Small fiber neuropathy

Abstract

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.

Estudio y manejo de las neuropatías de fibra fina

“…El diagnóstico precoz de estas dolencias tiene implicaciones terapéuticas y de mejoría del pronóstico 21,22 . Por ejemplo, en el caso de enfermedades raras como la amiloidosis sistémica por TTR, el diagnóstico precoz supone el acceso a nuevos tratamientos que modifican el curso evolutivo de esta enfermedad que, en su historia natural, tiene un pronóstico sombrío 23,24 .…”

Fibromyalgia Pathophysiology

“…Most SFNs are diagnosed with typical clinical features and a reduced intra-epidermal enrve fiber density via skin biopsy. SFN is brought on by a defect in glucose metabolism, immune dysregulation, gluten sensitivity and celiac disease, monoclonal gammopathy, vitamin deficiency, exposure to toxins, cancer, and unexplained causes [ 42 , 43 ].…”

Small fiber neuropathy with long-term, multifocal paresthesias after a SARS-CoV-2 vaccination

“…Small fiber neuropathy (SFN) is a peripheral nervous system (PNS) disorder affecting A-delta and C-fibres that conduct in a primarily afferent manner sensory qualities (pin-prick, pain, thermal, mechanical, chemical information) and autonomic information. 1 SFN usually manifests with sensory disturbances, pain, and autonomic abnormalities. 1 In general, SFN can be primary (hereditary) or secondary (acquired).…”

“… 1 SFN usually manifests with sensory disturbances, pain, and autonomic abnormalities. 1 In general, SFN can be primary (hereditary) or secondary (acquired). 1 Infectious, metabolic, toxic, immunological paraneoplastic, and neoplastic disorders have been described as causes of acquired SFN.…”

“… 1 In general, SFN can be primary (hereditary) or secondary (acquired). 1 Infectious, metabolic, toxic, immunological paraneoplastic, and neoplastic disorders have been described as causes of acquired SFN. 1 Among the immunological causes, several vaccines have been identified as the cause of SFN.…”