I finally got my biopsy reports from almost a year ago. So here are my new questions. I was recently diagnosed with small fiber neuropathy, possibly autoimmune mediated. This is from a complete physical exam by a neurologist as well as blood work (slightly elevated ANA and large family history of autoimmune) and diagnostic tests. I have no health insurance, and cannot afford the IVIG therapy he recommended, so have not been back to him to understand my results. I would appreciate if you could shed some light on these results and what I've been told?
Punch Biopsy was done on Distal leg, Distal thigh and Proximal thigh. Nevre density is reduced at distal leg and thigh, 2.8 fibers/mm at leg, 3.3 fibers/mm thigh. Proximal thigh normal. Impression: This biopsy shows a moderately severe, lenght-dependant, small fiber neuropathy. The distal sudomoter fibers also appear affected. Is "moderately severe" bad? Since I'm not getting IVIG or any other treatment, can I expect it to get worse? What is the difference between length dependant and distal sudomotor fibers?
QSART was done on left forearm, left proximal leg, left distal leg, left proximal foot. Result impression: responses at the left forearm and foot are reduced. These findings are nonspecific for etiology but are consistent with a postganglionic sympathetic sudomotor abnormality like that seen in autonomic/small fiber neuropathy.
Normal cardiovascular autonomic test panel, so I know it's not P.O.T.S. I was also told the EMG showed nothing. I do have a positive Romberg's test, and decreased reflexes in my ankles. I also have moderate osteoarthritis L4/L5 & L5/S1, would that cause the reduction of nerves as shown on the biopsy?