HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 63, Number 5, September 14, 2004 Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Herrmann, D. N. Articles by Logigian, E. L. Search for Related Content PubMed PubMed Citation Articles by Herrmann, D. N. Articles by Logigian, E. L. Related Collections Peripheral neuropathy EMG

Plantar nerve AP and skin biopsy in sensory neuropathies with normal routine conduction studies

From the Department of Neurology, University of Rochester, NY.

Address correspondence and reprint requests to David N. Herrmann, Department of Neurology, Box 673, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642; e-mail: david_herrmann{at}urmc.rochester.edu

Objective: To assess the medial plantar nerve action potential (NAP) and skin biopsy in the evaluation of suspected distal sensory neuropathies (SN) with normal routine nerve conduction studies (NCS).

Methods: A total of 110 consecutive patients with suspected distal SN and normal routine NCS underwent medial plantar NAP testing and punch skin biopsy. Patients were clinically stratified as having pure small fiber sensory neuropathy (SFSN), or distal SN with large fiber involvement (SN-LFI).

Results: A total of 56 patients were classified as SN-LFI and 54 SFSN. The medial plantar NAP, a measure of large fiber function, was abnormal in 31.8% of patients, more frequently in SN-LFI than SFSN. Distal leg epidermal nerve fiber (ENF) density, a measure of small fibers, was reduced in 47.3% of biopsies, with isolated ENF morphologic changes in 29.1% and normal findings in 23.6%. Biopsy abnormalities were more severe and prevalent in SN-LFI than in SFSN. In patients with a normal medial plantar NAP, distal leg biopsy showed reduced ENF density in 34.7%, and isolated morphologic changes in a further 37% of cases.

Conclusions: The medial plantar nerve action potential and skin biopsy are complementary in evaluation of distal SN with normal routine NCS. Small sensory nerve fibers are affected early in SN, and more severely so when large fiber involvement is apparent clinically.

Received February 20, 2004. Accepted in final form May 10, 2004.

This article has been cited by other articles:

				G. Devigili, V. Tugnoli, P. Penza, F. Camozzi, R. Lombardi, G. Melli, L. Broglio, E. Granieri, and G. Lauria The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology Brain, July 1, 2008; 131(7): 1912 - 1925. [Abstract] [Full Text] [PDF]

				D. N. Herrmann, J. N. Boger, C. Jansen, and C. Alessi-Fox In vivo confocal microscopy of Meissner corpuscles as a measure of sensory neuropathy Neurology, December 4, 2007; 69(23): 2121 - 2127. [Abstract] [Full Text] [PDF]

				E A De Sousa, A P Hays, R L Chin, H W Sander, and T H Brannagan III Characteristics of patients with sensory neuropathy diagnosed with abnormal small nerve fibres on skin biopsy. J. Neurol. Neurosurg. Psychiatry, August 1, 2006; 77(8): 983 - 985. [Abstract] [Full Text] [PDF]

				F Gemignani, F Brindani, S Alfieri, T Giuberti, I Allegri, C Ferrari, and A Marbini Clinical spectrum of cryoglobulinaemic neuropathy J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1410 - 1414. [Abstract] [Full Text] [PDF]

				J. Chai, D. N. Herrmann, M. Stanton, R. L. Barbano, and E. L. Logigian Painful small-fiber neuropathy in Sjogren syndrome Neurology, September 27, 2005; 65(6): 925 - 927. [Abstract] [Full Text] [PDF]