Originally Posted by glenntaj
--is unequivocally positive even in people with symptoms of small-fiber neuropathy.
A lot has to do with the extent of the damage, and exactly from where the samples are taken. Damage can be patchy, or the "normal" figures given for intraepidermal nerve fiber density--anything withing the fifth to ninety-fifth percentiles--may technically be designated as normal, but not be normal for you (it's almost impossible to know at what level one started before symptoms).
Do you have the report yourself, to relate to us?
Also, while skin biopsy is the gold standard for small fiber syndromes, there are some other (older) tests that are sometimes used, such as qualitative sensory testing and certain autonomic tests, such as quantitative sudomotor axon reflex testing (QSART), which measures the sweat response of small skin fibers.
There are certainly other conditions that can mimic small-fiber symptoms--circulatory dysfunction and central nervous system problems (such as central nervous system demyelinating syndromes) among them--what other testing has there been for these?
Thank you so much for your reply.
The samples were taken from two spots (left leg) : 1) thigh, and 2) just above my ankle.
I dont have the report with me but I could get it from the clinic. I will post it here once I have the report.
I mentioned the QSART to my neurologist when he did the skin biopsy and his response, more or less, was: "I am not so inclined on that test. Its just a sophisticated sounding test but its not much of a help. I could diagnosed you with autonomic neuropathy if your blood pressure goes down when you get up from a lying position."
The only test that I know that may involved the central nervous system was the MRI of my head. I am not familiar with central nervous system demyelinating sydromes. I will have to google it so I can understand what you mean.
Is there a published paper about a negative skin biopsy result but manifesting the PN symptoms? I am asking so I could better discussed with my doctor. Right now, I have the impression that he is no longer giving me further tests.
THank you for your help.