Quote:
Originally Posted by glenntaj
--that yes, a skin biopsy is the current "gold standard" for for determining if there is a small fiber neuropathy.
It's much easier to tolerate than a nerve biopsy, as well--a few shots of local anesthetic, a few 3mm wide by 1mm deep skin samples taken, a few band aids, and it's done--the samples are sent off for electron microscopy to determine the intraepidermal nerve fiber density and condition.
In my case, for example, the biopsy revealed a non-length dependent small fiber neuropathy. Nerve fiber density was significantly reduced as both ankle and thigh sites (many will also take a back-of-arm by the elbow sample), and the nerve fibers that were in evidence there were swollen and inflamed.
Unfortunately, skin biopsies aren't very good at determining the CAUSE of such a situation. Once in a while, more specialized testing of the samples might reveal something. (I had mine tested for amyloid--fortunately negative.)
There are a lot of people out there with skin-biopsy documented small-fiber neuropathy with severe symptoms still looking to determine a cause. Many have had a lot of the tests listed in the Liza Jane spreadsheets for neurologic symptoms (see: www.LizaJane.org--you can see what you've had to date in comparison) and they've all come back negative/normal. It's estimated that a good third or more of all small fiber syndromes are idiopathic. |
Thank you for your comments.
I have done all the tests listed in Liza's,
except for: 1. Tilt Table; 2. Sweat Test; 3. Quantitative Sensory Testing; 4. Fat Asipirate; 5. Sural Nerve Biopsy and 6. Bowel Studies.
My past tests are :
1. Thyroid Antibodies
2. Lyme Disease
3. Vit. B12 and Folate
4. Rheumatoid Arthritis Factor
5. Ana Direct
6. LDH
6. Sedimentation Rate
7. ANA Comprehensive Panel
8. Glucose
9. Anti-Hu Antibodies
10. Immunofixation Serum
11. RPR
12. Heavy Metal (Urine)
13. Hepatitis Profile
14. Thyroid Function - TSH : since the onset of my neuropathic symptoms last October 2011, this is the only test that is abnormal (I had total thyroidectomy in 2007). My primary care physician is trying to adjust my dosage of Synthroid. The neurologist(s) dont seem to be concerned about the hypothyroidism because they think that my numbers are not "far way-off" and besides I am taking medication for it so it must not be the cause. In the deepest of my heart, I am still hoping that its my abnormal TSH that is causing this horrible pain. I wanted to take R Lipoic Acid as it is highly recommended by most members here but when I asked my neurologist about it, she advised that I should wait until my TSH becomes normal.
Mrs.D mentioned about your posts on skin biopsy but I could not find it. Please direct me how I could search it.
I have the typical symptoms like prickly, stabbing "pins and needles", lancinating pain in my arms and legs and sometimes in my back. I have also the tight-band feeling, numbness and pain in both my feet. I could hardly walk nor stand now. I started on 100mg of Gabapentin (1200mg/day) but now the dosage has been increased to 600mg (1800mg/day).
I will really appreciate for your ideas/information.
Thank you.