Abstract
Chronic pain may affect 30–50% of the world’s population and an important cause is small fiber neuropathy (SFN). Recent research suggests that autoimmune diseases may be one of the most common causes of small nerve fiber damage. There is low awareness of SFN among patients and clinicians and it is difficult to diagnose as routine electrophysiological methods only detect large fiber abnormalities, and specialized small fiber tests, like skin biopsy and quantitative sensory testing, are not routinely available. Corneal confocal microscopy (CCM) is a rapid, non-invasive, reproducible method for quantifying small nerve fiber degeneration and regeneration, and could be an important tool for diagnosing SFN. This review considers the advantages and disadvantages of CCM and highlights the evolution of this technique from a research tool to a diagnostic test for small fiber damage, which can be a valuable contribution to the study and management of autoimmune disease.
Highlights
IntroductionSmall fiber neuropathy (SFN) can be described as a dysfunction of the nerve fibers of the smallest diameter (A delta and C-types) that make up 70–90% of the entire peripheral nervous system
Publisher’s Note: MDPI stays neutralSmall fiber neuropathy (SFN) can be described as a dysfunction of the nerve fibers of the smallest diameter (A delta and C-types) that make up 70–90% of the entire peripheral nervous system
Along with the relatively high cost, this technique cannot be repeated on the same area of skin, it is time consuming, requires a histological laboratory, and can lead to infection and bleeding [9], especially in patients with type 2 diabetes or impaired glucose tolerance, which comprises up to 56% of all patients with small fiber neuropathy (SFN) [10]
Summary
Small fiber neuropathy (SFN) can be described as a dysfunction of the nerve fibers of the smallest diameter (A delta and C-types) that make up 70–90% of the entire peripheral nervous system. The management of patients with SFN is challenging, especially with a lack of clear diagnostic criteria, limited understanding of the underlying pathophysiology, and relatively ineffective treatments [4]. Automated analysis and standardized evaluation criteria make the method appropriate for clinical application [12] It is a rapid, non-invasive ophthalmic technique which can be deployed in pediatric and adult patients with chronic diseases. It should be noted that, in patients with metabolic, toxic, or drug-induced SFN, damage to both small and large nerve fibers is often described and neuropathy usually is “mixed”. These patients have changes both in electroneuromyography and in the above-mentioned methods for diagnosing small fiber neuropathy. The application of sensitive diagnostic methods to identify SFN is key to the early diagnosis of small fiber damage due to metabolic diseases such as identification of small fiber damage in other neurologic diseases
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