Well after 21 years of large fiber sensory motor axonal peripheral neuropathy, diagnosed and confirmed by numerous Electromyography/ Nerve Conduction Studies on my feet, legs, hands, and arms since 2003, with the latest in 2021, i finally decided to do a skin punch biopsy to diagnose and confirm small fiber peripheral neuropathy..

I have had the symptoms of small fiber neuropathy, and was sure I had it as well as large fiber, I just didnt see the point in doing the biopsy, since it wouldnt change the treatment. i have had extensive testing done to determine the cause of large fiber neuropathy over the two decades, so it wasnt because i was adverse to testing.

Anyway, I did the biopsy, which was sent to Therapath labs. Therapath only does examination on two sites on the leg, which were the right leg thigh and the right leg calf.

My results were a little shocking to me, though i was sure I had small fiber neuropathy, I didnt expect the nerve fiber density to be as low as it is.

The epidermal nerve fiber density at the right thigh was 1.26 nerve fibers per millimeter with less than 6.2 being abnormal.

The epidermal nerve fiber density at the right calf was 0.07 nerve fibers per millimeter with less than 2.9 being abnormal.

The sweat gland nerve fiber biopsy at the right calf was 12.8 %, with less than 36. 5 % being abnormal.

There were no sweat glands present in the sample from the right thigh.

all of the above confirms small fiber peripheral neuropathy at the calf and thigh.

apparently therapth doesnt remark on axonal branching or swelling unless the results are normal.

looking back i should have done the skin punch biopsy many years ago to keep track of the progression of small fiber neuropathy like i was and continue to do with large fiber neuropathy.