Giuseppe Lauria1, Patrizia Dacci2, Raffaella Lombardi2, Daniele Cazzato2, Carla Porretta-Serapiglia2, Michela Taiana2, Jenny Sassone2, Eleonora Dalla Bella2, Sara Rinaldo2, Christian Lettieri2, Roberto Eleopra2, Grazia Devigili2. 1. From the 3rd Neurology Unit and Skin Biopsy (G.L., P.D., R.L., D.C., C.P.-S., M.T., J.S., E.D.B.), Peripheral Neuropathy and Neuropathic Pain Clinic, IRCCS Foundation Carlo Besta Neurological Institute, Milan; and Neurological Unit (S.R., C.L., R.E., G.D.), University Hospital S. Maria della Misericordia, Udine, Italy. glauria@istituto-besta.it. 2. From the 3rd Neurology Unit and Skin Biopsy (G.L., P.D., R.L., D.C., C.P.-S., M.T., J.S., E.D.B.), Peripheral Neuropathy and Neuropathic Pain Clinic, IRCCS Foundation Carlo Besta Neurological Institute, Milan; and Neurological Unit (S.R., C.L., R.E., G.D.), University Hospital S. Maria della Misericordia, Udine, Italy.
Abstract
OBJECTIVE: To assess the right-to-left and short-term variability of intraepidermal nerve fiber density (IENFD) at the distal site of the leg. METHODS: Patients with possible or probable small fiber neuropathy (SFN) and healthy volunteers (HVs) underwent skin biopsies at the right and left distal leg. A subgroup of participants underwent follow-up biopsies 20 days later. Biopsies were immunostained by polyclonal anti-protein gene product 9.5 antibodies, and IENFD was quantified in nonconsecutive sections following published guidelines by operators blinded to the participants' condition (diagnosis, side, and time of biopsy). Findings were referred to sex- and age-adjusted normative values. RESULTS: Forty patients and 17 HVs underwent bilateral skin biopsies; 15 patients and 8 HVs underwent follow-up skin biopsies. Sural nerve and dorsal sural nerve conduction studies were normal in all participants. Interside IENFD did not differ both in patients (median 2.45 IENF/mm ± 1.45 SD right; 2.2 IENF/mm ± 1.32 SD left) and HVs (median 6.3 IENF/mm ± 2.81 right; 6.2 IENF/mm ± 2.3 SD left). The right-to-left correlation coefficients were excellent (Pearson 0.95 in SFN and 0.97 in HVs). The analysis of IENFD at 20-day follow-up biopsy showed no difference between sides in both groups and yielded excellent correlation coefficients. CONCLUSIONS: The diagnosis of SFN can be reliably ascertained by unilateral skin biopsy at the distal site of the leg, and IENFD is not expected to vary within 3 weeks.
OBJECTIVE: To assess the right-to-left and short-term variability of intraepidermal nerve fiber density (IENFD) at the distal site of the leg. METHODS:Patients with possible or probable small fiber neuropathy (SFN) and healthy volunteers (HVs) underwent skin biopsies at the right and left distal leg. A subgroup of participants underwent follow-up biopsies 20 days later. Biopsies were immunostained by polyclonal anti-protein gene product 9.5 antibodies, and IENFD was quantified in nonconsecutive sections following published guidelines by operators blinded to the participants' condition (diagnosis, side, and time of biopsy). Findings were referred to sex- and age-adjusted normative values. RESULTS: Forty patients and 17 HVs underwent bilateral skin biopsies; 15 patients and 8 HVs underwent follow-up skin biopsies. Sural nerve and dorsal sural nerve conduction studies were normal in all participants. Interside IENFD did not differ both in patients (median 2.45 IENF/mm ± 1.45 SD right; 2.2 IENF/mm ± 1.32 SD left) and HVs (median 6.3 IENF/mm ± 2.81 right; 6.2 IENF/mm ± 2.3 SD left). The right-to-left correlation coefficients were excellent (Pearson 0.95 in SFN and 0.97 in HVs). The analysis of IENFD at 20-day follow-up biopsy showed no difference between sides in both groups and yielded excellent correlation coefficients. CONCLUSIONS: The diagnosis of SFN can be reliably ascertained by unilateral skin biopsy at the distal site of the leg, and IENFD is not expected to vary within 3 weeks.
Authors: Manuel P Pereira; Sebastian Mühl; Esther M Pogatzki-Zahn; Konstantin Agelopoulos; Sonja Ständer Journal: Dermatol Ther (Heidelb) Date: 2016-10-11
Authors: Maria Jeziorska; Andrew Atkinson; Lewis Kass-Iliyya; Christopher Kobylecki; David Gosal; Andrew Marshall; Rayaz A Malik; Monty Silverdale Journal: J Parkinsons Dis Date: 2019 Impact factor: 5.568