New Useful Tools for Small-Fiber Peripheral Neuropathy Clinical Assessment (P03.208)

Abstract

Objective: Our objective is to call attention to the new laboratory tolls for small-fiber peripheral neuropathies (SFPN)/neuropathic pain (NP) clinical assessment. Background SFPN are very frequent in clinical practice. Usually, these neuropathies are painful. The best tools to assess SFPN/NP are a comprehensive patient medical history and a well performed neurological examination. Secondly, appear the electrophysiological methods, and thirdly the imaging and the morphological ones. The 2009 revised guidelines on NP assessment proposed by the European Federation of Neurological Societies (EFNS), reinforce the previous recommendations (Cruccu G et al., 2010). They considered that amongst laboratory tests, laser evoked potentials (LEPs) are the best tool for assessing SFPN/NP, and skin biopsy for assessing distal loss of unmyelinated nerve fibers. Design/Methods: Standard techniques of contact heat evoked potentials (CHEPs), corneal confocal microscopy (CCM), and Meissner corpuscles (MCs) confocal microscopy were evaluated in the clinical assessment of patients presenting SFPN/NP by our different peripheral nerve centers. Results: CHEPs provided an objective approach to investigate cerebral responses to thermal stimuli mediated by Adelta fibers. In patients with skin denervation amplitudes of CHEPs were reduced. CCM is a non-invasive and easily reproducible clinical technique that disclosed early or severe damage of small-nerve fibers of the cornea in several disorders, including diabetic neuropathy. MCs are touch-pressure sensation receptors in glabrous skin. CM of MCs showed to be a potential for non-invasive detection and monitoring of SNF denervation or reinnervation. Normal data collections are in course for these new tools by ours groups. Conclusions: We have had the opportunity to assess all of the referred methods, including those proposed in the 2009 revised guidelines on NP assessment and we conclude that CHEPS, CCM and MCsCM are highly effective, non invasive and efficient tools in this field. Supported by: CNPq. Disclosure: Dr. Nascimento has nothing to disclose. Dr. De Freitas has nothing to disclose. Dr. Pupe has nothing to disclose. Dr. Dieckmann has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Valls-Sole has nothing to disclose. Dr. Schestatsky has nothing to disclose. Dr. Matta has nothing to disclose.