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

Abstract:

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.

journal_name

Neurology

journal_title

Neurology

authors

Herrmann DN,Ferguson ML,Pannoni V,Barbano RL,Stanton M,Logigian EL

doi

10.1212/01.wnl.0000137036.26601.84

subject

Has Abstract

pub_date

2004-09-14 00:00:00

pages

879-85

issue

5

eissn

0028-3878

issn

1526-632X

pii

63/5/879

journal_volume

63

pub_type

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