[amit]

It is not in my head anymore - positive results in the skin biopsy.

I don't know what to think about it or what is the new meaning of it - if at all. but now I have explanation to the numbness and the burning I have.
It is still small fibers neuropathy, still idiopatic... and to my feeling 0 still progressing.

[davidx]

Just wondering if you wouldnt mind sharing the results of your skin biopsy (i.e. the nerve fiber densities from the biopsy).

What does your doctor recommend (if anything) and does he/she recommend a repeat of the biopsy down the road?

I have had 3 skin biopsies done over the years with each showing a progressive deterioration on the small nerve fibers.

-David

[amit]

What is written on the results "moderate reduction of small nerve fiber innervation" - nothing else. I didn't see my neuro yet - so I don't have any further recommendations.
What were your results. Do the actually count the nerves fibers?
Tell us more about your case. is it idiopathic? for how long do you suffer?

[chamade]

Originally Posted by amit

What is written on the results "moderate reduction of small nerve fiber innervation" - nothing else. I didn't see my neuro yet - so I don't have any further recommendations.
What were your results. Do the actually count the nerves fibers?
Tell us more about your case. is it idiopathic? for how long do you suffer?

Doesn't an "idiopathic" skin biopsy at least prove it's not an autoimmune/inflammatory/granulomatous disease as there are no infiltrates seen?

[glenntaj]

Depending on the particular methods used, the skin biopsy may have only involved an enumeration of intraepidermal nerve fiber density. While condition of the small-fibers may be grossly noted, it's not automatic that further tests for inflammatory infiltrates would have been attempted.

If the nerves show excessive banching and swelling, though, such an etiology might be suspected. But such an autoimmune attack may not be of the "standard" anti-nuclear antibody variety--it may involve specific antibodies to peripheral nerve components (these can be detected by blood tests) or it may even involve antibodies unique to that individual as a result of molecular mimicry (a lot harder to test for).

The Cornell-Weill center has a test called a ganglioside agglutinin test, developed there, which is designed to grossly test for antibody activity to those peripheral nerve components; it's designed to pick up signs of both the known antibodies and those that may be more individual. A positive on this would generally lead to further testing in an attempt to see if there are known antibodies. Keep in mind, though, that many of these "known" antibodies have only been identified in the last 25 years, and there are probably more out there that numbers of people have (e.g., "non-individual") that have yet to be identified/catalogued.

[Ides]

My skin punches were done on my left foot and left upper thigh. At the time of my biopsy, I only had symptoms in the lower leg and foot. From my report:

The normative values for epidermal nerve fiber [ENF] density are evaluated by counting 3-6 different sections of each specimen and expressed as a number per millimeter length of epidermis. Any value that is equal to the fifth percentile or less is considered to be significantly reduced nerve fiber density, consistent with small fiber neuropathy. The fifth percentile value for the thigh is 8.0 millimeter. The fifth percentile value for the distal leg is 5.0 per millimeter.

Lt. Thigh, Epidermal Nerve Fiber Density: Skin with normal epidermal nerve fiber density. Result value = 9.26

Lt Foot: There are only traces left of the subepidermal neural plexis in the biopsy from the foot observed with the anti-PGP 9.5 immunohistochemical stain. Result value = 0.07

[glenntaj]

--even though Ides' intraepidermal nerve fiber density values for the thigh are within the "normal" parameters as set up by this protocol (the MacArthur protocol, after the person who originally designed it at Johns Hopkins), they're still in the very low part of "normal", since 8.0 is the fifth percentile.

The results are certainly consistent with a length-dependent small-fiber neuropathy.