OBJECTIVES: To describe the neuropathological features in skin biopsies from patients with diabetic truncal neuropathy. METHODS: Three patients with diabetic truncal neuropathy underwent skin biopsies from both symptomatic and asymptomatic regions of the chest and trunk. After local anaesthesia, biopsies were performed using a 3 mm diameter punch device (Acupunch). Intraepidermal nerve fibres (IENFs), the most distal processes of small myelinated and unmyelinated nerve fibres, were identified after staining with PGP 9.5 as previously described. RESULTS: Diabetes was diagnosed at the time of the neurological presentation in two, and one was a known diabetic patient. All three had associated sensory-motor polyneuropathy. In all, skin biopsies showed a marked reduction of both epidermal and dermal nerve fibres in the symptomatic dermatomes, compared with skin from asymptomatic truncal areas. In one patient, a follow up skin biopsy when symptoms had improved showed a return of IENFs. CONCLUSIONS: In diabetic truncal neuropathy, skin biopsies from symptomatic regions show a loss of IENFs. After clinical recovery, there is a return of the IENF population, suggesting that improvement occurs by nerve regeneration. These findings suggest that sensory nerve fibre injury in diabetic truncal neuropathy is distal to or within the sensory ganglia. Skin biopsy provides a possible tool for understanding the pathophysiology of the disease.
OBJECTIVES: To describe the neuropathological features in skin biopsies from patients with diabetic truncal neuropathy. METHODS: Three patients with diabetic truncal neuropathy underwent skin biopsies from both symptomatic and asymptomatic regions of the chest and trunk. After local anaesthesia, biopsies were performed using a 3 mm diameter punch device (Acupunch). Intraepidermal nerve fibres (IENFs), the most distal processes of small myelinated and unmyelinated nerve fibres, were identified after staining with PGP 9.5 as previously described. RESULTS:Diabetes was diagnosed at the time of the neurological presentation in two, and one was a known diabeticpatient. All three had associated sensory-motor polyneuropathy. In all, skin biopsies showed a marked reduction of both epidermal and dermal nerve fibres in the symptomatic dermatomes, compared with skin from asymptomatic truncal areas. In one patient, a follow up skin biopsy when symptoms had improved showed a return of IENFs. CONCLUSIONS: In diabetic truncal neuropathy, skin biopsies from symptomatic regions show a loss of IENFs. After clinical recovery, there is a return of the IENF population, suggesting that improvement occurs by nerve regeneration. These findings suggest that sensory nerve fibre injury in diabetic truncal neuropathy is distal to or within the sensory ganglia. Skin biopsy provides a possible tool for understanding the pathophysiology of the disease.
Authors: Andreas A Argyriou; Panagiotis Polychronopoulos; Angelos Koutras; Gregoris Iconomou; Alexander Iconomou; Haralabos P Kalofonos; Elisabeth Chroni Journal: Support Care Cancer Date: 2005-02-15 Impact factor: 3.603
Authors: Shannon M Smith; Robert H Dworkin; Dennis C Turk; Ralf Baron; Michael Polydefkis; Irene Tracey; David Borsook; Robert R Edwards; Richard E Harris; Tor D Wager; Lars Arendt-Nielsen; Laurie B Burke; Daniel B Carr; Amy Chappell; John T Farrar; Roy Freeman; Ian Gilron; Veeraindar Goli; Juergen Haeussler; Troels Jensen; Nathaniel P Katz; Jeffrey Kent; Ernest A Kopecky; David A Lee; William Maixner; John D Markman; Justin C McArthur; Michael P McDermott; Lav Parvathenani; Srinivasa N Raja; Bob A Rappaport; Andrew S C Rice; Michael C Rowbotham; Jeffrey K Tobias; Ajay D Wasan; James Witter Journal: J Pain Date: 2017-02-27 Impact factor: 5.820