A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation.

Rita Chiaramonte,Marcello Romano,Michele Vecchio

doi:10.3390/diagnostics10090613

Abstract

This systematic review describes the several methods to diagnose and measure the severity of small fiber neuropathies and aims to guide the physician to define all the diagnostic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Two reviewers independently reviewed and came to consensus on which articles met inclusion/exclusion criteria. The authors excluded all the duplicates, animals’ studies, and included the English articles in which the diagnostic measures were finalized to assess the effectiveness of rehabilitation and pharmacologic treatment of patients with small fiber neuropathies. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-one publications met the inclusion criteria and were included in the systematic review. Despite the range of diagnostic tools for the assessment of small fiber neuropathy, other robust trials are needed. In addition, always different diagnostic approaches are used, a unique protocol could be important for the clinicians. More research is needed to build evidence for the best diagnostic methodologies and to delineate a definitive diagnostic protocol.

Highlights

Small Fibre NeuropathySmall fiber neuropathy (SFN) is caused by impairment of unmyelinated C and thinly myelinatedAδ fibers
At follow-up 4 months later, his limb pain was only marginally improved after gabapentin and naproxen
1 p, 35 yo Small Fibre NeuropathySmall fiber neuropathy (SFN) associated with hantavirus infection

Summary

Introduction

Small fiber neuropathy (SFN) is caused by impairment of unmyelinated C and thinly myelinated. The symptoms are characterized by sensory symptoms, pain and autonomic symptoms, such as palpitations, gastrointestinal disturbances, and orthostatic dizziness. The symptoms and signs can be present as spontaneous (e.g., burning, deep, itching and paroxysmal) or evoked (e.g., thermal allodynia, light tough allodynia and hyperalgesia) pain. The diagnostic criteria for small fiber neuropathy are not established, influencing the approach to patients in clinical practice [1]. Genetic testing and quantitative sensory testing (QST) permit the definitive diagnosis, due to limitation of clinical examination, needle electromyography and nerve conduction. The sensitivity (78–92%) and specificity (65–90%) of skin biopsy for diagnosing a SFN is high [2]

Methods

Results

Discussion

Conclusion