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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 69, Number 23, December 4, 2007 All Versions of this Article: 01.wnl.0000282762.34274.94v1 69/23/2121    most recent Correspondence: Submit a response Correspondence: View responses 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 Related articles in Neurology 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 Alessi-Fox, C. Search for Related Content PubMed PubMed Citation Articles by Herrmann, D. N. Articles by Alessi-Fox, C. Related Collections All Imaging Peripheral neuropathy

In vivo confocal microscopy of Meissner corpuscles as a measure of sensory neuropathy

From the Departments of Neurology and Pathology (D.N.H.), University of Rochester; and Lucid, Inc., Rochester, NY (J.N.B., C.J., C.A.-F.).

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

Objective: To assess feasibility of noninvasive in vivo reflectance confocal microscopy (RCM) of Meissner corpuscles (MCs) as a measure of sensory neuropathy (SN).

Background: MCs are touch-pressure sensation receptors in glabrous skin. Skin biopsy studies suggest that fingertip MC density (MCs/mm²) is a sensitive measure of diabetic and idiopathic SN. In vivo RCM of skin is an emerging field, with applications including evaluation of cancer. It is painless and noninvasive. Feasibility of in vivo RCM of MCs has not been explored.

Methods: Fifteen adults (10 controls, 5 SN subjects) underwent in vivo RCM at the fingertip (Digit V) and thenar eminence. In vivo RCM was conducted to determine whether MCs were visible within dermal papillae and, if visible, to characterize their imaging appearance and assess MCs/mm² at each site.

Results: MCs were identified in dermal papillae at all sites in controls. MCs appeared as heterogeneous bright structures within dermal papillae, which appeared as dark "pits." Mean MC density in controls was 12 ± 5.3/mm² (Digit V) and 5.1 ± 2.2/mm² at the thenar eminence. MC density in SN was lower than controls at Digit V (2.8 ± 5.7/mm², p = 0.01) and the thenar eminence (1.4 ± 1.1/mm², p = 0.004). MCs were absent in a sensory neuronopathy; milder reductions in MC density were seen among diabetic and HIV-positive subjects.

Conclusions: Meissner corpuscles (MCs) can be visualized and quantitated in controls and sensory neuropathy (SN) using in vivo reflectance confocal microscopy (RCM). In vivo RCM of MCs has potential for noninvasive detection and monitoring of SN, if subsequent studies show that with denervation or reinnervation, reliable and recognizable changes or loss can be detected using our described approaches.

Abbreviations: ENFD = epidermal nerve fiber density; MC = Meissner corpuscle; PGP = protein gene product; RCM = reflectance confocal microscopy; RIV = relative intertrial variability; SFN = small fiber neuropathy; SN = sensory neuropathy.

Editorial, see page 2116

e-Pub ahead of print on September 26, 2007, at www.neurology.org.

Supported by University of Rochester Neurology Departmental funds. Lucid, Inc. provided access to an in vivo confocal reflectance microscope, and imaging expertise (C.A.-F., C.J., J.N.B.) for the study. D.N.H. is supported in part by NS43091 and NS058259 and was responsible for the statistical analysis.

Disclosure: The authors report no conflicts of interest.

Received February 23, 2007. Accepted in final form May 10, 2007.

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Peter J. Dyck
Neurology 2007 69: 2116-2118. [Full Text]  

This article has been cited by other articles:

				P. J. Dyck Enumerating Meissner corpuscles: Future gold standard of large fiber sensorimotor polyneuropathy? Neurology, December 4, 2007; 69(23): 2116 - 2118. [Full Text] [PDF]

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