What is the difference between length or non-length dependent small fiber neuropathy? I am not sure what type of neuropathy I have. 5 months ago I developed burning in my thighs and pain in my legs. Then, a week later I had tingling in my feet. Then, another week later my fingers began to tingle. Then, the next week my face began to tingle and my body bagan to twitch. The burning now is worse in my thighs, calves, and back. I feel burning less in my feet and hands right now. I don't have weakness yet. Thanks for helping...

--refers to the presentation of neuropathy that begins first in those nerve farthest from the center of the body--generally in the toes and tips of fingers.

It is the most common way that neuropathy begins, in keeping with endocrine (diabetic) and ischemic etiologies being the most common; generally, those nerves farthest from the center of circulation are the first to feel the effects of circulatory insufficiency, as oxygen/nutrients simply have a longer course to travel to get to them and waste products have a longer trip to be fully removed. In time, if the neuropathy progresses, there is "die back"--the neuropathy seems to move more towards the center of the body as nerves in the feet/legs and hands become involved.

Though this is the most common presentation, it is certainly not the only one. Other causes may result in other body parts being affected first, or various ones simultaneously, etc.

It refers to what part of the nerve is affected. Differentiation is done with a nerve density skin biopsy and comparing the proximal and distal nerve densities. If the distal nerve densities are decreased and the proximal ones are normal, then it is length dependent. If both are decreased, then it is non-length dependent. Symptoms can vary and should not be the basis of the differentiation. I have symptoms in my feet and hands, but I have a NLDPN. NLDPN and LDPN classically have different causes but there are overlaps, as well as the always fun idiopathic etiology.

Thank you kwinkler, do you know much about ganglion neuropathy. I read that non length neuropathies can attack the ganglion cells in the spine. What are your symptoms and where are you affected. Do you have twiches at all. Are you still mobile and how long have you had your neuropathy? Thanks a lot!

--that ganglionopathies are typically not length-dependent, as the attack, often autoimmune, is to the cell bodies in the dorsal rot ganglia, which causes the entire cell to be affected (ganglia consist of cell bodies), not just the axon.

Ganglionopathies, or neuronopathies, are typical in neuropathy secondary to Sjogren's syndrome and in some paraneoplastic syndromes, though many are idiopathic.

See:

http://neuromuscular.wustl.edu/antibody/sneuron.html

It is so difficult to get any meaningful diagnosis with PN. Really!

Many doctors don't know how to interpret the test results, and it can be very complex. When both conditions co-exist it is totally confusing.

Thanks to Glenn here and now kwinkler, and Liza Jane's spread sheets, we have a light shining on things to help posters here ask for the proper tests. Then remember some tests the doctors don't interpret correctly either.

Thanks! So, do you think diskitis could affect the ganglions in your back and cause widespread neuropathy? I have read about sjogren's syndrome, but I don't have that.

Just to add my two cents, my small fiber non-length dependent neuropathy was Dx'd by skin punch biopsies.

The Sjogren's was confirmed somewhat after that.

I eventually had a follow-up appointment with the neurologist who'd done the biopsies that identified SFN. Prior to my visit, I'd found on-line the paper she'd published about small fiber non-length dependent and its link to Sjogren's.

Imagine my surprise when, after reviewing my case, she said that my neuropathy was "idiopathic." I just sat there and looked at her, and have not gone back for any more neurology appointments.