Prospective study of the usefulness of sural nerve biopsy

Abstract

Objective-This study aimed to determine the usefulness of sural nerve biopsy in neurological practice. Methods-The first prospective study of sural nerve biopsy in 50 consecutive patients was undertaken. The investigating neurologist declared the prebiopsy diagnosis and management plan and after 3 months an independent neurologist evaluated the contribution of the biopsy to diagnosis and management. An independent audit oYcer sought information from the patient about the adverse eVects and value of the biopsy after 6 weeks and 6 months. Results-In seven cases the nerve biopsy changed the diagnosis, in 35 cases the biopsy confirmed the suspected diagnosis, and in eight cases the biopsy was noncontributory. The biopsy either changed or was helpful in guiding patient management in 60%, especially those with demyelinating neuropathy and multiple mononeuropathy. Seven patients reported having had infection and 10 reported increased pain at the biopsy site 6 months later. Conclusion-In a consecutive series of 50 cases, sural nerve biopsy altered the diagnosis in 14%, aVected management in 60%, and caused persistent increased pain at the biopsy site in 33%. (J Neurol Neurosurg Psychiatry 2000;69:442-446)

Sequelae following sural nerve biopsy in type 1 diabetic subjects

“…Perry and Bril reported that infections were uncommon after sural nerve biopsy and not more frequently seen among diabetic patients (12). However, infection rates of 12-14% in all types of patients have been reported (3,19), which is in accordance with our study (12%). A further aspect is the inability to work as usual after surgery, as in three of our patients, and one of them with a sick leave of 100 days.…”

“…All our patients were meticulously informed that a second procedure was preferable as an end point in the clinical drug study, but only around one third were positive to a second biopsy, which is in accordance with our previously published data (11). This is in view of the fact that 19 out of 23 patients reported their problems at the moment as none or mild (3,4). It emphasises the need for very detailed information even to patients in clinical practice and in clinical trials, particularly considering the high "drop outs" regarding the sural nerve biopsy procedure.…”

“…A sural nerve biopsy is still used (10) (18) and e) diagnosis in neurological practice (3,19), although its value has been questioned (9). All our patients were meticulously informed that a second procedure was preferable as an end point in the clinical drug study, but only around one third were positive to a second biopsy, which is in accordance with our previously published data (11).…”

“…A sural nerve biopsy can be used to detect and evaluate extent of neuropathy in a variety of conditions (1)(2)(3)(4). The procedure is still used to evaluate pathology and biochemical changes in the nerve, even including studies where new drugs against diabetic neuropathy are tested (5)(6)(7)(8).…”

Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review) [RETIRED]

“…Most of the articles discussed the nerve biopsy findings in specific diseases, the clinical suspicion of which had prompted the biopsy. [23][24][25][26][27][28][29][30][31][32][33][34] No article provided guidance regarding when to perform a nerve biopsy in the evaluation of DSP.…”