolated small nerve fiber involvement peripherally in the limbs and associated facial nerve palsy in a patient who had clinical and serological evidence of a preceding Mycoplasma pneumoniae infection[ncbi.nlm.nih.gov]
  • Rare adverse events including bleeding, hyperlipidemia, and pulmonary complications (interstitial lung disease and eosinophilic pneumonia) have been reported.[ncbi.nlm.nih.gov]
Decreased Lacrimation
  • lacrimation, decreased salivation, important trophic skin changes, changes in bowel habits (constipation or diarrhea) or urinary complaints (polyuria, urinary retention or incontinence), among others ( for a more extensive review of autonomic manifestations[scielo.br]
Skin Lesion
  • The anatomical distribution is similar to sarcoidosis small-fiber neuropathy (SSFN), in which sarcoidosis patients without evident skin lesions experience sensory disturbances of unknown etiology involving the face, the proximal extremities and the trunk[ncbi.nlm.nih.gov]
  • Testing for Fabry disease should be considered only in cases with additional characteristics, such as childhood onset, cardiovascular disease, renal failure, or typical skin lesions.[ncbi.nlm.nih.gov]
  • Skin lesions were not observed on either foot at the time of our hospital visit. Sensory symptoms were continued and unaffected by postural change.[austinpublishinggroup.com]
Foot Pain
  • For instance, some people might experience foot pain when wearing socks or touching bedsheets. Symptoms can be mild or severe, though early symptoms are often mild. Small fiber neuropathy tends to affect the feet first and progress upward.[healthline.com]
Numbness of the Feet
  • CIDP often causes limb weakness but may just cause problems with balance from numbness in the feet and legs. This is one of the few types of polyneuropathy where the underlying cause be treated.[honorhealth.com]
Behavior Disorder
  • NIAMS is an Institute that would apparently rather treat FM as a behavioral disorder than a physiological one and has little interest in funding it. (Funding has actually dropped over the past five years.)[prohealth.com]
Paresthesia
  • There is a handful of case reports of dysautonomia, painful paresthesias or acute polyradiculopathies related to Hodgkin Lypmhoma.[n.neurology.org]
  • The most common symptoms of SSFN recorded were numbness, pain and paresthesias (an abnormal sensation, such as numbness, tingling, or burning), mainly in the face, trunk, and proximal limbs.[sarcoidosisnews.com]
  • We report five patients who developed paresthesias within one day to two months following vaccination for rabies, varicella zoster, or Lyme disease.[ncbi.nlm.nih.gov]
  • Although strength remains preserved throughout the course of the disease, the pain and paresthesias are often disabling.[semanticscholar.org]
  • The main features were burning, painful paresthesias and dysesthesias in the feet, lancinating pains, moderate to severe distal small fiber sensory loss, absent ankle reflexes, and minimal or no distal foot weakness.[ncbi.nlm.nih.gov]
Dysesthesia
  • The main features were burning, painful paresthesias and dysesthesias in the feet, lancinating pains, moderate to severe distal small fiber sensory loss, absent ankle reflexes, and minimal or no distal foot weakness.[ncbi.nlm.nih.gov]
  • Dysesthesia, allodynia, pain, burning, and coldness sensations frequently present in a length-dependent pattern. Additional autonomic features in gastrointestinal, urinary, or cardiovascular systems are frequent but poorly objectified.[ncbi.nlm.nih.gov]
  • We describe the first case of intractable painful small fiber neuropathy of the foot successfully treated with spinal cord stimulation of the left L5 dorsal root ganglion.A 74-year-old man presented at our clinic with severe intractable pain, dysesthesia[ncbi.nlm.nih.gov]
  • Its clinical picture includes both negative and positive manifestations: sensory (pain/dysesthesias/pruritus) or combined sensory and autonomic complaints, associated with an almost entirely normal neurological examination.[ncbi.nlm.nih.gov]
  • A semi-structured interview was conducted to assess the features of pain or dysesthesia (International Association for the Study of Pain-IASP, ).[hepatitiscnewdrugs.blogspot.com]
Hypesthesia
  • 靴下状感覚消失 stocking hypesthesia靴下状感覚脱失 stocking hypesthesia靴下状知覚消失 stocking hypesthesia靴下状知覚脱失 streptozocinストレプトゾシン streptozotocinストレプトゾトシン streptozotocin-induced diabetesストレプトゾトシン惹起性糖尿病 streptozotocin-induced diabetesストレプトゾトシン糖尿病 stress hyperglycemiaストレス[jds.or.jp]
Neglect
  • The requests for cryoglobulin tests are far less frequent than would be expected, which suggests that cryoglobulinemia in SFN could be an important but neglected clinical condition[ 18 ].[journals.plos.org]

Workup

  • CONCLUSIONS: Skin biopsy changed management or diagnosis in 52% of patients evaluated for a possible SFN and appears to play a valuable role in the workup of these patients. Copyright 2013 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • Guidelines for appropriate diagnostic workup using a stepwise approach involving a combination of tests are warranted. Even if no treatment is available, patients may benefit from timely recognition of SFN.[ncbi.nlm.nih.gov]
  • Once the diagnosis has been established, there is an uncertainty how SFN may progress, whether larger fibers will become involved over time, whether quality of life may be compromised, or whether repeated diagnostic workup in patients with unknown underlying[karger.com]
White Matter Lesions
  • METHODS AND RESULTS: Patients were retrospectively analyzed for stroke, transient ischemic attack (TIA), white matter lesions (WML) and SFN with neuropathic pain.[ncbi.nlm.nih.gov]

