Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interesting condition because it consists typically of just burning, numbness, pain of the feet, sometimes the hands later on without necessarily having any abnormalities on your EMG or nerve conduction study. So what I tell patients and actually residents or students who train under us is that a normal nerve conduction study does not exclude a neuropathy. And we will confirm this by doing additional testing, specifically the nervous the the examination at the bedside asking patients about their symptoms, for example, loss of sensation to cool or or hot temperatures, loss of pain sensation and also doing skin biopsies where we look at nerve densities in the skin both.
From the calf and the thigh as well as doing a special test that looks at sweat function both in your foot in in the legs as well as the feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typically will progress unless the underlying cause is identified and reversed. Diabetes of course being the most common cause is always screened for. But once the more common causes are excluded and the focus becomes on excluding any underlying secondary disease process but also controlling pain because if patients’ symptoms of pain are generally controlled they tend to do pretty well and really have no other major functional deficits. I’ve really become interested over the years is how interconnected neurology.
And rheumatology are and one thing I often do on patients who have unexplained small fiber even autonomic neuropathy is have them see rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren’s or sarcoid and sometimes even if we are not directly involved in treating the patients, this can be the first sign of an underlying connective tissue disorder that can then be brought to the attention of rheumatology and addressed from their standpoint.
Neuromuscular Diseases Treatment at Ohio State
Neuromuscular disease or neuromuscular medicine specifically pertains to diseases of nerve roots, anterior horn cells, which are located in the spinal cord, peripheral nerves, nerve muscle connections or muscle itself. One of the things that I was very blessed and fortunate to be able to bring here to Ohio State and to central Ohio was the ability to evaluate and manage autonomic neuropathies or diseases that specifically affect the autonomic nervous system which I tell patients is kind of like your automatic nervous system. One very common diagnosis that patients get referred to me for is POTS or postural tachycardia syndrome, which is a very common cause of chronic fatigue. It used to be called chronic fatigue syndrome.
And which has very good available treatments but unfortunately many physicians in the general medical community are not aware of this diagnosis. I also bring a particular interest in autoimmune neurology in autoimmune neuropathies like CIDP or chronic inflammatory demyelinating polyradiculo polyradiculoneuropathy or AIDP or GBS as it’s commonly known. I also have an interest in small fiber neuropathies and diseases of the peripheral nerve. Now with that said, I still see patients with muscle disease, with diseases of the nerve muscle junction but those are areas that I have a particular interest in both at a al level and also at a research level. And I’m actually currently involved in one multicenter.
al trial looking at pain management for neuropathies and currently doing some retrospective reviews at a a evaluations for autoimmune neuropathies as well as small fiber neuropathies.