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Originally Posted by glenntaj
--I think you are showing some evidence of nerve damage--those axonal swellings. Large scale axonal swellings are not typical and imply some sort of immune attack, with lymphocyctic inflitration of the nerve tissue.
Also, while you may fall well within the guideline for "normal" nerve fiber density, that number is only a snapshot in time and doesn't tell us where you were before symptoms hit, and whether you would have had a higher/lower number then--I've written often on how the McArthur protocols rather arbitrarily define normal intraepidermal nerve fiber density as below the fifth percentile or above the ninety-fifth percentile for age-matched "normals", and how even if you get a "normal" finding, of being, say, in the twenty-fifth percentile we would not know if three years ago you would have been at the fiftieth percentile.
It is good, though, that skin biopsies are repeatable--often it is the tracking of percentiles and nerve fiber condition over time that allows for more of an interpretation as to progression or healing. Mine have gone from the second to the eighteenth percentile over time--so I am now technically "normal", but it is more important to note that I have gotten some re-enervation over the years.
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I really am fascinated... a bit excited... about what you write about lymphocyctic infiltration or immune attack on nerve tissue because maybe it's closer to an answer. I have had a persistent skin manifestation of the virus I had over two years ago called levido reticularis and the biopsy of that (not the skin punch biopsy for the nerve fiber density) showed a chronic inflammatory perivascular infiltrate. All testing for vasculitis is negative though and the area of the nerve punch biopsy did NOT show any inflammatory infiltrate. So, conflicting results within a close time frame. I really am lost as to why my neurologist hasn't honed in on this. And, even if he did, I haven't been lead to believe there's anything available to me but symptomatic treatment (Gabapentin). It worries me that I have a progressive inflammatory condition that is not being addressed and it will eventually result in irreversible damage. Really, so many thanks for sharing all your knowledge with us via Neurotalk.