Treatment

  • Treatment is based on multidisciplinary management, combining symptomatic treatment, psychological management and treatment of an associated etiology. 3 It should be clear that these three sample studies of many published reports outline that there are[caringmedical.com]
  • The limited efficacy of current treatment options dictates a rationalized design of novel compounds.[ncbi.nlm.nih.gov]
  • Management of small-fiber neuropathy depends on the underlying etiology with concurrent treatment of associated neuropathic pain.[ncbi.nlm.nih.gov]
  • The primary endpoint is the comparison of the percentage of responder subjects between the two treatment groups from the first randomization during the 12 weeks of treatment.[ncbi.nlm.nih.gov]
  • However, treatments for pain relief in these patients frequently fail.[ncbi.nlm.nih.gov]

Prognosis

  • The long-term prognosis is quite good in these participants. From our structuralized protocol, Fabry disease and familial amyloid polyneuropathy could be easily detected in these cases of uncommon DSPSFN.[ncbi.nlm.nih.gov]
  • […] is difficult for many patients to accept, especially when they learn that treatment often involves only diet and exercise, which they find difficult to sustain, and symptomatic pain management, which is often only modestly effective. 6 An uncertain prognosis[jamanetwork.com]
  • It also contributes to the poor prognosis of diabetic neuropathy because it plays a key role in the pathogenesis of foot ulceration and autonomic neuropathy.[ncbi.nlm.nih.gov]
  • The long-term prognosis is quite good in our participants.[journals.plos.org]
  • Each can have its own symptoms and prognosis. These are common types of peripheral neuropathy: Small fiber peripheral neuropathy is a polyneuropathy that occurs from damage to small peripheral nerve fibers present in the skin.[honorhealth.com]

Etiology

  • Etiological and clinical heterogeneity of small fiber neuropathy (SFN) precludes a unifying approach and necessitates reliance on recognizable clinical syndromes.[ncbi.nlm.nih.gov]
  • Participants who had previous historical or laboratory evidence of common etiologies of DSPSFN were excluded.[ncbi.nlm.nih.gov]
  • The etiology of DSPSFN is associated with various disorders.[journals.plos.org]
  • […] who met the criteria of 2 SFN-related symptoms, normal strength, tendon reflexes, vibration sense, and nerve conduction studies, and reduced intraepidermal nerve fiber density (IENFD) plus abnormal quantitative sensory testing (QST) and no underlying etiology[ncbi.nlm.nih.gov]
  • Not only does it significantly affect quality of life, but it also is a source of frustration for both the patient and physician because the etiology for pain often is unknown.[ncbi.nlm.nih.gov]

Epidemiology

  • This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management.[ncbi.nlm.nih.gov]
  • In adults, recent calculations show that SFN has a minimum prevalence of 53 cases in 100 000, which indicates it is not a rare disorder. 4 The impact on quality of life is severe, both physically and mentally. 5 In children, little is known about the epidemiology[pediatrics.aappublications.org]
  • Veves A, Backonja M, Malik RA (2008) Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med 9:660–674 PubMed CrossRef Google Scholar 4.[link.springer.com]
  • Atlanta, GA: Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, US Department of Health and Human Services; 2016 :52. [ Google Scholar ] 14.[ncbi.nlm.nih.gov]
  • Aetiology, epidemiology and pathogenesis The exact incidence and prevalence of SFN is unknown. 1 , 11 , 12 There have been no satisfactory studies to assess the epidemiology of SFN, because until recently, there was no generally accepted definition for[pn.bmj.com]
Sex distribution
Age distribution

Pathophysiology

  • This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management.[ncbi.nlm.nih.gov]
  • In this review, we discuss the role of Na(V)1.7 in pain and highlight the molecular genetics and pathophysiology of SCN9A-gene variants in SFN.[ncbi.nlm.nih.gov]
  • In this review, we highlight relevant pathophysiological aspects and discuss currently used therapeutic strategies for neuropathic pain. Possible pitfalls in neuropathic pain treatment in the elderly will be underlined.[ncbi.nlm.nih.gov]
  • In this article we review how the SFN seen in FM may be placed in context, and suggest how such a tissue abnormality might be used to better understand the pathophysiology of FM, and plan for its effective treatment.[ncbi.nlm.nih.gov]
  • Prospective studies using QST in pediatric oncology may help to elucidate the pathophysiology of small-fiber neuropathy and pain sensitization as well as their relevance for quality of survival. Copyright 2018 European Paediatric Neurology Society.[ncbi.nlm.nih.gov]

Prevention

  • Future studies are needed to clarify whether affected patients benefit from GLA enzyme replacement therapy for end-organ damage prevention.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: This preliminary study, which must be confirmed in a larger population, shows that EZSCAN risk score is associated with diabetes progression which have implications for prevention and disease management. Copyright 2013.[ncbi.nlm.nih.gov]
  • “We are developing a drug involving the clotting mechanism that prevents neuropathy in mice. We produced diabetes in the rodents, and this drug prevented damage to their small fibers; we used a control group to compare the effects.[jpost.com]
  • Atlanta, GA: Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, US Department of Health and Human Services; 2016 :52. [ Google Scholar ] 14.[ncbi.nlm.nih.gov]
  • Timely diagnosis and appropriate treatment is essential to ensure treating the condition and prevent further damage.[epainassist.com]

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