Current View of Diagnosing Small Fiber Neuropathy

Raasing, Lisette; Vogels, O.J.M.; Veltkamp, Marcel; Swol, Christiaan F. P. van; Grutters, Jan C.

doi:10.3233/jnd-200490

Cited by 40 publications

(33 citation statements)

References 161 publications

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“…Because the symptoms of PIPN mostly manifest with sensory impairment, 28 we roughly classified nerve fibers into larger fibers (diameter > 5 μm) and small fibers (diameter < 5 μm) depending on the type of sensory information conveyed. 29 Large fibers with greater than 5 μm diameter carry information related to proprioception, touch, and pressure. In contrast, small fibers with less than 5 μm diameter carry information related to temperature and pain.…”

Section: Resultsmentioning

confidence: 99%

Discovery of Potential Neuroprotective Agents against Paclitaxel-Induced Peripheral Neuropathy

Chen

et al. 2022

J. Med. Chem.

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Chemotherapy-induced neurotoxicity is a common adverse effect of cancer treatment. No medication has been shown to be effective in the prevention or treatment of chemotherapy-induced neurotoxicity. Using minoxidil as an initial template for structural modifications in conjunction with an in vitro neurite outgrowth assay, an image-based high-content screening platform, and mouse behavior models, an effective neuroprotective agent CN016 was discovered. Our results showed that CN016 could inhibit paclitaxel-induced inflammatory responses and infiltration of immune cells into sensory neurons significantly. Thus, the suppression of proinflammatory factors elucidates, in part, the mechanism of action of CN016 on alleviating paclitaxel-induced peripheral neuropathy. Based on excellent efficacy in improving behavioral functions, high safety profiles (MTD > 500 mg/kg), and a large therapeutic window (MTD/MED > 50) in mice, CN016 might have great potential to become a peripherally neuroprotective agent to prevent neurotoxicity caused by chemotherapeutics as typified by paclitaxel.

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Section: Resultsmentioning

confidence: 99%

Discovery of Potential Neuroprotective Agents against Paclitaxel-Induced Peripheral Neuropathy

Chen

et al. 2022

J. Med. Chem.

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“…Secondary SFN is due to metabolic, infectious, vaccination‐associated, toxic, immune‐mediated, neoplastic/paraneoplastic causes. Metabolic causes of SFN include diabetes, renal failure, thyroid dysfunction, vitamin B12 deficiency, copper deficiency, 21 and several others. Infectious diseases complicated by SFN include HIV, hepatitis‐C, 21 Hanta, 22 borreliosis, 23 and SARS‐CoV‐2 24,25 .…”

Section: Etiologymentioning

confidence: 99%

“…Metabolic causes of SFN include diabetes, renal failure, thyroid dysfunction, vitamin B12 deficiency, copper deficiency, 21 and several others. Infectious diseases complicated by SFN include HIV, hepatitis‐C, 21 Hanta, 22 borreliosis, 23 and SARS‐CoV‐2 24,25 . SFN can be also a complication of vaccinations against rabies, varicella, HPV, lyme, or SARS‐CoV‐2 13,26 …”

Section: Etiologymentioning

confidence: 99%

“…Autoimmune disease manifesting with SFN include monoclonal gammopathy; sarcoidosis, 24,29,30 rheumatic disease (mixed connective tissue disease, systemic vasculitis), 8,31,32 Sjögren syndrome, 33 anti-plexin D1-IgG antibodies in mice, 34 Behcet disease, 35 familial Mediterranean fever, 35 celiac disease, 36 primary systemic vasculitis, Guillain-Barre syndrome (GBS), chronic, inflammatory, demyelinating polyneuropathy (CIDP), lupus, AA, and AL amyloidosis, which can be associated with familial Mediterranean fever and hyperlipidemia, and acute, inflammatory SFN. 21 Neoplasms associated with SFN include keloids, 37 lymphoma, carcinoid, 18 and others. Rare secondary causes of SFN include selective autonomic failure due to alpha-synuclein deposition, 38 Parkinson's disease due to peripheral sympathetic denervation, 39,40 The most frequent causes of secondary SFN are diabetes and autoimmune disease.…”

Section: Secondary Sfnmentioning

confidence: 99%

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Small fiber neuropathy

Finsterer

Scorza

2022

Acta Neuro Scandinavica

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Small fiber neuropathy (SFN) is a peripheral nervous system disease due to affection of A‐delta or C‐fibers in a proximal, distal, or diffuse distribution. Selective SFN (without large fiber affection) manifests with pain, sensory disturbances, or autonomic dysfunction. Though uniform diagnostic criteria are unavailable, most of them request typical clinical features and reduced intra‐epidermal nerve fiber density on proximal or distal skin biopsy. Little consensus has been reached about the treatment of SFN, why this narrative review aims at summarizing and discussing treatment options for SFN. Treatment of SFN can be classified as symptomatic, pathophysiologic, or causal. Prerequisites for treating SFN are an established diagnosis, knowledge about the symptoms and signs, and the etiology. Pain usually responds to oral/intravenous pain killers, antidepressants, anti‐seizure drugs, or topical, transdermal specifications. Some of the autonomic disturbances respond favorably to symptomatic treatment. SFN related to Fabry disease or hATTR are accessible to pathogenesis‐related therapy. Immune‐mediated SFN responds to immunosuppression or immune‐modulation. Several of the secondary SFNs respond to causal treatment of the underlying disorder. In conclusion, treatment of SFN relies on a multimodal concept and includes causative, pathophysiologic, and symptomatic measures. It strongly depends on the clinical presentation, diagnosis, and etiology, why it is crucial before initiation of treatment to fix the diagnosis and etiology. Due to the heterogeneous clinical presentation and multi‐causality, treatment of SFN should be individualized with the goal of controlling the underlying cause, alleviating pain, and optimizing functionality.

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“…Attributing sensory symptoms of the face to anxiety is unsupported by the presented data because various differentials were not excluded. Sensory symptoms (numbness and tingling) were 'mainly on one side of the face', so small-fibre neuropathy is rather unlikely to be the cause of these symptoms given the fact that small-fibre neuropathy usually manifests in the feet and the hands [2]. Attributing sensory symptoms of the face to processing of reports in mass media about a suspected association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations and facial palsy is misleading as sensory abnormalities of the face suggest that the trigeminal nerve, rather than the facial nerve is affected.…”

Section: To the Editormentioning

confidence: 99%