Small fiber neuropathy

Classification according to ICD-10
G62	Other neuropathies
G62.88	Other specified polyneuropathies
ICD-10 online (WHO version 2019)

A small-fiber neuropathy is a disease that mainly by nerve damage to the small unmyelinated peripheral nerve fibers caused. These so-called C-fibers are found in the skin , in the peripheral nerves and in various organs. They serve to innervate the skin (somatic fibers) and are involved in the regulation of the organs (autonomous fibers). Affected patients often experience burning pain in the lower extremities. The disease is often slowly progressive .

causes

Diabetes mellitus , diseases of the mast cells such as u. a. Mastocytosis , connective tissue diseases such as Ehlers-Danlos syndrome , and rheumatic diseases such as Sjögren's syndrome or fibromyalgia , as well as vitamin B ₁₂ deficiency , hepatitis C and HIV infections can cause small fiber neuropathy. The genesis often remains unclear.

Diagnosis

The focus is on a detailed clinical examination and taking anamnesis with regard to possible causes. The clinical-apparatus-based diagnosis of nerve conduction velocity and electromyography are mostly inconspicuous, as they mainly cover the large nerve fibers. A skin punch biopsy to determine the intraepidermal nerve fiber density by a neuropathological laboratory therefore has the highest diagnostic value. The QST and QSART tests are also used in special diagnostics.

therapy

The primary goal is to try to treat the underlying cause (e.g., increased blood sugar levels). Anticonvulsants , local anesthetics , opioids or antidepressants are used against the pain .

literature

Lan Zhou, Jinny Tavee: Small fiber neuropathy: A burning problem. In: Cleveland Clinic Journal of Medicine. 2009 May; 76 (5), pp. 297-305. doi: 10.3949 / ccjm.76a.08070
EW Gregg, Q. Gu, D. Williams, N. de Rekeneire, YJ Cheng, L. Geiss, M. Engelgau: Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among US adults aged 40 or older. In: Diabetes Res Clin Pract. 2007 Sep; 77 (3), pp. 485-488.

Individual evidence

↑ Derrick Blackmore, Zaeem A. Siddiqi: Diagnostic Criteria for Small Fiber Neuropathy . In: Journal of Clinical Neuromuscular Disease . tape 18 , no. 3 , March 2017, ISSN 1537-1611 , p. 125-131 , doi : 10.1097 / CND.0000000000000154 , PMID 28221302 ( nih.gov [accessed June 26, 2020]).

[1] Derrick Blackmore, Zaeem A. Siddiqi: Diagnostic Criteria for Small Fiber Neuropathy . In: Journal of Clinical Neuromuscular Disease . tape 18 , no. 3 , March 2017, ISSN 1537-1611 , p. 125-131 , doi : 10.1097 / CND.0000000000000154 , PMID 28221302 ( nih.gov [accessed June 26, 2020]).